 an essential mineral for the proper function of all biologic system in the body

 It is stored in many sites throughout the body (liver, spleen, and bone marrow)
 It is also the principal nutrition deficiency in the United States, resulting in
anemia.

An oxygen carrier in both hemoglobin and myoglobin (oxygen-carrying molecule in

muscle tissue), and thus is critical for tissue respiration. Also a required component of a
number of enzyme system in the body and is necessary for energy transfer in the
cytochrome oxidase and xanthine oxidase enzyme systems.

Corrects Iron-Deficiency Symptoms such as anemia, dysphagia, dystrophy of the nails

and skin, and fissuring of the angles of the lips.

Ferrous fumarate iron salts (Femiron) contains the largest amount of iron per gram of
salt consumed.

HALF-LIFE ONSET PEAK DURATION

PO 6 hr 3-10 days Unknown Variable
Iron Dextran (InFed, DexFerrum) A colloidal solution of iron (as ferric hydroxide) and
dextram. Sodium ferric gluconate (Ferrlecit) and iron sucrose (Venofer) are other
available forms of injectable iron.

HALF-LIFE ONSET PEAK DURATION

PO 5-20 hr Unkown 24-48 hr ≥3 wk

 Known drug allergy

 Hemolytic anemia
 Hemochromatosis (Iron Overload)
 And any anemia not associated with iron deficiency

 Gastrointestinal: Nausea, constipation epigastric pain, black and tarry stools,

vomiting, diarrhea
 Integumentary: Temporarily discolored tooth enamel and eyes, pain upon
injection

Absorption of iron can be enhanced when it is given with ascorbic acid or decreased
when it is given with antacids. Iron preparations can decrease the absorption of thyroid
drugs, tetracyclines, and quinolone antibiotics.
 Assess medical history
 Assess Current condition
 Assess Medication profile including prescription, over-the-counter, and herbal
alternative medications.
 Assess Laboratory results such as Hgb, Hct, reticulocytes, bilirubin levels, and
baseline levels of folate and B-complex vitamins.
 Assess nutritional status of the patient
 Monitor for contraindications, drug interactions and adverse effects.
 Monitor the patients iron intake in the patients diet

 Imbalanced nutrition, less than body requirements, related to disease process

 Activity intolerance related to fatigue and lethargy associated with anemias
 Deficient knowledge related to limited exposure to use of medication
 Risk for injury related to adverse effects of iron products

 Liquid oral forms of iron products should be diluted per manufacturer instructions
and taken through a plastic straw to avoid discoloration of tooth enamel.
 Oral forms should be given with juice
 Advise patient to take oral dosages with meals due to high risk of gastrointestinal
distress.
 Iron dextran should be given after all iron preparations have been discontinued.
 Epinephrine and resuscitative equipment should always be availbe in case of
anaphylactic reaction.
 Place client in a recumbent position at least 30 minutes to prevent drug-induced
orthostatic hypotentsion.
  Monitor for presence of mentioned adverse effect
 Monitor for effectiveness of comfort measures
 Monitor patient response to therapy
 Monitor the patient nutritional status and its well-being.
 Monitor for compliance to drug therapy

Goals
 Patient attains normal nutritional status through use of pharmacologic and
nonpharmacologic measures
 Patient regains his/her normal level of activity, as ordered
 Patient discuss rationale for use, adverse effect of blood-forming drugs.
 Patient remains free of symptoms related to adverse effects of blood forming
drusg(e.g iron products)

Outcome Criteria
 Patient keeps daily journal of dietary intake to share with health-care provider
every week
 Patient is able to tolerate gradual increase in activity as ordered (e.g performing
activities of daily living, walking 10 minutes per day with increases as tolerated)
while taking blood-forming drugs.
 Patient uses measures to minimize occurrence of adverse effects of blood-
forming drugs, such as taking with food.
 Patient takes medication exactly as prescribed to enhance its efficacy.
 Patient reports symptoms associated with increase symptomatology related to
disease process or to adverse reactions to medications, such as abdominal
distention, cramping, nausea and vomiting.
 FOLIC ACID

Description

Is a water-soluble B-complex vitamins. Also synonymously referred to as folate, the

name of its anionic form.

Dieatary sources of folic acid include dried beans, peas, oranges, and green vegetables.

Folic acid is absorbed in the upper doudenum, malabsorption syndromes are the most
common cause of deficiency.

Mechanism of Action and Drug Effects

It is converted to tetrahydrofolic acid in the body, which is used for erthropoiesis and
for synthesis of nucleic acids (DNA and RNA). Dietary ingestion of folate is required for
the prodution of the nucleic acids DNA and RNA. Also essential for normal erytropoiesis.
Not active in the ingested form. First be converted to tetrahydrofolic acid, which is a
cofactor for reactions in the biosynthesis of purines and thy midylates of nucleic acids.

Indications

 Folic acid deficiency anemia

 Tropical Sprue
 Prophylaxis of neural tube defects in pregnant women

Contraindications

Allergy to drugs

Any anemia not related to folic acid deficiency(e.g. pernicious anemia).

Should be emphasized that folic acid should not be used to treat anemias until the
underlying cause and type of anemia have been determined. (e.g. administer to a
patient with pernicous anemia may correct the hematologic changes of anemia, while
deceptively masking other symptoms of pernicious anemia.
Adverse Effects

Allergic reaction or yellow discoloration of urine may occur.

Interactions

Oral contraceptives, corticosteroids, sulfonamides, and dihydrofolate reductase

inhibitors can cause signs of folic acid deficiency.

Can also lower the serum levels of phenytoin with possible breakthrough seizures.

Pharmacokinetics

Half-life PO: Unknown Onset PO: Unknown Peak PO: 60-90 min

Duration PO:unknown

Metabolism: liver

Excretion: kidney (urine)

OTHER BLOOD-FORMING DRUGS

Other drugs that may be used in the prevention and treatment of anemia are
cyanocobalamin (vit. B12) and erythropoietin (Epogen, Procrit).

 NURSING PROCESS
 ASSESSMENT

Assess medical history; current condition; and medication profile, including prescription,
over-the-counter, and herbal/alternative medications.
Contraindications, cautions, and drug interactions should be assessed thoroughly prior
to initiation of drug therapy.

Laboratory studies (Hgb, Hct, reticulocytes, bilirubin levels)

A nutritional assessment should be performed, with concetration on the amount of iron

intake in the patient's diet and a 24-hour recall of all food intake with serving sizes.
Dietary consultation may prove beneficial if ordered.

 NURSING DIAGNOSES
 Activity intolerance related to fatigue and lethargy associated with anemias
 Risk for injury related to adverse effects of iron products
 Deficient knowledge related to limited exposure to use of medication
 Imbalanced nutrition, less than body requirements, related to disease process

 Planning

Goals

 Pt. regains his/her normal level of activity, as ordered.

 Pt. remains free of symptoms related to adverse effects of blood-forming
drugs(e.g. iron products).
 Pt. discusses rationale for use, adverse effects, and patient education guidelines
related to use of blood-forming drugs.
 Pt. attains normal nutritional status through use of pharmacologic and
nonpharmacologic measures.

Outcome Criteria

 Pt. is able to tolarate gradual increase in activity as ordered (e.g. performing

activities of daily living, walking 10 mins. per day with increases as tolerated)
while taking blood-forming drug.
 Pt. uses measures to minimized occurrence of adverse effects of blood-forming
drugs, such as taking with food.
 Pt. takes medication exactly as prescribed to enhance its efficacy.
 Pt. reports symptoms associated with increased symptomatology related to
disease process or to adverse reactions to medications, such as abdominal
distention, cramping, nausea and vomiting.
 Pt. uses examples of balanced diet for daily menu planning.

 IMPLEMENTATION

 Liquid oral forms of iron products should be diluted per manufacturer instructions
and taken through a plastic straw to avoid discoloration of tooth enamel.
 Oral forms should be given with juice or milk.
 Taking oral dosages with meals/food is recommended mainly because of the
high risk for gastrointestinal distress.
 Intramuscularly administered iron should be given deep in a large muscle maa
using the Z-track method.
 Intravenous iron dextran should be given after the intravenous line is flushed
with 10 mL of normal saline.
 Ferrous salts, if given to infants, should be administered only with vitamin E to
prevent the possible occurrence of hemolytic anemia.
 Ferrous salts are best given between meals for maximal crease gastrointestinal
upset.
 Important to also inform patients that use of any iron product will turn stools to
black and tarry color.

 EVALUATION
Evaluation of therapeutic responses to blood-forming drugs should evolve around goals
and outcome criteria as well as monitoring for therapeutic versus adverse effects.
Therapeutic responses to iron products include improved nutrition status, increasing
weight, activity intolerance and well-being, and absence of fatigue. Toxic signs may
include nausea, diarrhea (green, tarry stools), hematemesis, pallor, cyanosis, shock,
and coma.

Pharmacokinetics

Half-life PO: 6 hr Onset PO:3-10 days Peak PO: unknown

Duration PO: variable

CYANOCOBALAMIN (B12)

-Is a cobalt containing water soluble B-complex vitamin. It synthesized by

microorganisms and is present in the body as co different co enzyme
adenosylcobalamin and methylcobalamin.

-Required for growth and cell replication and hematopoesis and nucleoprotein
and myelin synthesis

MECHANISM OF ACTION

- Humans must have an exogenous source of cyanocobalamin because it is

required for nucleoprotein and myelin synthesis, cell reproduction , normal
growth and the maintenance of normal erythropoeisis.

INDICATIONS

- Cyanocobalamin is used to treat deficiency states that develop because of an

insufficient intake of the vitamin. It is also included in multivitamin
formulation that is used as dietary supplement.

Cyanocobalamin: Adverse Effects

Body System Adverse Effects

Cardiovascular Heart failure , peripheral vascular

thrombosis, pulmonary edema
Central Nervous Flushing, optic nerve atrophy
Gastrointestinal Diarrhea
Integumentary Itching rash
Metabolic Hypokalemia

CONTRAINDICATIONS
 The only usual contraindications to administration of extrinsic cyanocobalamin
(vitamin B12) are known drug product allergies. These may include sensitivity to the
chemical element cobalt, which is part of the structure of cyanocobalamin, as this
chemical name implies. Other contraindication include hereditary optic nerve atrophy
(Lebers disease)

ADVERSE EFFECTS

Vitamin b12 is non toxic , and large doses must be ingested to produce adverse
effects, which include itching, transitory diarrhea and fever.

Pharmacokinetics
Half life Onset Peak Duration
15-20 days Unknown Unknown Unknown
 Erythropoietin (epogen, pocrit)

Mechanism of Action

 Erythropoietin is naturally occurring hormone, produced by the kidneys.

 It stimulates the bone marrow to make red blood cells.

Indication

 Chemotherapy-induced anemia; anemia associated with chronic renal failure,

zidovudine therapy (for HIV infection); reduction of need for blood transfusions
in surgical patients.
 Chemotherapy-induced leukopenia.
 Chemotherapy – induced thrombocytopenia.

Contraindication

 Pure red cell aplasia following erythropoietin.

 Uncontrolled hypertension.

Adverse / Side Effects

CNS: fever, headache

CV: hypertension (epoetinalfa), edema

GI: Anorexia, nausea, vomiting, diarrhea,

Others : blood dyscrasias, bone pain

Nursing Considerations

 Avoid injections containing benzyl alcohol in neonates.

 It is important that blood pressure, reticulocyte, hemoglobin and electrolyte
counts be closely monitored.
 Interrupt treatment if blood pressure becomes uncontrollable.
 Exclude other causes of anemia and give iron supplements where appropriate.
 If used before orthopaedic surgery this may present an increased risk for
thrombosis.
Assessment

Prior to admission:
 Obtain complete health history including allergies, drug history, and possible
drug reactions.
 Assess reason for drug administration such as presence/history of anemia
secondary to chronic renal failure, malignancy, chemotherapy, autologous blood
donation, and HIV-infected clients treated with zidovudine.
 Assess vital signs, especially blood pressure.
 Assess complete blood count, specifically hematocrit and hemoglobin levels, to
establish baseline values.

Nursing Diagnosis

 Ineffective tissue perfusion related to response to drug

 Risk for injury (weakness, dizziness, syncope) related to anemia
 Risk for injury related to seizure activity secondary to drug
 Activity intolerance related to RBC deficiency
 Deficient knowledge related to drug therapy

Planning

The client will:

 Exhibit an increase in hematocrit level and improvement in anemia-related
symptoms.
 Immediately report severe headache, chest pain, confusion, numbness, or loss of
movement in an extremity.
 Demonstrate an understanding of the drug’s action by accurately describing drug
side effects and precautions.

Implementation

 Monitor vital signs, especially blood pressure.

Rationale: The rate of hypertension is directly related to the rate of rise of the
and seizures. Hypertension is also much more likely in clients with chronic renal
failure.
 Monitor for side effects, especially symptoms of neurological or cardiovascular
events.
 Rationale: Headache, seizures and hypertension have been related to drug
usage.
 Monitor client’s ability to self-administer medication.
Rationale: Inability to self-administer medication requires the nurse to arrange
for someone else to administer the medication.
 Monitor laboratory values such as hematocrit and hemoglobin to evaluate
effectiveness of treatment.
Rationale: Increases in hematocrit and hemoglobin values indicate increase RBC
production.
 Monitor client for signs of seizure activity.
Rationale: Seizures result in a rapid rise in the hematocrit- especially during first
90 days of treatment.
 Monitor client for signs of thrombus such as swelling, warmth, and pain in an
extremity.
Rationale: As hematocrit rises, there is an increased chance of thrombus
formation, particularly for clients with chronic renal failure.
 Monitor dietary intake. Ensure adequate intake of all essential nutrients.
Rationale: Response to this medication is minimal if blood levels of iron, folic
acid, vitamin B12 are deficient.

Evaluation

Evaluate the effectiveness of drug therapy by confirming that client goals and
expected outcomes have been met:
 The client exhibits an increase in hematocrit level and improvement in anemia-
related symptoms.
 The client report severe headache, chest pain, confusion, numbness, or loss of
movement in an extremity.
 The client demonstrate an understanding of the drug’s action by accurately
describing drug side effects and precautions.