Hematopoietic drugs

Pharmacology exam 3

What is epoetin alfa?

An erythropoiesis-stimulating agent (ESA) that acts like the natural hormone erythropoietin to stimulate red blood cell (RBC) production in the bone marrow

How does epoetin alfa work?

It stimulates erythroid precursor cells in the bone marrow to produce more RBCs, increasing hemoglobin and the blood’s oxygen-carrying capacity

What is epoetin alfa used for?

It creates certain types of anemia, including anemia associated with chronic kidney disease, selected chemotherapy-associated anemia, and selected surgical patients to reduce transfusion requirements

How do you know epoetin alfa is working?

Hemoglobin and hematocrit increase over time, potentially improving anemia symptoms such as fatigue, weakness, and reduced exercise tolerance

What labs and assessments should be monitored with epoetin alfa?

Hemoglobin, CBC, iron status, blood pressure, and symptoms of thrombosis

Monitor according to the treatment indication and prescribed protocol

What are the major adverse effects of epoetin alfa?

Hypertension, blood clots, stroke, myocardial infarction, and rarely seizures

Cardiovascular risks increase when hemoglobin rises too high

A patient receiving epoetin alfa develops a severe headache and markedly elevated blood pressure. What should the nurse do?

Promptly assess blood pressure and neurological status, escalate the findings urgently, and follow medication hold parameters and emergency protocols

Severe hypertension can cause serious complications

Why is iron status important during epoetin alfa therapy?

Iron is required to make hemoglobin

Iron deficiency can limit the response to epoetin alfa, so iron status should be assessed and deficiency corrected when indicated

Does epoetin alfa work immediately?

No

RBC production increases gradually over days to weeks

Epoetin alfa is not a substitute for immediate treatment of severe, symptomatic anemia requiring urgent correction

Why should hemoglobin not be raised excessively with epoetin alfa?

Higher hemoglobin targets can increase the risk of cardiovascular events and thrombosis

Treatment uses the lowest effective dose and an appropriate target for the patient’s indication

What is filgrastim?

A granulocyte colony-stimulating factor (G_CSF) that stimulates neutrophil production in the bone marrow

How does filgrastim work?

It stimulates the production, maturation, and release of neutrophils, which help protect the body against infection

What is filgrastim used for?

It reduces the duration of chemotherapy-associated neutropenia in appropriate patients, treats selected severe chronic neutropenia conditions, and helps mobilize stem cells for collection in certain settings

Which labs should be monitored with filgrastim?

A CBC with differential and absolute neutrophil count (ANC)

These help assess treatment response and detect excessive increase in white blood cells

What is the most common adverse effect of filgrastim?

Bone pain, caused by increase bone marrow activity

What serious complication can occur with filgrastim?

Splenomegaly and, rarely, scenic rupture, which can cause life-threatening internal bleeding

A patient taking filgrastim reports sudden left upper abdominal pain radiating to the left shoulder. What is the priority?

Suspect a possible splenic complication and arrange urgent assessment

Dizziness, fainting, or hypotension increases concern for internal bleeding

A patient receiving filgrastim develops a fever. What should the nurse do?

Promptly assess the patient and follow the febrile-neutropenia protocol

Fever in a patient receiving chemotherapy can indicate a medical emergency, even if filgrastim is being administered

What other serious symptoms should a patient taking filgrastim report?

Difficulty breathing, severe allergic symptoms, left upper abdominal or shoulder pain, and symptoms suggesting serious capillary leak or inflammatory complications

What teaching is important for patients receiving filgrastim injections?

Follow the prescribed schedule and injection instructions, store the medication as directed, attend blood count monitoring appointments, and report fever or warning signs of splenic complications

What is the difference between neutropenia and anemia?

Neutropenia is a low neutrophil count, increasing infection risk

Anemia is a reduction in RBCs or hemoglobin, reducing oxygen-carrying capacity

What is the difference between epoetin alfa and filgrastim?

Epoetin alfa stimulates RBC production to treat certain types of anemia

Filgrastim stimulates neutrophil production to help reduce or manage neutropenia

What are interferons?

Immune signaling proteins used as medications to modify immune responses

Depending on the product, they can have antiviral, immunomodulatory, or anti proliferative effects

How do interferons work?

They alter cellular signaling and immune activity

Some inhibit viral replication, some modify immune activity in diseases such as multiple sclerosis, and others inhibit the growth of selected cancer cells

What are the major indications for interferons?

Selected viral diseases, multiple sclerosis with certain interferon-beta products, and specific cancers or blood disorders with particular interferon products

What are common adverse effects of interferon therapy?

Flu-like symptoms, including fever, chills, muscle aches, headache, and fatigue

What blood abnormalities can occur with interferons?

Bone marrow suppression can cause neutropenia, anemia, and thrombocytopenia, increasing infection, fatigue, and bleeding risks

Which psychiatric symptoms are important to monitor during interferon therapy?

Depression, worsening mood, major behavioral changes, and suicidal thoughts

These require prompt evaluation, with immediate safety intervention for suicidal thoughts

Why are liver function test important with some interferons?

Interferons can cause liver injury

Monitor liver tests as prescribed and report jaundice, dark urine, or significant abdominal symptoms

What teaching can help a patient manage flu-like symptoms from interferons?

Discuss appropriate symptom-management strategies with the healthcare team, maintain hydration if not restricted, follow the prescribed regimen, and report severe or persistent symptoms

What should the nurse monitor during interferon therapy?

CBC, liver function, treatment response, mood and behavior, and other assessments specific to the particular interferon and indication

What is aldesleukin?

A recombinant interleukin-2 (IL-2) that stimulates selected immune-cell populations

How does aldesleukin work?

It stimulates the growth and activity of T lymphocytes and natural killer cells, enhancing immune responses against selected tumor cells

What cancers may be treated with aldesleukin?

Selected cases of metastatic renal cell carcinoma and metastatic melanoma, depending on the treatment protocol and indication

What is capillary leak syndrome?

A dangerous movement of fluid and proteins out of blood vessels into surrounding tissues

It can cause edema, low blood pressure, reduced circulating volume, and organ dysfunction

What are warning signs of capillary leak syndrome during aldesleukin therapy?

Hypotension, rapid weight gain, generalized edema, reduced urine output, shortness of breath, and altered mental status

A patient receiving aldesleukin develops severe hypotension and respiratory distress. What should the nurse do first?

Immediately assess and support airway, breathing, and circulation, activate emergency assistance, and follow the specialist treatment protocol

This may be life-threatening capillary leak syndrome

What assessments are important during aldesleukin treatment?

Frequent vital signs, oxygenation, fluid balance, urine output, weight, renal function, and signs of pulmonary or cardiovascular compromise

Why can a patient receiving aldesleukin have edema and hypotension at the same time?

Capillary leak shifts fluid from the bloodstream into tissues

The patient can develop edema while the effective circulating blood volume decreases

Is aldesleukin an immunosuppressant?

No

Aldesleukin is an immunostimulatory mediation that activates selected immune cells

Immunosuppressants, such as cyclosporine, reduce particular immune responses