Drugs affecting the Blood including Blood products (Whole, PRBC, Packed Cells etc)

You can find part one here – http://www.nclexreviewonline.com/nclex-medication-review-drugs-that-affect-the-blood-part-1/

Hematopoietic Growth Factors

Expected Action: Act on bone marrow to increased RBC production

Examples: Epoetin alfa (Epogen, Procrit) — Others: darbepoetin alfa

Therapeutic Uses: Anemia of chronic renal failure or chemotherapy, HIV patients taking zidovudine (Retrovir), Anemia in patients schedule for elective surgery

Adverse Effects: Hypertension 2º increased Hct, increased risk for CV event (MI, stroke, arrest) ĉ increased Hgb > 12 g/dL or > 1 g in 2 weeks

Contraindications/Precautions: CI: uncontrolled hypertension

Education:
RBC production requires iron, folate, and vitamin _B12Monitor Hgb and Hct 2x per week until target range is reached

Granulocyte Colony Stimulating Factor

Expected Action: Medications stimulate bone marrow to increased production of neutrophils.

Examples: filgrastim (Neupogen) — Others: pegfilgrastim (Neulasta)

Therapeutic Uses: decreased infection risk with neutropenia (e.g. cancer)

Adverse Effects: Bone pain, Leukocytosis: decreased dose / interrupt treatment if WBC > 50,000/cc, ANC > 20,000/cc, or platelets > 500,000/cc.

Contraindications/Precautions: CI: Sensitive to E. coli proteins

Education:
Filgrastim should not be agitated nor mixed
Monitor CBC 2x per week

Granulocyte Macrophage Colony Stimulating Factor

Expected Action: increased production of WBCs in bone marrow

Examples: Sargramostim (Leukine)

Therapeutic Uses: Facilitates recovery of bone marrow after marrow transplant.

Adverse Effects: Diarrhea, weakness, rash, malaise, and bone pain (call), Leukocytosis, thrombocytosis: Δ if WBC>50,000, ANC>20,000, PLT>500,000

Education: Sargramostim should not be agitated nor mixed with other meds.

Thrombopoietic Growth Factors

Expected Action: Increases production of platelets

Proto: oprelvekin (Interleukin 11, Neumega)

Therapeutic Uses: decreased thrombocytopenia ĉ myelosuppressive chemotherapy

Adverse Effects: Fluid retention (peripheral edema, dyspnea on exertion), Dysrhythmias, Conjunctival injection, transient blurring, and papilledema

Education: Treat for 21 days or until PLT increased > 50,000

BLOOD PRODUCTS
Whole Blood

Expected Action: Increases circulating blood volume

Therapeutic Uses: Acute blood loss, extensive burns, dehydration, shock

Adverse Effects:
Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids)
Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m
Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m
Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine
Mild allergy: If respiration uncompromised, antihistamines and restart
Circulatory overload: Place upright / O₂ and diuretics / slower rate

Education: Requires countersign, assess before, during, & after, Assess site & patency, Use ≥19 ga, filter, Y-tubing, No Mix, Complete in 2-4 hours, increased Hgb 1-2 g/dL per unit

Packed RBCs

Expected Action: increased # of RBCs

Therapeutic Uses: Erythroblastosis fetalis, Hemoglobinopathies, Severe symptomatic anemia (Hgb<6 g/dL), Med-induced hemolytic anemia

Adverse Effects:
Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids)
Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m
Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m
Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine
Mild allergy: If respiration uncompromised, antihistamines and restart
Education: Requires countersign, Assess before, during, & after, Assess site & patency, Use ≥19 ga, filter, Y-tubing, No Mix, Complete in 2-4 hours, increased Hgb 1-2 g/dL per unit

Platelet Concentrate

Expected Action: increased platelet count

Therapeutic Uses: Thrombocytopenia (< 20,000/cc), Active bleeding (platelets < 80,000/cc)

Adverse Effects:
Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids)
Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m
Mild allergy: If respiration uncompromised, antihistamines and restart

Education: Requires countersign, Assess before, during, & after, Assess site & patency, Use special platelet kit (smaller filter, shorter tube

Fresh Frozen Plasma

Expected Action: Replaces coagulation factors

Therapeutic Uses: Massive hemorrhage, Extensive burns, Shock, Disseminated intravascular coagulation, Antithrombin III deficiency, Thrombotic thrombocytopenic purpura, Reverse warfarin effects, Replacement therapy for factors II, V, VII, IX, X, & XI

Adverse Effects:

Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids)
Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m
Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m
Mild allergy: If respiration uncompromised, antihistamines and restart
Circulatory overload: Place upright / O₂ and diuretics / slower rate

Education: Requires countersign, Assess before, during, & after, Assess site & patency, No Mix

Pheresed Granulocytes

Expected Action: Replace neutrophils / granulocytes

Therapeutic Uses: Neonatal sepsis, Severe neutropenia (ANC < 500), Neutrophil dysfunction, Nonresponsive life-threatening infection

Adverse Effects:

Albumin

Expected Action: Expands circulating blood volume by oncotic pressure

Therapeutic Uses: Hypovolemia, Burns, Adult respiratory distress, Hypoalbuminemia, Cardiopulmonary bypass surgery, Hemolytic disease of the newborn

Adverse Effects: Risk for fluid volume excess such as pulmonary edema

Contraindications: CHF or renal insufficiency

Education: Must administer IV: Slowly using an infusion pump, Can be administered ĉ whole blood, plasma, saline, or glucose.

Past Medication posts –

Nervous System Meds (4 parts)

http://www.nclexreviewonline.com/nervous-system-medication-part-1-the-receptors/

http://www.nclexreviewonline.com/nervous-system-meds-drugs-part-2/

http://www.nclexreviewonline.com/medications-affecting-the-nervous-system-part-3/

http://www.nclexreviewonline.com/nclex-nervous-system-meds-anesthetics-psych-meds-and-withdrawal-part-4/

Cardiac Medications

Part 1 – http://www.nclexreviewonline.com/cardiac-drugs-for-nclex-part-1/
Part 2 – http://www.nclexreviewonline.com/nclex-cardiac-drugs-part-2/
Part 3- http://www.nclexreviewonline.com/nclex-cardiac-drugs-part-3/

Pain Meds and Inflammation – http://www.nclexreviewonline.com/nclex-test-help-pain-meds-and-inflammation/