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143 Cards in this Set
- Front
- Back
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What are the agents that are used with differnt anemias?
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Folic Acid
Cyanocobalamin Iron Erythropoietin Hydroxyuria |
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A megoblastic anemia wich is chracterized by large dysfunctional RBC's resulting from Vit B12 deficency is an indication for the use of?
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Folic Acid
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What is another indication of Folic Acid?
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To prevent nueral tube defects during pregnancy
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T or F
Folic acid carries a warning against monotherapy with treatment of pernicious anemia and other anemias where Vit. B12 is deficient |
True
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What is the exogenous folate required for?
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Nucleoprotein synthesis and the maintenance of normaal erythropoiesis
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What does impairment of nucleic acid synthesis with folate acid deficiency account for?
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Defective DNA synthesis that leads to megaloblast formation and megaloblastic and macrocytic anemias
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what is the RDA for folic acid?
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.2 mg - .4 mg daily
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How much do most normal diets contain?
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.1 - .5 mg daily
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T or F
Excessive ETOH usage requires less folic acid |
F
requirements are more with ETOH use |
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Phenytoin concentrations may be increased or decreased by folic acid?
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Decreased
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T or F
Folic acid can be purchased over the counter at .4 mg, .8 mg and 1 mg |
F
in order to get 1 mg it must be prescribed |
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Which dose is given to pregnant women and with lactation?
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.8 mg
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Dosage for maintenance and patients that are high risk is?
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.4 mg
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What should be indicated for vitamin deficiency due to malabsorption syndrome, GI pathology, dysfunction or surgery, intestinal worms,GI malignancies, sm. bowel growth (bacterial) and gastrectomy
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cyanocobalamin (B 12)
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What are some conditions where the requirements of B 12 are increased?
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Pregnancy, hemolytic anemia, hemorrhage, renal and hepatic Dz
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What test is administered to determine vitamin B 12 absorption and helps to Dx pernicious anemia?
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Schilling test
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What does Vit. B 12 require binding with to be used in the body.
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Intrinsic factor
Where is this combination reabsorbed at? |
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Where is this combination reabsorbed at?
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Distal part of the ileus
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Vit B 12 is essential for growth, cell reproduction, and __________ and _________ synthesis.
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Nucleoprotien and myelin
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How does Vit. B 12 (cyanocobalamin) participate in the erythropoeitic process in RBC formation?
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though the activation of folic acid coenzymes
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The warning with Cyanocobalamin is that the use of folic acid in Vitamin B12 deficient megaloblastic anemia could result in progressive and irreversible_____________ ____________.
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Neurological damage
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What can be developed in pts with severe megaloblastic anemia intensely trreated with Vit. B12 can develop _________ /_________.
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hypokalemia/ sudden death
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What is the RDA for adults, pregnancy and lactation?
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Adult 2.4 mcg
Pregnancy 2.6 mcg Lactation 2.8 mcg |
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What is the dosage that should be given with Vit B12 deficiency?
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250 mcg/ day orally
30 mcg/ day IM or deep SQ 5- 10 days, then 100-200 mcg a month then 1000mcg a month |
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How much Vit B12 should be administered with the Schilling test?
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1000 mcg
1st dose is radioactive to measure absorption |
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which way of administration of Vit B12 is most effective?
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IM
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This type of anemia is also as a result of deficiency, malabsorption, inadequate intake, blood loss and increaesed requirement with pregnancy?
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Iron deficiency anemia
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what is the leading cause of fatal poisoning in children , 6 y.o. with iron administration?
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Accidental overdose of iron containing products is the leading cause
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After the digestion and acidification of iron the uptake occurs in the ______ & _______ _______.
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Duodenum & small intestine
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T or F
Iron goes directly into the plasma and the enters RBC production. |
True
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Iron in stored form is known as?
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ferrritin
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Where is it stored in the body?
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Mucosa
Liver and spleen |
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what is iron an important component of?
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Hemoglobin, myoglobin, and a number of other enzymes
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what can Iron deficeny affect?
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Muscle metabolism, heat production and catecholamine metabolism.
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When Catecholamine metabolism is affected in children what is the result?
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Associated behavioral or learning problems in children.
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Iron only assists with the transportation of O2 via hemoglobin.
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False,
It assists with the transportation of O2 and CO2 |
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Iron needs what substance to be absorbed?
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Acid which makes it helpful to take with orange juice.
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what is the daily requirement for men and non menstruating women?
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1 mg/day
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menstruating women should have how much iron per day?
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1.4 mg
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In the last two trimesters of pregnancy what is the recommended intake of iron?
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5-6 mg
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what is the other recommendation of 5-6 mg per day?
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Infants
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General treatment guidelines suggest that iron be administered 2 325 mg per day for maitenence but how many times should that same 325 mg be given in a day for anemia?
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BID - TID
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What is the main reason that people stop using Iron?
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(Jed) says constipation
(Charlie) says N/V |
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How much elemental iron does Ferrous Sufate contain?
what is the tablet dose? |
20%
325 mg |
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How much elemental iron does Ferrous Gluconate contain?
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12%
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How much elemental iron does Ferrous Fumarate contain?
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33%
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What is the biggest ADR that causes pts to discontinue use if iron?
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GI irritation
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should iron be taken on a empty stomach or with food?
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Should be taken on empty stomach unless there is GI irritation
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What are the two erythropoietin recombinants and which one has three times duration that the other?
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Epotin Alfa (epogen & Procrit)
Darbapoietin Alfa (Aranesp) Darbepoietin has three times the duration than Epotin |
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What are the indications for Erythropoietin?
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1. Anemia assoc. with chronic renal failure
2. Anemia asssoc. with zidovudine (HIV) therapy 3. Anemia associate with cancer (chemotherapy) 4. reduction of blood transfusion in surg. pts. 5. unlabled uses of critical illnesses and prematurity |
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What are the two erythropoietin recombinants and which one has three times duration that the other?
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Epotin Alfa (epogen & Procrit)
Darbapoietin Alfa (Aranesp) Darbepoietin has three times the duration than Epotin |
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What are the indications for Erythropoietin?
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1. Anemia assoc. with chronic renal failure
2. Anemia asssoc. with zidovudine (HIV) therapy 3. Anemia associate with cancer (chemotherapy) 4. reduction of blood transfusion in surg. pts. 5. unlabled uses of critical illnesses and prematurity |
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what is the MOA for erythropoietin?
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stimulates the division and differentiating of committed erythroid progenitor cells; Induces the release of reticulocytes in the blood stream
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What are the three warnings associated with use of erythropoietin?
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CV complications
Blood doping in athletes results in deaths High rate of seizures in the first 90 days of therapy |
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T or F
Hydroxyurea is thought to interfere with DNA synthesis during G1 phase of cell division as well as interfering with RNA or protein synthesis |
False
It interferes with the DNA @ S phase and does not interfere with RNA or protein synthersis |
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What is the indication for Hydroxyurea?
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Reduce the painful crises and the need for blood transfusions in adults with SIckle Cell Anemia
(generally three crises during the preceding year) |
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What is hydroxyurea CI with?
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Marked bone marrow depression and severe anemias.
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What is the pregnancy category with Hydroxyurea?
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Cat D due to the harm that it can cause the fetus.
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Why is it important to closely monitor administration of hydroxyurea and what should be done if SE is seen?
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It can cause serious mylosuppression at which point there should be an interruption of treatment and dosage reduction.
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What is the BBW with Hydroxyurea?
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Administration should be done under the supervision of the physician with cancer chemo therapy experience as it is clastogenic and mutagenic which has been reported to cause secondary leukemias and tumorogenic phenotypes.
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The Hydroxyurea dose should always be _________ to pt response and WBC counts.
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Titrated
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Pts with Hydroxyurea Tx should notify the caregiver if what occurs?
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If the pt experiences fever, chills, sore throat, N/V, loss of appetite, sores i the mouth, unusual bleeding or bruising
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What are the agents used to treat bleeding?
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Vit K
Aminocaproic acid Protamine Aprotinin |
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what is the other name for Vit. K?
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Phytonadione
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What is the mode of action with Vit. K?
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Promotes the hepatic synthesis of active clotting through factors II,VII, IX, X
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Vit. K is indicated for pts that have ?
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coagulation disorders caused by the faulty formation of factors II, VII, IX, X
Anticoagulantinduced prothrombin deficiency Secondary Hypoprothrombinemia Warfarin therapy reversal |
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T or F
Vit K will promote counteraction of heparin administration |
False
It will not counteract heprin |
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How long does it take to see measurable improvement in PT with IV administration?
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1-2 hrs with the initial dose.
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Vit K promotes the synthesis of?
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Prothrombin
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What is the BBW with Vit K?
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Severe reactions including death have occurred during and immediately after IV injection, even after dilution and slow infusion.
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what does the reaction resemble?
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Hypersensitivity and anaphylaxis including shock or respiratory arrest which can occur with pts 1st exposure.
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what is the dosing oral, SQ, IM, IV?
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2.0 to 10 mg initially and the INR test
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what is the MOA with Amicar or Aminocaproic acid?
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It inhibits fibrinolysis via inhibition of plasminogen activator substances
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Aminocaproic acid is indicated for what syndrome?
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Acute bleeding syndrome
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What are the unlabeled uses?
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Thrombocytopenia, control oral bleeding in congenital and acquired coagulation D/O as well as traumatic hyphea.
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What are the ADRS with Aminocaproic acid?
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Arrhythmias, bradycardia and hypotension.
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what can induce the ADRS?
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rapid IV administration
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This drugs classification is a hemostatic blood product derivative that is a broad spectrum serine protease inhibitor
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Aprotinin (Trasylol)
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What is Aprotinins MOA?
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attenuates the coagulation, fibrinolytic and inflammatory pathways by interfering with the thrombin, plastin and kallikrein
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what is the indications for Aprotinin?
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Peri operative blood loss in pts at high risk of bleeding during CABG.
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What is thought to be responsible for inflammatory response with CABG that leads to deregulated coagulation?
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Induced blood cells contact with the bypass equipment
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According to a study done in 06 Which is asssociated with more risks, Aprotinin or Aminocaproic acid?
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Aprotinin
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What should be given with Aprotinin to determine allergy sensitivity?
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Test dose
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When is the loading dose administered?
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After induction of anesthesia but prior to sternotomy.
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T or F
Continued infusion of Aprotinin should be given until the surgery is complete? |
True
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What is the classification of protamine sulfate?
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Antidote
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What is the MOA of protamine sulfate?
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Combines with strongly acidic heparin to form a stable complex, neutralizing that anticoagulant activity of both drugs but is a weak anticoagulant by itself.
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What is the indication for protamine sulfate?
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Heparin overdose and post CABG reversal of heparin; also neutralizes the effects of heparin during surgery and dialysis procedures.
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Why can pts develop a hypersensitivity with protamine sulfate?
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If they have a HX of allergy to fish as it is made from the sperm of salmon.
Can also cause bradycardia, hypotension, and dyspnea |
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What is the IV dose of protamine sulfate determined by?
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The amount of heparin that was given and the time that has elapsed since it was given as well as the rout given.
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What treatments are given for the prevention of clotting?
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Plavix
Dipyridamol Eptifibatide ASA |
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What is the other name for Plavix and its classifaction?
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Clopidogrel which is a anti platelet
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What receptors does Plavix block that prevent fibrinogen binding at that site reducing the possibility of platelet adhesions and aggregation
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ADP receptors
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what are the indications and dosage with Plavix?
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Recent MI, stroke or CAD 75mg QD
Non ST segment elevation 300mg loading the 75mg QD with 81-325 mg ASA ST segment elevation with MI 75mg QD with ASA 81-162mg QD |
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What is the CI with Plavix?
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Peptic ulcer or intercranial hemorrhage.
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T or F
Plavix is known to have no serious D-D interactions. |
False
Administration with NSAIDS and Warfarin can increase bleeding incidence. |
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What is the other name for Dypyridamol?
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Persantine
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What is persantine indicated for?
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Adjunctive therapy with warfarin to decrease thrombosis after artificial heart valve replacement given PO
Evaluation of CAD given IV |
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Along with being classified as a anti platelet what other classification does it carry?
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Vasodialator
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What is Persantines MOA?
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inhibition adenosine deaminase and phosphdiesterase activity that causes accumulation of mediators that inhibit platelet agregation and can cause vasodialation.
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ADRS of persantine with PO adminstration include?
IV administration? |
Dizzyness
Dizzyness, HA and exacerbation of angina |
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What is the classsification for Eptifibatide (integralin)?
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Antiplatelet, glycoprotien IIb/IIIa inhibitor
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What is the mode of action for integrilin?
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Blocks glycoprotien IIb/IIIa receptor the binding site for fibrinogen, von williebrand factor and other ligands.
reversibly blocks platelet aggregation and prevents thrombosis. |
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What are the indications for Itegrilin?
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Acute coronary syndrome
Percutaneous coronary intervention angioplawsty with or without stenting with ASA and heparin therapy. |
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What is the ADR that is shown than less than 10 % of pts?
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Bleeding, major concern and can sometimes become serious.
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Contraindications are with active bleeding or strokes major surgery or trauma within the last ___________ days. Also severe _____________.
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30
Hypertension |
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What is the classification for ASA?
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Salicylate, prostaglandin inhibitor
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What is the MOA for ASA?
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Prevents the formation of the platelet aggregating substance thromboxane A2.
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What are the usual indications that are antiplatelet related?
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ACUTE MI
MI prophlaxis CABG PTCA Stent implatations carotid endarerectomy acute storke stroke prevention TIA |
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What are the doses for ASA?
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81, 162, 325 mg
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With ASA, GI bleeding & hemorrhagic stroke are?
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Contraindications
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What are the anticoagulant agents used ?
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Enoxaparin, Heparin and warfarin
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What is the classification of Enoxaparin (lovenox)?
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Low molecular wieght heparin.
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The mode of action with Lovenox is inhibition of rate of clotting _________ by antithrombin III impairing the normal hemostasis an inhibition of factor Xa.
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protease
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T or F
LMWH have a big effect on the activated partial thromboplastin time and is a weak inhibitor of factor Xa. |
False
t has a small effect on the activated partial thromboplastin time and strongly inhibits factor Xa |
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What is the indications for Lovenox?
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-DVT prophylaxis given SQ for hip or knee replacement therapy
-Abdominal surgery -Medical pts @ risk for DVT -DVT treatment -unstable angina or non Q wave MI |
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Two ADRS with Lovenox are?
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Hemmorhage and injection site hematoma
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What is the classification for heparin
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anticoagulant
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Mode of action for Heparin potentiating the action of_________ and thereby inactivates ___________ as well as factors IX, S, XI, XII and plasmin.
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Antithrombin II; thrombin
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what conversion does heparin prevent?
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The conversion of fibrinogen to fibrin.
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What are the indications for heparin?
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-DVT prophlaxis - SQ
-Systemic anticoagulation IV -ACS or MI IV -DVT/PE IV -Intermittent IV coagulation -Maitenence and patency of a IV line Parental nutrition |
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ADRs for heparin include?
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-Active bleeding
HIT Osteoporosis which is rare with chronic use |
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T orF
Heparin lock flush solution is intended only for patency of IV devices and not to be used for anticoagulation therapy. |
true
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Can heparin be used for IM injections?
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No it is very painful
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What is the heparin derived from?
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Pork intestinal mucosa.
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What is te MOA of Warfarin/ Coumadin?
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Interferes with the hepatic synthesis of Vit. K dependent factors (II,VII,IX,X)
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What is the drug coumadin indicated for?
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Prevention or treatment of thrombosis/embolism
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Some of the ADRs that you should watch out for with warfarin/ coumadin are...
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-Bleeding anywhere that it may occur
-Bruising, black stools epistaxis |
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When should warfarin be Contra indicated?
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Any bleeding tendencies such as recent surgery, pts bleeding form GI respiratory or GU tract
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What pregancy catagory is Coumadin/warfarin?
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Cat. X
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True or false
Coumadin/ Warfarin does enter the breast milk and therefore should not be given to those that are lactating. |
False,
this drug does not enter the breast milk |
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WHAT KIND OF FOODS CAN INHIBIT THE ANTICOAGULATION AFFECT OF COUMADIN?
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FOODS SUCH AS BEEF, LIVER, GREEN TEA AND LEAFY GREEN VEGGIES THAT ARE HIGH IN VIT. K
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What other foods should be avoided in large amounts?
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alfalfa, broccoli, Brussels sprouts cabbage and asparagus.
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Since there are many drug to drug interactions with coumadin, what are the effects?
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Some increase or can decrease the anticoagulation effect.
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What is the dosage available?
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Orally 1-10 mg
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What do you usually start the oral coumadin @?
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5 mg
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Since frequent INR testing is needed to adjust the dose of comadin what is the target INR
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2.0 - 3.0 (2.5)
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Elderly folk that are less active than a normal active adult need less or more of a dose?
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Less of a dose
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What is the mode of action with thrombolytics?
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All act either directly or indirectly to convert plasminogen to plasmin which in turn cleaves fibrin and lysing the thrombi.
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What are the uses of thrombolytics?
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DVT & Serious PE's but used less frequently D/T bleeding
Now more commonly used for strokes and unclotting of catheters and shunts |
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What is the other name associated with Alteplase?
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Activase
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What is Alteplase used for?
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Used for acute ischemic strokes and is superior to streptokinase.
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When should Alteplase be used with ischemic stroke?
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should be used within three hours of the ischemic stroke and tends to show significant benefit with patients that are selected.
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