Hematological Drugs Fall 2017 – Flashcards

B. Drink it through a straw. D. Dilute it first with water. Because ferrous sulfate can stain the teeth, tell the patient to dilute the liquid form with water, drink it through a straw, and rinse her mouth after swallowing it. Food reduces the absorption of ferrous sulfate, so tell her to take it on an empty stomach for best absorption. Patients who develop gastrointestinal distress from the drug can try taking it with food as long as they understand that this will reduce absorption and thus prolong therapy.

1. Folic acid-- D. Megaloblastic anemia Folic acid treats megaloblastic anemia due to malabsorption syndrome, alcohol abuse, or hepatic disease. 2. Factor VIII--C. Hemophilia A Factor VIII treats hemophilia A on demand for bleeding episodes or prophylactically to prevent bleeding. 3. Filgrastim (Neupogen)--A. Chronic neutropenia Filgrastim treats severe chronic neutropenia and reduces the infection risk associated with bone marrow transplantation. 4. Heparin (Lovenox)-- B. Deep-vein thrombosis Heparin reduces clotting for an evolving CVA, pulmonary embolism, and deep-vein thrombosis. It prevents postoperative venous thrombosis and treats acute myocardial infarction and disseminated intravascular coagulation.

PT/INR At the start of warfarin therapy, you should monitor prothrombin time (PT) and international normalized ratio (INR) daily and adjust the dosage to maintain an INR of 2 to 3. Monitor the patient for indications of bleeding such as abdominal pain, black tarry stools, or nosebleeds. Warfarin does not affect fibrinogen level, a parameter to assess prior alteplase (Activase) therapy. Warfarin does not affect platelets. Aspirin (Ecotrin) is an example of a drug that inhibits platelet aggregation. Warfarin does not affect fibrinogen level, a parameter to assess prior to alteplase (Activase) therapy. Warfarin does not affect activated partial thromboplastin time (aPTT), a parameter to assess every 4 to 6 hr initially and then daily for patients receiving continuous IV heparin.

A. Monitor blood pressure. C. Limit venipunctures. D. Check level of consciousness. E. Apply pressure to oozing sites Alteplase, a thrombolytic, can cause bleeding. You should monitor venipuncture sites and open wounds for bleeding and apply pressure dressings. Avoid or minimize venipunctures. Limit the patient's movement to prevent further bleeding or trauma. Monitor his level of consciousness and pupils to assess for intracranial bleeding. Alteplase can also cause a fever. Monitor temperature and, for fever, administer acetaminophen (Tylenol).

Filgrastim (Neupogen)-- C. Stimulates leukocyte production Filgrastim, a leukopoietic growth factor, stimulates leukocyte (WBC) production for patients who are myelosuppressed due to chemotherapy or disease. Alteplase (Activase)-- A. Dissolves blood clots Alteplase, a thrombolytic drug, dissolves a thrombi or blood clot that is already formed. Epoetin alfa (Procrit)--D. Stimulates RBC production Epoetin alfa stimulates RBC production in the bone marrow. It treats anemia from renal failure, malignancies, or AIDS. Clopidogrel (Plavix)--B. Inhibits platelet aggregation Clopidogrel, an antiplatelet drug, inhibits platelet aggregation and reduces thrombus formation.

A. Petechiae D. Weakness E. Vision changes Clopidogrel, an antiplatelet drug, can cause bleeding. You should tell the patient to report any indications of bleeding, such as petechiae, bruising, bleeding gums, abdominal pain, or hematemesis. Youl should also monitor for indications of a hemorrhagic stroke, such as a severe headache, unilateral weakness, disturbed vision, or aphasia. Clopidogrel is unlikely to cause tinnitus or diaphoresis. Aspirin (Ecotrin) is a drug that can cause tinnitus and diaphoresis, especially with excessive doses.

ECG ?Oprelvekin, a thrombopoietic growth factor, can cause cardiac dysrhythmias, such as atrial fibrillation, atrial flutter, and tachycardia. You should monitor the patient's vital signs, heart rate, and ECG carefully. The patient should be told to report palpitations, rapid pulse, or dizziness. Oprelvekin can cause peripheral edema and fluid retention, but it is unlikely to alter liver function. Oprelvekin can affect vision, but it is unlikely to affect hearing. It is unlikely to affect level of consciousness, although it can cause insomnia and dizziness.

Protamine Protamine reverses the effects of heparin. For an overdose, the health care professional should stop heparin and administer protamine no faster than 20 mg/min. Aminocaproic acid, a coagulator, acts by inhibiting fibrinolysin. It can stop excessive bleeding due to alteplase (Activase). A chelating agent, such as deferoxamine, treats iron toxicity. Vitamin K reverses the effects of warfarin (Coumadin).

A. Thrombocytopenia B. Hypotension D. Deep-vein thrombosis E. Fever You should monitor this patient's platelet count for thrombocytopenia and stop heparin for any sudden drop in platelets. Patients receiving heparin are at risk for bleeding, which can cause hypotension and tachycardia. Heparin-induced thrombocytopenia produces antibodies that cause thrombus formation, so you should watch for indications of a new blood clot. Heparin can cause a hypersensitivity reaction, which manifests as fever, chills, and hives. It is essential to administer a test dose to determine hypersensitivity. Heparin is more likely to cause hyperkalemia than hypokalemia.

warfarin takes 3 to 5 days to achieve therapeutic effects. Warfarin takes 3 to 5 days to achieve its therapeutic effects. Once it provides effective anticoagulation, with an INR of 2 to 3, the provider should discontinue heparin therapy. IV heparin is effective as an anticoagulant, but becomes impractical and costly for the patient to receive at home. Stopping heparin therapy does not increase the risk for thrombocytopenia. It actually decreases the risk in this case, because thrombocytopenia is not an adverse effect of warfarin. Similar to heparin, however, warfarin can cause bleeding.

A. Avoid taking NSAIDs. C. Brush his teeth with a soft toothbrush. E. Ask the provider before taking over-the-counter drugs. F. Check bowel movements for signs of bleeding. You should instruct the patient to avoid taking NSAIDs and other over-the-counter drugs that could interact with warfarin. NSAIDs, especially aspirin, can increase anticoagulation and cause bleeding. Many other drugs interact with warfarin, so it is essential for the patient to check with the provider before taking them. The patient should use an electric razor to prevent injuries that might bleed and should brush with a soft toothbrush to avoid gum irritation and bleeding. Dark green, leafy vegetables are high in vitamin K and, if consumed in excessive amounts, can reduce anticoagulation. Patients should monitor and report bleeding, such as excessive or easy bruising and blood in the urine, stools, or emesis.

A. Administer a test dose is correct. Iron dextran can cause a hypersensitivity reaction. It is essential to administer a test dose to determine hypersensitivity prior to giving the full dosage initially and to allow 1 hr for identifying any adverse reactions. B. Monitor blood pressure is correct. Iron dextran can cause hypotension and hypersensitivity reactions, so it is important to monitor blood pressure. C. Have epinephrine available is correct. Iron dextran can cause a hypersensitivity reaction. It is essential to have epinephrine and resuscitation equipment available and to monitor for skin rash, fever, and chills. E. Use the Z-track technique is correct. Health care professionals giving the drug IM should use the Z-track technique to make sure to deposit it deep into the buttocks. Superficial injection can cause abscesses and brown discoloration of the skin.

within 3 hr of symptom onset. Alteplase, a thrombolytic drug, is most effective in treating acute myocardial infarction if the patient receives it as soon as possible after the onset of symptoms.

Enlarged spleen With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. Health care professionals should tell patients taking the drug to monitor and report abdominal pain or fullness.

Clarify the prescription with the provider. Leukocytosis can occur with filgrastim therapy. It is essential to monitor CBC twice per week and reduce the dosage or stop therapy for a WBC count above 10,000/mm3?. The health care professional should notify the provider of the patient's current WBC count and clarify the prescription prior to administration.

Hypertension Epoetin alfa, an erythropoietic growth factor, can cause hypertension. The health care professional should monitor blood pressure and regulate it prior to initiating epoetin alfa therapy, then monitor it during therapy. For elevations, recommend a reduced dosage or antihypertensive drug therapy.

Increases platelet production Oprelvekin, a thrombopoietic growth factor, increases platelet production. It treats thrombocytopenia that is associated with myelosuppression.

Ibuprofen (Motrin) NSAIDs, such as ibuprofen and especially aspirin, can increase the risk of bleeding for patients taking warfarin, an anticoagulant.

A. Conjunctivitis Oprelvekin, a thrombopoietic growth factor, can cause conjunctivitis, blurred vision, and papilledema. Patients should report eye redness or blurred vision. C. Swollen ankles Oprelvekin, a thrombopoietic growth factor, can cause fluid retention. The health care professional should monitor I;O and patients should report edema or difficulty breathing. E. Palpitations Oprelvekin, a thrombopoietic growth factor, can cause cardiac dysrhythmias. Patients should report palpitations or dizziness.

Insert the needle into the vial once. Instructions for administering the drug include inserting the needle into the vial only once. Health care professionals should also examine the solution and discard it if it is cloudy or discolored.

Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. Health care professionals should monitor fluid intake and output for patients receiving the drug therapy.

Headache Alteplase, a thrombolytic drug, can cause intracranial bleeding. Monitor patients receiving the drug for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.

Inhibiting cyclooxygenase action in platelets Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.

A. Eat iron-enriched foods. Patients who have iron-deficiency anemia should increase iron intake with foods such as egg yolks, wheat germ, meat, and fish to supplement ferrous sulfate. B. Spread the dosage across each day. Spreading out the iron intake throughout patients' waking hours allows the bone marrow to maximize the production of RBCs. C. Take the drug on an empty stomach. Food reduces the absorption of ferrous sulfate. Patients should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, patients can take the drug with food. E. Increase dietary fiber intake. Ferrous sulfate can cause constipation. Patients should increase fiber and fluid intake and exercise more often or more intensely.

Deferoxamine (Desferal) Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.

Thrombocytopenia Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The health care professional should monitor platelet count, bruising, bleeding gums, and petechiae.

Creutzfeldt-Jakob disease Recombinant factor IX is safer than the plasma-derived formulation because of the risk of Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. Plasma-derived products also carry a minimal risk of acquiring hepatitis A and parvovirus B19.

Reticulocyte count A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Patients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness.

Have emergency equipment ready. Factor VIII can cause a hypersensitive reaction and anaphylaxis. The health care professional should monitor for hives, fever, wheezing, and difficulty breathing, and have emergency equipment and drugs readily available.

Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.

Aminocaproic acid (Amicar) Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops fibrinolytic bleeding. For severe bleeding, patients often require blood replacement.

Filgrastim (Neupogen) Filgrastim, a leukopoietic growth factor, stimulates production of neutrophils in the bone marrow. It helps reduce the risk for infection due to bone marrow transplantation, severe chronic neutropenia, and myelosuppressive chemotherapy.

Vitamin B12 Patients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both. Cyanocobalamin (Nascobal) treats moderate vitamin B12 deficiencies. Patients who have a severe vitamin B12 deficiency should take cyanocobalamin and folic acid.

Filgrastim (Neupogen) Patients who are sensitive to Escherichia coli-derived proteins or have acute respiratory distress syndrome should not receive filgrastim, a leukopoietic growth factor.

Peptic ulcer disease Patients who have peptic ulcer disease should not take clopidogrel because it can cause gastric bleeding.

Hgb Epoetin alfa, an erythropoietic growth factor, increases the production of RBCs for patients who have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with effective therapy.