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Arrest hypertension heart failure thrombotic events

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Unformatted text preview: cancer Can shorten time to tumor progression Reduce overall survival 80 Epoetin Alfa (Erythropoietin) Epoetin Brand names – Epogen, Procrit Brand – Hematopoietic growth factor – Recombinant DNA technology Uses Uses – Anemia associated with chronic renal Anemia failure failure – For HIV-infected patients taking zidovudine – Chemotherapy-induced anemia – Anemia in patients facing surgery 81 Epoetin Alfa (Erythropoietin) Epoetin Adverse effects – Hypertension – Cardiovascular events Cardiac arrest Hypertension Heart failure Thrombotic events (stroke and MI) 82 Epoetin Alfa (Erythropoietin) Epoetin Dosage – To minimize risks Use minimum needed to gradually raise Use hemoglobin content to eliminate the need for RBC transfusions transfusions Hemoglobin level should not exceed 12 g/dL Monitoring – Monitor hemoglobin level twice weekly 83 Filgrastim (Neupogen) Filgrastim Granulocyte colony-stimulating factor – Leukopoietic growth factor – Recombinant DNA technology Reduces the incidence of severe Reduces neutropenia neutropenia Produces dose-dependent increase in Produces circulating neutrophils circulating Reduces the incidence of infection, need Reduces for hospitalization, and need for intravenous antibiotics intravenous 84 Filgrastim (Neupogen) Filgrastim Uses – Cancer – Severe chronic neutropenia Adverse effects – Bone pain – Leukocytosis 85 Sargramostim (Granulocyte-Macrophage Colony-Stimulating Factor) Colony-Stimulating Brand name – Leukine Brand – Hematopoietic growth factor – Recombinant DNA technology Uses – Adjunct to autologous bone marrow Adjunct transplantation transplantation – Treatment of failed bone marrow transplants – Patients with acute myelogenous leukemia (AML) Adverse effects – Leukocytosis – Thrombocytosis 86 Oprelvekin (Interleukin-11) Oprelvekin Brand name – Neumega Brand – Thrombopoietic growth factor – Recombinant DNA technology Uses – Used with myelosuppressive chemotherapy to minimize Used thrombocytopenia and to decrease the need for platelet transfusions transfusions Adverse effects – Fluid retention – Cardiac dysrhythmias – Sudden death 87 CAUTION CAUTION Epoetin alfa, filgrastim, sargramostim, and Epoetin oprelvekin stimulate proliferation of bone marrow cells marrow USE WITH GREAT CAUTION, if at all, for USE patients with cancers of bone marrow origin origin 88 Critical Thinking Case Study Ms. B, 65 years old, lives alone. She comes to the neighborhood nursing clinic with years complaints of feeling tired all the time. She tells the nurse that she has tingling and numbness in her hands and feet. Ms. B asks the nurse what she can do for her. During the interview with Ms. B, the nurse finds out that she had a total gastrectomy 2 years ago. Also she only recently moved to the area and has not followed up with her routine healthcare needs. followed 1. What is the most likely cause of Ms. B’’s complaints of extreme tiredness? What s 1. is most likely the cause of the numbne...
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