Chapter 28 Drugs for Hematopoietic Disorders 1. What is epoetin? Epoetin is a DNA engineered erythropoietin.

It is used to stimulate erythrocyte, leukocyte, or platelet production. It may be prescribed to treat complications of diseases such as cancer, AIDS, and chronic renal failure. It reduces the anemia caused by these diseases. 2. How does darbopoetin differ from epoetin? It has the same pharmacological action, efficacy, and safety profile; however, it has an extended duration of action that allows it to be administered once weekly. 3. What disease states are most likely to require use of these drugs? Anemia associated with chemotherapy or chronic renal failure. 4. What is/are the most serious side effect/s of epoetin? Most serious is HTN also the risk of emboli (TIAs) is increased. 5. How laboratory data will indicate that these drugs are working? Check their hematocrit and hemoglobin levels to evaluate effectiveness. Increases indicate increased RBC production What happens if these levels rise to high? Rapid rise in hematocrit can result in seizures. Also, as hematocrit rises, there is an increased chance of thrombus formation, particularly for clients with chronic renal failure. 6. How long does it take these agents to be effective? 7-14 days 7. What screening should occur before administering epoetin or darbopoetin? Obtain baseline CBC and vital signs. Note if client has HTN because epoetin is known to raies blood pressure to dangerous levels. chronic renal failure and is on dialysis. Assess for food or drug allergies, because epoetin alfa is contraindicated in individuals who are hypersensitive to many protein based products. 8. What is filgrastim? Filgrastim is DNA engineered CSF - similar to natural G-CSF. It is used to increase leukocytes and activate WBCs. What is its primary indication? It is primarily used for chronic neutropenia or neutropenia due to chemotherapy and bone marrow suppression and may be used in clients with AIDS-related immunosuppression. If we can increase WBC faster for chemotherapy patients, their therapy is more successful and it shortens the length of time they are susceptible to lifethreatening infections. 9. Why should this drug not be given to persons with myeloid disease, like leukemia? Filgrastim may stimulate proliferation of these malignant cells. 10. What is the primary concern in clients using filgrastim? Assess for hypersensitivity to certain foreign proteins, specifically those in Escherichia coli. Because if filgrastims structural components, the drug is contraindicated in clients with this type of hypersensitivity. 11. What therapy would you recommend for the bone pain that sometimes accompanies this therapy? Use acetaminophen for bone pain. 12. Most breads/cereals are fortified; why would a client be deficient in vitamin B-12? The most common cause of B12 deficiency is not diet, but absence of intrinsic factor, a protein secreted by stomach cells. Instrinsic factor is required for B12 to be absorbed from the intestine. 13. Why can oral dosing of cyanocobalamin problematic? (SQ or IV only) Ascorbic acid affects the stability of vitamin B12. 14. Other than hematologic, what effects are seen from vitamin B-12 deficiency? Memory loss, confusion, unsteadiness, tingling or numbness in the limbs, delusions, mood disturbances and hallucinations. 15. What electrolyte needs to be monitored carefully when administering cyanacobalamin? Monitor potassium levels, because hypokalemia is a possible side effect. 16. What is the most common cause of anemia? Iron deficiency. 17. Of what harmless effect of iron therapy should the patient and the nurse be aware? Taking iron causes stools to turn dark green or black. 18. What should clients using oral liquid forms of iron be taught? Use a straw or place liquid preparations on back of tongue to prevent staining teeth. 19. How are parenteral doses of iron administered? IM = Use the Z-track method (deep muscle) when giving IM. IV be careful to prevent infiltration, as iron is highly irritating to tissues. 20. What dietary education should a client using iron receive? Maintain adequate dietary intake of iron-rich foods. 21. What should be monitored in all clients receiving therapy for anemia? Vital signs/ PO, CBC/diff