Ati Hematologic Syste Meds (Growth Factors)

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erythropoietic growth factors

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proto: epoetin alfa (Epogen, Procrit)

others: darbepoetin alfa (Arenesp)- long-acting erythropoietin
methoxy polyethylene glycol (MGEG) epoietin beta (Micera)- very long-acting erythropoietin

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erythorpoietin MOA

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act on bone marrow to increase production of red blood cells

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erythropoietin use

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anemia related to chronic renal failure, use of zidovudine in clients who have HIV, chemotherapy, elective surgery

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erythropoietin adverse

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hypertension secondary to elevations in hematocrit level
DVT
headache and body ache
seizure
risk for thrombotic event such as MI or stroke if client has Hgb of 11g/dl or higher, or an increase of more than 1 g in 2 weeks

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erythropoiein contraindications

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uncontrolled hypertension
certain cancers because of the possibility of tumor growth

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erythropoietin admin

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administer by subcutaenous or IV bolus injection
do not mix med with any other med in syringe
monitor Hbg and Hct twice a week until target range is reached

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erythropoietin effectiveness

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may be evidenced by Hgb level of 10-11 g/dL and maximum Hct of 33%

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leukopoietic growth factor

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filgrastim (Neuopogen)
pegfilgrastim ( Neulasta)

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leukopoietic growth factor MOA

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stimulate bone marrow to increase production of neutrophils

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leukopoietic growth factor use

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decreases risk of infection in clients who have neutropenia
build up numbers of hematopoietic stem cells prior to harvesting in autologous transplant

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leukopoietic growth factor adverse

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bone pain, leukocytosis, splenomegaly and risk of splenic rupture

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leukopoitic growth factor interventions

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monitor CBC two times a week
decrease dose or interrupt treatment if WBC is greater than 100,000 mm 3 or absolute neutrophil count exceeds 10,000 mm3

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leukopoetic growth factor contraindications

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sensitivity to E.Coli protein
cancer of bone marrow

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leukopoetic growth factor admin

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monitor CBC two times a week
intermittent IV bolus, continuous IV, subQ or sub Q injection

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leukopoetic growth factor effectiveness

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absence of infection
WBC count and differential within expected reference ranges

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granulocyte macrophage colony stimulating factor

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proto: sargramostim (Leukine)

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granulocyte macrophage colony stimulating factor MOA

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acts on bone marrow to increase production of white blood cells ( neutrophils, monocytes, macrophages, eosinophils)

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granulocyte macrophage colony stimulating factor use

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hastens bone marrow function after bone marrow transplant
used in treatment of failed bone marrow transplant

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granulocyte macrophage colony stimulating factor adverse

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diarrhea, weakness, rash, malaise, bone pain
leukocytosis, thrombocytosis
tachycardia, hypotension, chills, fever, diaphoresis, dyspnea

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granulocyte macrophage colony stimulating factor contraindications

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allergic to yeast products
heart disease, hypoxia, peripheral edema, pleural or pericardial effusion
cancer of bone marrow

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granulocyte colony stimulating factor admin

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obtain baseline CBC, differential, and platelet count
reconstitute with water if administered subQ
administer by IV infusion
slow or discontinue infusion if client who has pre-existing heart failure or respiratory disorder experiences dyspnea

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granulocyte colony stimulating factor effectiveness

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absence of infection
WBC and differential within expected reference ranges

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thrombopoetic growth factors

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proto: oprelvekin (Interleukin-11, Neumega)

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thrombopoetic growth factors MOA

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increases production of platelets

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thrombopoetic growth factors use

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decreases thrombocytopenia and need for platelet transfusions in clients receiving chemotherapy

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thrombopoetic growth factors adverse

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fluid retention
cardiac dysrhythmias
conjunctival infection
allergic reactions, possible anaphylaxis

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thrombolytic growth factors interventions

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cautiously in those with cardiac dysrhythmias
monitor vital signs, heart rate, and rythm
observe for adverse effects

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thrombolytic growth factors contraindications

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cancer of bone marrow
heart failure
pleural effusion

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thrombolytic growth factors admin

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baseline CBC platelet count, and electrolytes
oprelvekin should not be agitated and or combined with other meds
administer once daily by subQ injection until platelet count reaches prescribed level

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thrombolytic growth factor effectiveness

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evidenced by platelet count greater than 50,000