Pharm Exam 3 Prototypes.docx - EXAM 3 ANEMIA\/VITAMINS ANEMIAS Decrease in erythrocytes(RBCs Number Size Hemoglobin content Causes Blood loss Hemolysis

Pharm Exam 3 Prototypes.docx - EXAM 3 ANEMIA/VITAMINS...

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ANEMIAS: •Decrease in erythrocytes (RBCs) •Number •Size •Hemoglobin content •Causes •Blood loss •Hemolysis •Bone marrow dysfunction •Deficiency of substances essential for RBC formation and maturation Red Blood Cell Development •Development begins in the bone marrow •Matures in the blood •Evolves through four stages •Healthy development requires: •Healthy bone marrow erythropoietin, iron, and other factors to support DNS synthesis Cyanocobalamin (Vitamin B 12 ) •Folic acid (Folate, FA) Vitamins and minerals given to combat anemia Most common are: o cyanocobalamin (Vitamin B12) o folic acid (Folate) o ferrous sulfate Intrinsic Factor o Protein secreted by stomach cells o Required for vitamin B12 metabolism o Lack of intrinsic factor leads to B12 deficiency Inflammatory disease of stomach Surgical removal of stomach Strict vegetarian diet IRON DEFICIENCY ANEMIA: Elimination—1 mg of iron is excreted each day o Regulated through control of intestinal absorption Daily requirements o Determined by rate of erythrocyte production o Increased during pregnancy Dietary sources o Available in foods of plant and animals Common causes: pregnancy, blood volume expansion in childhood, chronic blood loss (GI, uterine) Ferrous Sulfate (p. 643,44, table 55-2 & 55-3) Preparations: Ferrous sulfate – contains 30% of elemental iron Ferrous fumarate – contains 33% elemental iron Ferrous gluconate – contains 12% elemental iron Iron: Supplemental iron may be given as a single drug or as part of a multivitamin preparation Oral iron preparations are available as ferrous salts o ferrous fumarate (Femiron), ferrous gluconate, ferrous sulfate (FeSO4) EXAM 3: ANEMIA/VITAMINS
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Parenteral o iron dextran (INFeD, Dexferrum) o iron sucrose (Venofer) o ferric gluconate (Ferrlecit) o ferumoxytol (Feraheme) SE: Adverse effects: Most common AE – GI upset – take with food will ↓ this AE but ↓ Fe absorption by as much as 70%. May provide false (+) occult blood in stools GI disturbances: take with food (only if absolutely needed since it decreases absorption), discoloration of stools Constipation Staining of teeth: (take it with a straw so it bypasses teeth and rinse mouth afterwards) Toxicity: regular lab evaluation of hgb, hct Nursing Considerations/ Teaching Implications: pg. 688-90 Oral forms should be given with juice, but not with milk or antacids Oral forms of iron should be taken between meals for maximum absorption, but may be taken with meals if GI distress occurs May produce dark stools Monitor BM - ↑ dietary fiber Administer with vitamin C Administer liquid preparation with a straw to prevent teeth staining (rinse mouth after intake) Encourage ↑ intake of food rich in Fe: liver, eggs yolks, brewer yeast, green leafy vegetables, wheat germ Administration •Administration Alert –When administering IV, be careful to prevent infiltration (irritant to tissue) or allergic reaction –Injectable forms cause pain upon injection –Use Z-track method (deep muscle) when giving IM –Do not crush tablets or empty contents of capsule when administering
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