The Hemotalogic System (Pharm Made Easy 3.0)

Front 1

Drug Therapy for Anemias

Back 1

•Microcytic anemia: caused by iron deficiency

•Megaloblastic anemia: caused by either vitamin B 12 malabsorption or deficiency or by folic acid deficiency

Front 2

Drugs for microcytic anemia

Back 2

•Ferrous sulfate (Feosol)

•Iron dextran (INFeD)

Front 3

Iron preparation (microcytic anemia)

Back 3

•Treats: Iron deficiency anemia, prevention of iron deficiency anemia for patients at risk (infants, children, women who are pregnant) and after blood loss

•Examples:

-Ferrous sulfate

-Iron dextran

-Ferrous gluconate

-Ferrous fumarate

•Correct iron deficiency

•Side effects:

-Nausea, heartburn, diarrhea and constipation

-Metallic taste

-Staining of teeth

-Fatal iron toxicity (overdose in children)

•With or without food depending if negative G.I effects occurs, preferably take without food because food reduces iron absorption

•Monitor bowel patterns (treat constipation by increasing fluid and fiber)

•Antidote: deferoxamine (desferal)

•Give liquid iron with a straw to prevent staining teeth

•Monitor hemoglobin, hematocrit and reticulocyte count

•Do not give iron preparation to patients with severe liver disease

•Do not give to patients with hemolytic anemia

•Do not give to patients with peptic ulcer disease, ulcerative colitis or regional enteritis

Front 4

Vitamin B 12

Back 4

•Treats: pernicious anemia and vitamin B 12 deficiency

•Example:

-cyanocobalamin (Nascobal)

•Causes: Impaired absorption of vitamin B 12 (G.I malabsorption syndrome with celiac disease, elevated gastric pH, lack of intrinsic factor with pernicious anemia)

•Action: Vitamin B 12 converts folic acid into its active form for DNA synthesis; the neurological system and blood cell forming organs are primarily affected by low vitamin B 12

•Side effects:

-Diarrhea

-HYPOkalemia

•Maintain hydration in patients taking vitamin B 12 (due to diarrhea side effect)

•Monitor potassium level

•Recommend potassium supplement and potassium containing foods

•Obtain baseline vitamin B 12, hemoglobin, hematocrit, RBC and reticulocyte count

•Give vitamin B 12 with food to increase absorption

•Patients with pernicious anemia need to take vitamin B 12 as a lifelong treatment

•Report persistent diarrhea

•Report muscle weakness, nausea, palpitations or paresthesia (hypokalemia)

Front 5

Folic acid

Back 5

•Treats: folate deficiency (caused by alcoholism & malabsorption syndrome), megaloblastic anemia and prevents neural tube defect in developing fetus

•Example:

-Folic acid

•Needed for DNA synthesis (cell replication) and folic acid is activated by vitamin B 12

•Side effects:

-Flushing and warmth following I.V administration

•Encourage patients to eat green vegetables, liver, lentils to increase folic in the diet)

•Obtain baseline serum folate, hemoglobin, hematocrit, RBC and reticulocyte count; also check vitamin B 12 levels

Front 6

Drugs Therapy for bleeding disorders: Hemophilia

Back 6

•Factor 8

•Factor 9

•Desmopressin

Front 7

Factors 8 & 9 (replacement)

Back 7

•Factor 8 treats hemophilia A

•Factor 9 treats hemophilia B

•Examples:

-Plasma derived (Hemofil-M) treats hemophilia A

-Recombinant factor 8 or Advate

-Plasma derived (AlphaNine SD) used to treat hemophilia B

-Recombinant factor 9 (BeneFix)

•Replacement of factor 8 & 9 which are clotting factors

•Side effects:

-Allergy reaction, anaphylaxis ☆

-Creutzfeldt-Jakob disease (minimal risk of this disease with plasma derived ONLY)

•Monitor for signs of allergic reaction (give diphenhydramine to counteract) or anaphylaxis (give epinephrine to counteract)

•Obtain baseline for factors 8 & 9 and monitor periodically

Front 8

Desmopressin

Back 8

•Treats: mild hemophilia A & controls trauma induced bleeding and maintains hemostasis during surgery

•Example:

-Desmopressin (DDAVP)

•Stimulates release of factor 8 and only effective in patients with hemophilia A that have some production of factor 8

•Side effects:

-Fluid retention

-HYPOnatremia

•Monitor I & O

•Monitor serum sodium levels

•Use diuretic therapy for moderate to severe fluid retention

•Weight self daily and report significant increases in weight over a short time or signs of edema

•Do not give desmopressin to patients with renal disease

•Do not give to patients with nephrogenic diabetes insipidus

•Do not give to patients with type 2 von williebrand disease

Front 9

Drug Therapy to Prevent and Dissolve Thrombi

Back 9

•Anticoagulant

•Antiplatelets

•Thrombolytics

Front 10

Anticoagulants

Back 10

•Inhibitor factor Xa and thrombin (factor II)

•Vitamin K inhibitor

Front 11

Inhibitor factor Xa and thrombin (factor II)

Back 11

•Treats: cerebro-vascular accident, pulmonary embolism, DVT, acute myocardial infarction, unstable angina and disseminated intravascular coagulation

•Examples:

-Factor Xa and thrombin inhibitor: Heparin

-Factor Xa Inhibitor: fondaparinux

-Thrombin inhibitor: bivalirudin

•Bind with antithrombin which inactivates factor Xa and thrombin as well as prevent development of fibrin

•Side effects:

-Hemorrhage

-Neurological injury (from hematoma formation during lumbar puncture, epidural anesthesia)

-Thrombocytopenia (low platelet count)

-Hypersensitivity

•Monitor vitals signs for hemorrhage (blood pressure, heart rate)

•Monitor (aPTT for heparin)

•Antidote for heparin: protamine sulfate

•Stop heparin for platelet count below 100,000 mm3

•Monitor spinal insertion site for hematoma

•Administer heparin subcutaneously 2 mm from the umbilicus

•Patients should report bruising, petechiae, hematoma or black tarry stools

•Immediately report calf pain, tenderness and swelling

•Report shortness of breath

•Report inching and hives

•Do not give heparin to patients with uncontrollable bleeding

•Do not give to patients with severe thrombocytopenia

•Do not give to patients with lumbar puncture, regional anesthesia or brain, eye or spinal cord surgery ☆

•Do not give to pregnant women (spontaneous abortion)

Front 12

Anticoagulant (Vitamin K inhibitors)

Back 12

•Treats: prevents thrombosis, secondary pulmonary embolism, prevents ischemia cerebro-vascular accident secondary to A-fib, prevents thromboembolism in patients who have a prosthetic heart valve and prevents recurrent myocardial infarction (MI) and transient ischemic attacks (TIAs)

•Example:

-Warfarin (Coumadin)

•Blocks activation of Vitamin K, decreases production of vitamin K and dependent factors 7, 9, 10 and prothrombin

•Side effects:

-Hemorrhage

-Toxicity

•Monitor for vital signs checking for hemorrhage (blood pressure, heart rate)

•Check hematocrit & CBC

•For warfarin overdose, stop the drug and administer vitamin K (I.V form)

•Monitor INR (therapeutic range is 2 to 3) & monitor PT every 2 to 3 weeks during Coumadin therapy

•Do not give warfarin during pregnancy (pregnancy category X)

•Do not give warfarin to patients with vitamin K deficiency

•Do not give to patients with thrombocytopenia (low platelet count)

•Do not give to patients with liver disease (low clotting ability with damaged liver)

•Do not give to patients with alcoholism

•Do not give to patients with uncontrollable bleeding

•Do not give to patients who had a lumbar puncture, regional anesthesia or brain, eyes or spinal cord surgery ☆

Front 13

Antiplatelets

Back 13

•Salicylics

•Adenosine diphosphate receptor inhibitors

•Glycoprotein Inhibitors

•Arterial vasodilators

Front 14

Salicylic

Back 14

•Treats: inhibits platelet aggregation and reduces risk for myocardial infarction, ischemic cerebro-vascular accident and angina and prevents reocclusion of a coronary stent

•Example:

-Aspirin

-Abciximab

-Pentoxifylline

•Inhibits cyclooxygenase action in platelets and vasoconstriction is inhibited as well

•Daily dose of 81 mg is typically given to prevent cardiovascular and cerebro-vascular events

Front 15

A.D.P inhibitors

Back 15

•Treats: inhibits platelet aggregation which reduces risk for myocardial infarction, ischemic cerebro-vascular accident, angina and prevents reocclusion of coronary stents

•Examples:

-Clopidogrel

-Ticlopidine

•Block adenosine diphosphate receptors on platelets which inhibits platelet aggregation

•Side effects:

-Gastric upset, abdominal pain, diarrhea, nausea

-Gastric ulceration and bleeding (less than aspirin)

-Thrombotic thrombocytopenia purpura (common with clopidogrel)

•Monitor for G.I bleeding (black, tarry stools, abdominal pain and hematemesis)

•Monitor for ecchymosis and petechial rash (indicates blood disorder)

•Check platelet count periodically (especially with clopidogrel)

•Monitor for signs of hemorrhagic C.V.A

•Discontinue A.D.P inhibitor drugs 1 week before surgery

•Take A.D.P inhibitor with milk or 8 ounce of water to prevent G.I upset

•Do not give to patients with peptic ulcer disease

•Do not give to patients with bleeding disorders

•Do not give to patients with thrombocytopenia

•Do not give to patients with intracranial bleeding

Front 16

Thrombolytics

Back 16

•Treats: thrombolytics break down thrombi that have already developed and are used for acute myocardial infarction, massive pulmonary embolism, deep vein thrombosis and re-establishing patency of occluded central I.V catheters

•Examples:

-Alteplase

-Tenecteplase

-Reteplase

•Selectively convert plasminogen into plasmin, plasmin breaks down fibrin and plasmin also breaks down other clotting factors

•Side effects:

-Bleeding (intracranial, gastrointestinal, needle puncture sites and wounds)

•Monitor aPTT, PT, INR and bleeding time, hemoglobin, hematocrit and platelet count

•Antidote for thrombolytics: aminocaproic acid ☆

•Apply pressure up to 30 minutes to puncture sites, such as puncture to obtain arterial blood gases

•Limit venipuncture and injections

•Tell patients to report unusual or prolonged bleeding

•Tell patients to report unilateral weakness, headache or dizziness

•Do not give to patients with hemorrhage and cerebral lesions

•Do not give to patients with suspected aorta dissection

•Do not give to patients with recent head or facial trauma surgery in the past 3 months

•Do not give to patients with acute pericarditis

•Do not give to patients with a brain tumor

Front 17

Drugs that support hematopoiesis

Back 17

•Erythropoietic growth factor

•Leukopoietic growth factor

•Thrombopoietic growth factor

Front 18

Erythropoietic Growth factor

Back 18

•Supports production of erythrocytes in

-Chronic renal failure

-Preoperative anemia

-Chemotherapy

-Zidovudine (Retrovir) therapy for HIV

•Examples:

-epoetin alfa

-darbepoetin alfa

•Stimulates production of red blood cells in the bone marrow

•Side effects:

-HYPERtension

-Cardiovascular and cerebro-vascular events

-Malignancy progression (cancer)

•Monitor blood pressure periodically (due to hypertension)

•Obtain baseline blood pressure, hemoglobin, hematocrit, iron level

•Do NOT give to patients with uncontrollable hypertension ☆

•Do NOT give to patients with malignancies/tumors without chemotherapy or radiation ☆

•Do not give to patients with iron deficiency anemia

Front 19

Leukopoetic Growth factor

Back 19

•Reduces infection risk with

-Bone marrow transplantation

-Severe or chronic neutropenia

-Myelosuppressive chemotherapy

•Examples:

-Filgrastim

-Pegfilgrastim (long acting)

•Leukocyte, granulocytes, lymphocytes and monocytes (WBCs); leukopoietic growth factor stimulates cells in the bone marrow to increase production of mature neutrophils

•Side effects:

-Leukocytosis

-Bone pain

-Fever

-Splenomegaly (long term use)

•Monitor CBC twice a week during treatment

•Give low dose of drug or stop if WBCs are above 10,000 mm3

•Monitor temperature and give acetaminophen if fever is present

•Monitor for spleen enlargement

•Do not administer leukopoietic growth factor within 24 hours of cytotoxic chemotherapy

•Do NOT give to patients sensitive to E.Coli derived proteins

•Do not give to patients with acute respiratory distress syndrome

•Do NOT give with CONCURRENT chemotherapy or radiation

Front 20

Thrombopoietic Growth factor

Back 20

•Treats: thrombocytopenia from myelosuppressive chemotherapy for non-myeloid cancers

•Example:

-Oprelvekin

•Stimulates synthesis of megakaryocytes in the bone marrow and enhances maturation of megakaryocytes

•Side effects:

-Fluid retention ☆

-Cardiac dysrhythmias (A-fib, A-flutter, tachycardia) ☆

-Allergic reactions ☆

-Conjunctival injection, transient blurring of vision and papilledema

•Monitor vital signs, heart rate and ECG

•Stop drug if dysrhythmias occurs

•Monitor I & O and weight patient daily

•Monitor for peripheral edema and dyspnea

•Stop drug if indication of allergic reaction

•Stop drug for manifestations of eye problems

•Obtain CBC with differential and platelet count, plus electrolytes

•Continue therapy until platelet count is 50,000 mm3 (140,000 to 500,000 mm3)

•Do not give to patients with myeloblative chemotherapy