Drug Name Mechanism of Action
Effects
Folic Acid Reduced form of folic acid,
required for nucleoprotein
synthesis and maintenance
of normal erythropoiesis
Hydroxocobalamin Essential for nucleic acid
and protein synthesis; used
for growth, cell
reproduction,
hematopoiesis, and
nucleoprotein and myelin
synthesis
Indication Contraindications Side Effects/Adverse Nursing Considerations
Treatment of megaloblastic Presence of known allergies Allergic reactions, pain and Pernicious anemia should
anemia due to folate to these drugs or to their discomfort at injection site be ruled out with Schilling
deficiency components test and vitamin B12 blood
level before initiating
therapy
Assess for therapeutic
improvement: improved
sense of well-being, relief
from iron deficiency
symptoms (fatigue,
shortness of breath, sore
tongue, headache, pallor)
Patient/family teaching
Eat foods rich in folic acid
including fruits, vegetables
organ meats
Treatment of vitamin B12 Presence of known allergies Itching, transitory Assess for any known
deficiency; to meet to these drugs or to their exanthema, mild diarrhea, allergies to these drugs or
increased vitamin B12 components anaphylactic reaction, heart drug components, other
requirements related to failure, pulmonary edema, anemias, pregnancy,
disease, pregnancy or blood hypokalemia, pain at lactation and nasal erosion
loss injection site
Assess baseline status
before beginning therapy to
determine any potential
adverse effects. This
includes affect, orientation,
and reflexes; pulse, blood
pressure, and perfusion;
respirations and
adventitious sounds, and
CBC to determine
effectiveness of drug
therapy
Drug Name Mechanism of Action Indication Contraindications Side Effects/Adverse Nursing Considerations
Effects
Hydroxyurea Inhibits DNA synthesis Reduction of frequency of Presence of known allergies Dizziness, headache, rash, Obtain bone marrow
without interfering with painful crisis and need for to these drugs or to their erythema, anorexia, nausea, studies, hepatic/renal
RNA synthesis or protein blood transfusion in adult components vomiting, stomatitis, bone function tests before
patients with sickle cell marrow depression, cancer therapy begins, periodically
anemia thereafter.
Obtain Hgb, WBC, platelet
Increases fetal hemoglobin count, serum uric acid at
production in the bone baseline weekly during
marrow and dilutes the therapy. Those with marked
formation of abnormal renal impairment may
hemoglobin S develop visual or auditory
hallucinations, marked
hematologic toxicity

Monitor daily pattern of

bowel activity
Monitor for hematologic
toxicity, symptoms of
anemia

Assess for skin for rash,

erythema
Monitor CBC with
differential platelet count,
Hgb, renal/hepatic function,
uric acid

Patient/family teaching
Promptly report fever, sore
throat, signs of local
infection, unusual
bleeding/bruising at any
site
Encourage patient to drink
10-12 glasses of water each
day while taking this drug