Pharmacologic Profile

General Use

Prevention and treatment of anemias.

General Action and Information

Iron (ferric carboxymaltose, ferric pyrophosphate citrate, ferrous fumarate, ferrous gluconate, ferrous sulfate, ferumoxytol, iron dextran, iron sucrose, polysaccharide-iron complex, sodium ferric gluconate complex) is required for production of hemoglobin, which is necessary for oxygen transport to cells. Cyanocobalamin and hydroxocobalamin (vitamin B₁₂) and folic acid are water-soluble vitamins that are required for red blood cell production. Darbepoetin, epoetin, and methoxy polyethylene glycol-epoetin beta stimulate production of red blood cells.

Contraindications

Undiagnosed anemias. Hemochromatosis, hemosiderosis, hemolytic anemia (Iron). Uncontrolled hypertension (darbepoetin, epoetin, and methoxy polyethylene glycol-epoetin beta).

Precautions

Use parenteral iron (ferric carboxymaltose, ferric pyrophosphate citrate, ferumoxytol, iron dextran, iron sucrose, sodium ferric gluconate complex) cautiously in patients with a history of allergy or hypersensitivity reactions.

Interactions

Oral iron can ↓ the absorption of tetracyclines, fluoroquinolones, or penicillamine. Vitamin E may impair the therapeutic response to iron. Phenytoin and other anticonvulsants may ↓ the absorption of folic acid. Darbepoetin and epoetin may ↑ the requirement for heparin during hemodialysis.

Nursing Implications

Assessment

• Assess patient's nutritional status and dietary history to determine possible causes for anemia and need for patient teaching.

Potential Nursing Diagnoses

• Activity intolerance (Indications)
• Imbalanced nutrition: less than body requirements (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Iron salts are available in combination with many vitamins and minerals (see Appendix [not included in this PDA edition]).

Patient/Family Teaching

• Encourage patients to comply with diet recommendations of health care professional. Explain that the best source of vitamins and minerals is a well-balanced diet with foods from the four basic food groups.
• Patients self-medicating with vitamin and mineral supplements should be cautioned not to exceed RDA. The effectiveness of mega doses for treatment of various medical conditions is unproven and may cause side effects.

Evaluation/Desired Outcomes

• Resolution of anemia.