Hematopoietic Agents – Flashcards
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RBCs:
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epoetin alfa [Erythropoietin] (Epogen, Procrit) darbepoetin alfa (Aranesp)
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RBC Normal Values
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RBC: Men: 4.7 - 6.1 Women: 4.2 - 5.4 Hgb: Men: 14-18 Women: 12-16 Hct: Men: 42-52 Women: 37-47
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epoetin alfa [Erythropoietin] (Epogen, Procrit)
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Identical to human erythropoietin (produced in kidneys) Stimulates erythropoietin in the bone marrow -> erythropoiesis-stimulating agents (ESAs) No kidney fxn/poorly functioning kidneys -> little/no erythropoietin is manufactured -> dec. RBC production (anemia)
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Indications
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Anemia w/ chronic renal failure Severe anemia w/ AIDS, chemotherapy tx (chemo destroys bone marrow)
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Outcome
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Inc. RBC, H&H (hematocrit level between 30-33%) in 2-6 weeks
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Administration
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SQ - 3x/week Or prn based on lab values, IV Draw up in TB syringe
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Side Effects
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Hypertension related to inc. H&H -> inc. blood viscosity (polycythemia) -> inc. blood pressure, tachycardia Joint/bone pain Muscle weakness Chest pain Edema Weight gain HA N, V, D Seizures (rare) Clotting of shunt for dialysis
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Nursing Implications
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Determine hematocrit before tx begins and 2x/weekly until target level is reached and maintenance dose is established Cost: 8 weeks tx for a 70 kg cancer pt w/ the starting dose of 150 Units/kg 3x/week dose = $3000 Need for Fe+ supplements Perform neurological exams for the risk of seizures DON'T SHAKE VIAL, give only one dose/vial & store in fridge (warm it up, cold injections are PAINFUL)
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Contraindications
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Hypertensive pts Need to monitor BP & treat w/ HTN drugs
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epoetin alfa [Erythropoietin] (Epogen, Procrit) Pt Education
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Dietary sources of Fe, Folic acid, B12 Monitor BP routinely Self administration techniques
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darbepoetin alfa (Aranesp)
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Long acting erythropoietin w/ longer half life (2 days) Given less frequently Only indication -> CRF
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WBCs
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filgrastim (Neupogen) pegfilgrastim (Neulasta)
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WBCs Normal Values
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5,000 - 10,000
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filgrastim (Neupogen)
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Granulocyte colony-stimulating factor (G-CSF)
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filgrastim (Neupogen) Indications
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Inc. neutrophil count in cancer pts Tx of severe chronic neutropenia (low WBC count)
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filgrastim (Neupogen) Route:
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IV, SC only
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filgrastim (Neupogen) Side Effects
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Bone pain (25%) - dose related, mild to moderate Leukocytosis (Inc. WBC)
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filgrastim (Neupogen) Nursing Implications
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Store at room temp up to 6 hrs DO NOT SHAKE Obtain CBC prior to initial administration and 2x/weekly
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pegfilgrastim (Neulasta)
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Long acting G-CSF Dosing -> one SC dose injected 24 hrs after each round of chemotherapy every 2 weeks
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Platelets
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oprelvekin (Interleukin-11, Neumega)
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Platelet Normal Values
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150,000 - 400,000
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oprelvekin (Interleukin-11, Neumega)
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Thrombopoietic growth factor Stimulate production of platelets
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oprelvekin (Interleukin-11, Neumega) Indications
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Pts taking myelosuppressive chemotherapy Lessen need for platelet transfusions
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oprelvekin (Interleukin-11, Neumega) Route
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SC only
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oprelvekin (Interleukin-11, Neumega) Side Effects
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Fluid retention (edema, anemia) Cardiac dysrhythmias (tachycardia, atrial fibrillation, atrial flutter)
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oprelvekin (Interleukin-11, Neumega) Nursing Implications
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DO NOT SHAKE Must be used w/in 3 hrs after reconstitution Store in fridge Monitor baseline CBC & platelet counts, fluid/electrolyte status Administer 4-6 hrs after chemotherapy until platelet count reaches about 50,000/mm^3
