Question 1

iron salts

Accepted Answer

Stored as ferritin in the body
 Used in Iron deficiency anemia (RBCs are microcytic and hypochromic)
 Prescription and over the counter (OTC)

Question 2

Oral Iron

Accepted Answer

Ferrous gluconate, Ferrous sulfate, Ferrous fumarate
1 hour before meals
 Decrease absorption: Antacids, abx and thyroid drugs, foods containing
milk, some grains and cereals
 Increase absorption :Vitamin C
 Liquid iron must be admin with a straw

Question 3

IV/IM Iron

Accepted Answer

(Iron dextran)
 Used when oral is unsatisfactory or impossible
 Z-track administration required

Question 4

Iron Side effects

Accepted Answer

GI: upset stomach, n&v, diarrhea, constipation
 Dark, tarry stools
 Skin: discoloration of skin/teeth and pain upon injection
 Nursing considerations:
 Monitor for side effects
 Give iron 1 hour before meals preferably

Question 5

educate abt iron

Accepted Answer

roper admin and medications that increase and decrease absorption
 Importance of adequate food sources to maintain iron (lean meats, liver, egg yolks, dried
beans, green veggies)
 Educate on expected stool changes

Question 6

vitamin b12

Accepted Answer

deficiency affects neuro, hematologic and GI systems
 Used to treat pernicious anemia (megaloblastic, macrocytic anemia)
 Pts with GI surgeries that remove all or part of stomach will require lifelong injections

Question 7

Cyanocobalamin (Vitamin B12 injectable)

Accepted Answer

IM or deep SQ admin
 Z-track admin for IM
 Protect from light

Question 8

Cyanocobalamin (Vitamin B12) side effects

Accepted Answer

Flushing, diarrhea, itching/pain at injection site

Question 9

Cyanocobalamin (Vitamin B12) considerations

Accepted Answer

Monitor therapeutic level for Vitamin B12 (Schilling test)
 Rotate sites for parenteral admin and use Z-track
 Protect injection from light
 Monitor K+ level
 Educate on food sources of B12

Question 10

s/s of B12 deficiency

Accepted Answer

(numbness/tingling in extremities, weakness, fatigue,
anorexia, loss of taste, diarrhea, memory loss, mood changes)

Question 11

folic acid folate

Accepted Answer

vitamin needed for DNA synthesis/cell division
 Deficiency associated with neural tube defects in fetus and megaloblastic
macrocytic anemia
Oral replacement for a deficiency/ preventative in pregnancy
 0.4mg/day maintenance and 1mg/day therapeutic

Question 12

folic acid folate effects

Accepted Answer

Yellow discoloration of urine, nausea, altered sleep, depression, rash, bronchospasm
 Nursing considerations
 Educate patient that alcohol consumption decreases folic acid levels
 Educate on food sources

Question 13

hydroxyurea

Accepted Answer

Antineoplastic agent
 Used in polycythemia vera (bone marrow suppression)
 Used in sickle cell (decreases sickled cells and reduces hemolysis)
 Pregnancy category D
 PO
 Side effects
 Bone marrow suppression, stomatitis, rash

Question 14

hydroxyurea considerations

Accepted Answer

Determine status of kidney, liver and bone marrow function
 Monitor I&O, increase fluid intake

Question 15

clotting factors

Accepted Answer

Factor VIII
 Used to treat Hemophilia A
 Factor IX
 Used to treat Hemophilia B, Cryoprecipitate
 Concentrated form of fibrinogen, obtained from fresh frozen plasma (FFP)

Question 16

Desmopressin acetate (DDAVP) clotting factor

Accepted Answer

Antidiuretic hormone with additive effect of increasing Factor VIII
 Used in Hemophilia A and Von Willebrand disease
 Intranasal, IV, SQ
 Contraindicated in pregnancy
 Short lived, used pre-procedural

Question 17

anticoaugulants

Accepted Answer

Agents that prevent or delay blood coagulation
 Warfarin (PO)
 Heparin (IV, SQ)
 Low-molecular weight Heparin (SQ)
 Dalteparin
 Enoxaparin

Question 18

Selective Factor Xa Inhibitors (PO, SQ)

Accepted Answer

Rivaroxaban
 Fondaparinux
 Apixaban
 Edoxaban

Question 19

Heparin

Accepted Answer

Works on thrombin; prevents fibrinogen to fibrin
 SQ for VTE prevention
 IV for VTE treatment (requires q6-8h PTT monitoring)
 Protamine Sulfate: antidote
 Prolongs activated Partial Thromboplastin Time (PTT)

Question 20

Low-molecular-weight Heparin—Enoxaparin (Lovenox)

Accepted Answer

SQ
 Prevents Prothrombin to thrombin
 Risk for HIT lower, unless previously on heparin

Question 21

Vitamin K antagonists - Warfarin (Coumadin)

Accepted Answer

Interferes with synthesis of Vit-K dependent clotting factors
 Does not effect existing clotting factors
 Vitamin K: antidote
 Monitor PT & INR
 Give same time everyday, Do not change brands, diet teaching (Vitamin K)

Question 22

Selective factor Xa inhibitors

Accepted Answer

Fondaparinux (Arixtra) SQ
 Rivaroxaban (Xarelto) and apixaban (Eliquis) PO
 VTE prevention and treatment
 Coag monitoring not required
 Produces rapid anticoagulation

Question 23

Aspirin antiplatelet

Accepted Answer

PO, most commonly used, cheap
 Used in PAD, CAD, MI, stroke, VTE
 Give on full stomach to minimize GI upset

Question 24

Clopidogrel antiplatelet

Accepted Answer

PO
 Added in pts with stroke, MI, and PAD

Question 25

Cilostazol antiplatelet

Accepted Answer

PO
 Reduces symptoms of intermittent claudication

Question 26

Teach: avoid herbs that can

Accepted Answer

increase risk of bleeding (garlic, chamomile, gingko, turmeric, golden
seal, green leaf tea
 Teach to monitor for s/s of bleeding, bruising and anemia

Question 27

ACE inhibitors

Accepted Answer

Maintain tight BP control, reduce PAD symptoms

Question 28

Antiplatelets

Accepted Answer

Critical for reducing cardiovascular disease risk and death
 Includes ASA 81mg
 May add Clopidogrel for high risk patients
 Anticoagulants NOT RECOMMENDED in PAD

Question 29

Cilostazol

Accepted Answer

Phosphodiesterase inhibitor
 Inhibits platelet aggregation and increases vasodilation

Question 30

Pentoxifylline

Accepted Answer

Xanthine derivative
 Improves flexibility of blood cells and decreases platelet adhesiveness
 Not as effective as cilostazol and not used often

Question 31

Calcium channel blockers

Accepted Answer

(nifedipine, diltiazem, verapamil, amlodipine)
 Relaxes smooth muscle and prevents arterial spasm
 Used in Raynaud’s, HTN
 Monitor for hypotension and headache

Question 32

Corticosteroids (prednisone, methylprednisolone)

Accepted Answer

give with food
 Anti-inflammatory and immunosuppressive activity
 Used in ITP (immune thrombocytopenic purpura), TTP (thrombocic thrombocytopenic
purpura), aplastic anemia, asthma, COPD, pneumonia
 Monitor glucose, WBC, platelets

Question 33

anticoagulant vs antiplatelet

Accepted Answer

antiplatelets (e.g., aspirin) keep platelets from clumping, primarily preventing arterial clots (heart attacks/strokes). Anticoagulants (e.g., Warfarin, Eliquis) slow the body’s clotting mechanism, treating venous clots

Question	Answer
iron salts	Stored as ferritin in the body  Used in Iron deficiency anemia (RBCs are microcytic and hypochromic)  Prescription and over the counter (OTC)
Oral Iron	Ferrous gluconate, Ferrous sulfate, Ferrous fumarate 1 hour before meals  Decrease absorption: Antacids, abx and thyroid drugs, foods containing milk, some grains and cereals  Increase absorption :Vitamin C  Liquid iron must be admin with a straw
IV/IM Iron	(Iron dextran)  Used when oral is unsatisfactory or impossible  Z-track administration required
Iron Side effects	GI: upset stomach, n&v, diarrhea, constipation  Dark, tarry stools  Skin: discoloration of skin/teeth and pain upon injection  Nursing considerations:  Monitor for side effects  Give iron 1 hour before meals preferably
educate abt iron	roper admin and medications that increase and decrease absorption  Importance of adequate food sources to maintain iron (lean meats, liver, egg yolks, dried beans, green veggies)  Educate on expected stool changes
vitamin b12	deficiency affects neuro, hematologic and GI systems  Used to treat pernicious anemia (megaloblastic, macrocytic anemia)  Pts with GI surgeries that remove all or part of stomach will require lifelong injections
Cyanocobalamin (Vitamin B12 injectable)	IM or deep SQ admin  Z-track admin for IM  Protect from light
Cyanocobalamin (Vitamin B12) side effects	Flushing, diarrhea, itching/pain at injection site
Cyanocobalamin (Vitamin B12) considerations	Monitor therapeutic level for Vitamin B12 (Schilling test)  Rotate sites for parenteral admin and use Z-track  Protect injection from light  Monitor K+ level  Educate on food sources of B12
s/s of B12 deficiency	(numbness/tingling in extremities, weakness, fatigue, anorexia, loss of taste, diarrhea, memory loss, mood changes)
folic acid folate	vitamin needed for DNA synthesis/cell division  Deficiency associated with neural tube defects in fetus and megaloblastic macrocytic anemia Oral replacement for a deficiency/ preventative in pregnancy 0.4mg/day maintenance and 1mg/day therapeutic
folic acid folate effects	Yellow discoloration of urine, nausea, altered sleep, depression, rash, bronchospasm  Nursing considerations  Educate patient that alcohol consumption decreases folic acid levels  Educate on food sources
hydroxyurea	Antineoplastic agent  Used in polycythemia vera (bone marrow suppression)  Used in sickle cell (decreases sickled cells and reduces hemolysis)  Pregnancy category D  PO  Side effects  Bone marrow suppression, stomatitis, rash
hydroxyurea considerations	Determine status of kidney, liver and bone marrow function  Monitor I&O, increase fluid intake
clotting factors	Factor VIII  Used to treat Hemophilia A  Factor IX  Used to treat Hemophilia B, Cryoprecipitate  Concentrated form of fibrinogen, obtained from fresh frozen plasma (FFP)
Desmopressin acetate (DDAVP) clotting factor	Antidiuretic hormone with additive effect of increasing Factor VIII  Used in Hemophilia A and Von Willebrand disease  Intranasal, IV, SQ  Contraindicated in pregnancy  Short lived, used pre-procedural
anticoaugulants	Agents that prevent or delay blood coagulation  Warfarin (PO)  Heparin (IV, SQ)  Low-molecular weight Heparin (SQ)  Dalteparin  Enoxaparin
Selective Factor Xa Inhibitors (PO, SQ)	Rivaroxaban  Fondaparinux  Apixaban  Edoxaban
Heparin	Works on thrombin; prevents fibrinogen to fibrin  SQ for VTE prevention  IV for VTE treatment (requires q6-8h PTT monitoring)  Protamine Sulfate: antidote  Prolongs activated Partial Thromboplastin Time (PTT)
Low-molecular-weight Heparin—Enoxaparin (Lovenox)	SQ  Prevents Prothrombin to thrombin  Risk for HIT lower, unless previously on heparin
Vitamin K antagonists - Warfarin (Coumadin)	Interferes with synthesis of Vit-K dependent clotting factors  Does not effect existing clotting factors  Vitamin K: antidote  Monitor PT & INR  Give same time everyday, Do not change brands, diet teaching (Vitamin K)
Selective factor Xa inhibitors	Fondaparinux (Arixtra) SQ  Rivaroxaban (Xarelto) and apixaban (Eliquis) PO  VTE prevention and treatment  Coag monitoring not required  Produces rapid anticoagulation
Aspirin antiplatelet	PO, most commonly used, cheap  Used in PAD, CAD, MI, stroke, VTE  Give on full stomach to minimize GI upset
Clopidogrel antiplatelet	PO  Added in pts with stroke, MI, and PAD
Cilostazol antiplatelet	PO  Reduces symptoms of intermittent claudication
Teach: avoid herbs that can	increase risk of bleeding (garlic, chamomile, gingko, turmeric, golden seal, green leaf tea  Teach to monitor for s/s of bleeding, bruising and anemia
ACE inhibitors	Maintain tight BP control, reduce PAD symptoms
Antiplatelets	Critical for reducing cardiovascular disease risk and death  Includes ASA 81mg  May add Clopidogrel for high risk patients  Anticoagulants NOT RECOMMENDED in PAD
Cilostazol	Phosphodiesterase inhibitor  Inhibits platelet aggregation and increases vasodilation
Pentoxifylline	Xanthine derivative  Improves flexibility of blood cells and decreases platelet adhesiveness  Not as effective as cilostazol and not used often
Calcium channel blockers	(nifedipine, diltiazem, verapamil, amlodipine)  Relaxes smooth muscle and prevents arterial spasm  Used in Raynaud’s, HTN  Monitor for hypotension and headache
Corticosteroids (prednisone, methylprednisolone)	give with food  Anti-inflammatory and immunosuppressive activity  Used in ITP (immune thrombocytopenic purpura), TTP (thrombocic thrombocytopenic purpura), aplastic anemia, asthma, COPD, pneumonia  Monitor glucose, WBC, platelets
anticoagulant vs antiplatelet	antiplatelets (e.g., aspirin) keep platelets from clumping, primarily preventing arterial clots (heart attacks/strokes). Anticoagulants (e.g., Warfarin, Eliquis) slow the body’s clotting mechanism, treating venous clots

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unit 4 meds