ATI Hematologic System Drugs Questions (107 Terms) with Answers Latest
Update 2023.
1. What administration considerations apply to warfarin?
Answer: Administer orally.
Measure baseline vital signs and prothrombin time (PT), reported as an international normalized
ratio (INR).
Monitor INR; recommend reduced dosage for an INR above 2 to 3, depending on condition
being treated, and an increased dosage for an
INR below this range
Monitor PT/INR daily initially and eventually every 2 to 4 weeks. Expect anticoagulant effects to
take 8 to 12 hr, with the full therapeutic effect in 3 to 5 days.
Increase PT monitoring for clients who take drugs that interact with warfarin.
2. What are adverse drug reactions associated with warfarin?
Answer: Hemorrhage
Toxicity (overdose)
3. What is the brand/trade name for warfarin?
Answer: Coumadin
4. What instructions should be provided for a client taking warfarin?
Answer: Stop taking the drug for signs of hemorrhage.
Report bruising, petechiae, hematomas, or black tarry stool immediately.
Wear medical identification indicating warfarin use.
Avoid excessive alcohol ingestion.
Tell clients to record the dosage, route, and time of warfarin administration on a daily basis.
Make sure clients watch for and report signs of bleeding (bruising, gums bleeding, abdominal
pain, nosebleeds, coffee-ground emesis, tarry stools).
Tell them not to take over-the-counter NSAIDs, especially aspirin, or drugs containing
salicylates.
Advise them to use an electric razor for shaving and a soft toothbrush.
5. What contraindications are there for the use of warfarin?
Answer: Pregnancy risk - teratogenic
Vitamin K deficiency
Thrombocytopenia
Liver disease
Alcoholism
Uncontrollable bleeding
During lumbar puncture, regional anesthesia, or surgery that involves the brain, eyes, or spinal
cord
Threatened spontaneous abortion
6. What are potential interactions for warfarin?
Answer: Heparin, aspirin, acetaminophen (Tylenol), glucocorticoids, sulfonamides, and
parenteral cephalosporins increase anticoagulation.
Phenobarbital (Luminal), carbamazepine (Tegretol), phenytoin
(Dilantin), oral contraceptives, and vitamin K decrease anticoagulation.
Excessive intake of foods high in vitamin K, such as dark green leafy vegetables including
cabbage, broccoli, and Brussels sprouts, mayonnaise, canola, and soybean oils decrease
anticoagulation. Warfarin interacts with many other prescription and over-the-counter drugs,
foods, and herbals, so clients should check with their primary care provider and pharmacist to
make sure no other interactions apply.
7. What interventions should be planned for a client taking warfarin?
Answer: Monitor vital signs, checking for hypotension and tachycardia. Check hematocrit and
blood counts.
For warfarin overdose, stop the drug and administer vitamin K parenterally, usually IV.
Administer vitamin K to promote synthesis of coagulation factors VIII, IX, X, and prothrombin.
Administer IV vitamin K slowly and in a diluted solution to prevent serious reactions.
Administer small doses of vitamin K (2.5 mg by mouth, 0.5 to 1 mg IV) to prevent development
of resistance to warfarin.
If vitamin K cannot control bleeding, administer fresh frozen plasma or whole blood.
8. What precautions are there for the use of warfarin?
Answer: Hemophilia
Increased capillary permeability
Dissecting aneurysm
Peptic ulcer disease
Severe hypertension
Severe hepatic or renal disease
9. What are the therapeutic uses for warfarin?
Answer: Prevention of venous thrombosis, pulmonary embolism during atrial fibrillation
Prevention of thromboembolism in clients who have prosthetic heart valves
Prevention of recurrent myocardial infarction and transient ischemic attacks
10. What administration considerations apply to heparin/enoxaparin?
Answer: Measure baseline vital signs, CBC, platelet count, and hematocrit.
Administer subcutaneously or IV, usually every 12 hr.
Use an infusion pump for continuous IV administration; monitor rate of infusion every 30 to 60
min.
Monitor aPTT every 4 to 6 hr initially, then monitor daily. (Enoxaparin does not require aPTT
monitoring.)
Keep aPTT at one and a half to two times the baseline value. Administer deep subcutaneous
injections in the abdomen at least 2 inches from the umbilicus and rotating sites; apply moderate
pressure for 1 to 2 min after injection, do not rub.
11. What are adverse drug reactions associated with heparin/enoxaparin?
Answer: Bleeding/hemorrhage
Thrombocytopenia (low platelet count)
Hypersensitivity reactions
Neurological injury (from hematoma formation during lumbar puncture, epidural anesthesia)
12. What is the brand/trade name for enoxaparin?
Answer: Lovenox
13. What instructions should be provided for a client taking heparin/enoxaparin?
Answer: Report bruising, petechiae, hematomas, or black tarry stools.
Report calf pain, tenderness, or swelling immediately.
Report shortness of breath.
Report itching, rash or hives.
Avoid use of OTC NSAIDs and aspirin
Advise them to use an electric razor for shaving and a soft toothbrush.
14. What contraindications are there for the use of heparin/enoxaparin?
Answer: Uncontrollable bleeding
Severe thrombocytopenia
During lumbar puncture, regional anesthesia, or surgery that involves the brain, eyes, or spinal
cord
Threatened spontaneous abortion
15. What are potential interactions for heparin/enoxaparin?
Answer: NSAIDs, aspirin and antiplatelet drugs increase bleeding risk.
IV nitroglycerin reduces anticoagulation.
Protamine reverses heparin activity.
Herbals ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding risk.
16. What interventions should be planned for a client taking heparin/enoxaparin?
Answer: Monitor vital signs, checking for hypotension and tachycardia. Monitor activated
partial thromboplastin time (aPTT), making sure it is no higher than twice the baseline value.
For heparin overdose, stop heparin and administer protamine, which binds with heparin to form a
heparin-protamine complex that has no anticoagulant properties.
Administer IV protamine no faster than 20 mg/min or 50 mg in 10 min. Monitor platelet count
periodically throughout treatment, especially in the first month.
Stop heparin for platelet counts below 100,000/mm3 and administer a non-heparin anticoagulant,
such as lepirudin (Refludan).
Administer a small test dose first.
Monitor for itching and rash or hives
Monitor spinal insertion site for signs of hematoma formation, such as bruising or swelling.
Monitor sensation and movement of lower extremities.
17. What precautions are there for the use of heparin/enoxaparin?
Answer: Hemophilia
Increased capillary permeability
Dissecting aneurysm
Peptic ulcer disease
Severe hypertension
Severe hepatic or renal disease
18. What are the therapeutic uses for heparin/enoxaparin?
Answer: Anticoagulation for evolving cerebrovascular accident, pulmonary embolism, massive
deep-venous thrombosis
Adjunct therapy during angioplasty, open-heart surgery, hemodialysis, blood transfusion
Prophylaxis for postoperative venous thrombosis and pulmonary emboli
Acute myocardial infarction (with thrombolytic therapy)
Ischemic complications of unstable angina and some dysrhythmias
Disseminated intravascular coagulation
19. What administration considerations apply to clopidogrel?
Answer: Give daily dose orally, with or without food.
Check platelet counts periodically.
Discontinue 1 week before elective surgery.
20. What are adverse drug reactions associated with clopidogrel?
Answer: Gastric upset, abdominal pain, diarrhea, nausea, gastric ulceration/bleeding (less than
aspirin)
Bleeding (less likely than with aspirin)
Thrombotic thrombocytopenic purpura - rare
21. What is the brand/trade name for clopidogrel?
Answer: Plavix
22. What instructions should be provided for a client taking clopidogrel?
Answer: If needed, take with food, milk, or 8 oz of water to minimize gastrointestinal effects.
If diarrhea occurs, drink plenty of clear fluids
Report persistent gastric Irritation and signs of bleeding.
Report any unusual or prolonged bleeding.
Report sudden severe headache, weakness, numbness, paralysis, vision changes, nausea,
vomiting, or seizures.
Report easy bruising, bleeding gums, pinpoint purplish (petechial) rash.
23. What contraindications are there for the use of clopidogrel?
Answer: Peptic ulcer disease
Bleeding disorders
Thrombocytopenia
Intracranial bleeding
24. What are potential interactions for clopidogrel?
Answer: Anticoagulants, NSAIDs, glucocorticoids, and alcohol increase bleeding risk.
Proton pump inhibitors reduce antiplatelet effects.
Herbal supplements ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding
risk.
25. What interventions should be planned for a client taking clopidogrel?
Answer: Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, abdominal
pain, nausea, hematemesis).
Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from minor injuries).
Monitor for warning signs of hemorrhagic cerebrovascular accidents.
Monitor for ecchymosis or petechial rash.
Check platelet counts periodically.
26. What precautions are there for the use of clopidogrel?
Answer: Gastrointestinal bleeding
Liver or kidney dysfunction
High risk for bleeding
27. What are the therapeutic uses for clopidogrel?
Answer: Inhibition of platelet aggregation for risk reduction related to myocardial infarction,
ischemic cerebrovascular accident, transient ischemic attacks, coronary stents
28. What administration considerations apply to desmopressin?
Answer: Administer IV or intranasally.
Dilute IV form in 0.9% sodium chloride solution.
Administer slowly via IV bolus over 15 to 30 min.
Administer desmopressin (Stimate) intranasally; nasal DDAVP does not treat hemophilia.
Spray the nasal form high into the nasal cavity but not into the throat.
29. What are adverse drug reactions associated with desmopressin?
Answer: Fluid retention, hyponatremia
Seizures, drowsiness, headache, nausea, and mild GI discomfort
30. What is the brand/trade names for desmopressin?
Answer: DDAVP, Stimate
31. What instructions should be provided for a client taking desmopressin?
Answer: Obtain daily weight and report significant increase over a short period of time or
edema.
Instruct client on correct intranasal administration techniques. Instruct clients to report
uncontrolled bleeding, headache, dyspnea, and abdominal discomfort.
Advise the client to avoid alcohol consumption while taking the medication.
32. What contraindications are there for the use of desmopressin?
Answer: Renal failure
Nephrogenic diabetes insipidus
Type IIB von Willebrand disease
33. What are potential interactions for desmopressin?
Answer: Interactions affect the drug's use for diabetes insipidus, not hemophilia.
Loop diuretics and glucocorticoids increase the risk of hyponatremia Concurrent use with
NSAIDs, SSRIs, TCS, and thiazide diuretics may increase the risk of hyponatremia as well as
fluid retention
34. What interventions should be planned for a client taking desmopressin?
Answer: Monitor fluid intake and output.
Monitor serum sodium levels.
Restrict fluids and sodium intake when appropriate.
Recommend diuretic therapy for moderate and severe fluid retention. Monitor for diabetes
insipidus as well as plasma factor VIII coagulant, antigen, and ristocetin cofactor
35. What precautions are there for the use of desmopressin?
Answer: Hypertension
History of hyponatremia
Severe heart failure
History of thromboembolic events
36. What are the therapeutic uses for desmopressin?
Answer: Mild hemophilia A (controls trauma-induced bleeding and maintains hemostasis during
surgery)
37. What administration considerations apply to epoetin?
Answer: Obtain baseline blood pressure, CBC, Hgb, BUN, uric acid, phosphorus, potassium,
creatinine, transferrin saturation, and ferritin concentration and monitor periodically; for HIV,
obtain an erythropoietin level. Make sure to control blood pressure for clients with chronic renal
failure prior to starting drug therapy.
Administer IV or subcutaneously three times a week, or once a week with some types of
chemotherapy.
Do not shake vials or mix with other drugs.
Use each vial for one dose only.
Check Hgb twice per week until adequate and then periodically.
Report Hgb that rises above 12 g/dL or increases more than 1g/dL within 2 weeks; for cancer
clients, report Hgb that rises to 10 g/dL. Monitor iron level and maintain it within the expected
range, as adequate quantities of iron, folic acid, and vitamin B12 are essential for RBC growth.
38. What are adverse drug reactions associated with epoetin?
Answer: Hypertension
Seizures
Cardiovascular and cerebrovascular events (myocardial infarction, heart failure, cerebrovascular
accident, cardiac arrest)
Malignancy progression
39. What is the brand/trade names for epoetin?
Answer: Epogen, Procrit
40. What instructions should be provided for a client taking epoetin?
Answer: Have frequent blood pressure checks.
Report headaches.
Report sudden chest pain, severe headache, weakness, numbness, paralysis, vision changes,
nausea, vomiting, or seizures.
Report worsening symptoms of malignancy
41. What contraindications are there for the use of epoetin?
Answer: Uncontrolled hypertension
Cancer - dependent upon overall treatment protocol
Iron-deficiency anemia
42. What are potential interactions for epoetin?
Answer: Epoetin alfa may increase the amount of heparin needed during hemodialysis.
43. What interventions should be planned for a client taking epoetin?
Answer: Monitor HgB and blood pressure.
For hypertension, recommend antihypertensive drugs; if still high, recommend a lower epoetin
alfa dosage
Administer the lowest possible dose to support erythropoiesis.
Do not give drug to cancer clients with Hgb above 10 g/ dL.
Monitor for tumor progression.
44. What precautions are there for the use of epoetin?
Answer: Stroke
Cardiovascular disease
Seizure disorders
45. What are the therapeutic uses for epoetin?
Answer: Supports production of erythrocytes in chronic renal failure, preoperative anemia,
chemotherapy, and zidovudine (Retrovir) therapy for HIV
46. What administration considerations apply to factor VIII concentrate, factor IX concentrate?
Answer: Administer solutions of the powdered form IV.
Administer slowly via IV bolus over 5 to 10 min.
Give on demand to manage bleeding episodes.
For prophylaxis (to prevent bleeding), administer on a regular dosing schedule, generally one to
three times per week.
Assure clients that risk for viral (hepatitis, HIV) contamination is minimal.
Be aware that recombinant factors VIII and IX are safer than plasmaderived factors (due to the
risk of Creutzfeldt-Jakob disease from human sources).
Obtain baseline factor VIII/IX levels and monitor periodically.
47. What are adverse drug reactions associated with factor VIII concentrate, factor IX
concentrate?
Answer: Allergic reaction
Creutzfeldt-Jakob disease (minimal risk, plasma-derived products only)
48. What is the brand/trade names for factor VIII concentrate, factor IX concentrate?
Answer: factor VIII concentrate: Advate, Hemofil-M factor IX concentrate: BeneFix, AlphaNine
SD
49. What instructions should be provided for a client taking factor VIII concentrate, factor IX
concentrate?
Answer: Report rash, itching, difficulty breathing, swelling of airway immediately.
Be aware that factor VIII/IX formulations are extremely safe from contamination, but a very
minimal risk from human-derived forms could carry the protein that causes Creutzfeldt-Jakob
disease.
50. What contraindications are there for the use of factor VIII concentrate, factor IX concentrate?
Answer: None
51. What are potential interactions for factor VIII concentrate, factor IX concentrate?
Answer: Aspirin blocks platelet aggregation and can result in gastrointestinal ulceration and
bleeding. This is not a true interaction with factor VIII or IX, but clients receiving it must not
take aspirin
First-generation, COX-1 and COX-2 inhibiting NSAIDs act similarly to aspirin; clients with
hemophilia should not take them
Second-generation, COX-2 inhibiting NSAID, celecoxib (Celebrex) is safer
52. What interventions should be planned for a client taking factor VIII concentrate, factor IX
concentrate?
Answer: Monitor for signs of allergic reaction (rash and itching) and anaphylaxis
(difficulty breathing and swelling of the airway)
Treat mild allergic reactions with diphenhydramine (Benadryl) Have emergency equipment and
subcutaneous epinephrine ready for anaphylaxis.
Explain that prions, the proteins that cause Creutzfeldt-Jakob disease, resist inactivation.
53. What precautions are there for the use of factor VIII concentrate, factor IX concentrate?
Answer: Previous allergic reactions to factor VIII or IX
54. What are the therapeutic uses for factor VIII concentrate, factor IX concentrate?
Answer: Hemophilia A (factor XIII) and hemophilia B (factor (IX)
55. What administration considerations apply to Folic Acid?
Answer: Give orally (preferable), subcutaneously, IM, or IV
Check vitamin B12 levels to confirm absence of B12 deficiency Obtain baseline serum folate,
Hgb, Hct, RBC, and reticulocyte count and monitor periodically thereafter. Hct should start to
improve within 2 weeks
56. What are adverse drug reactions associated with Folic Acid?
Answer: Increased yellowing of urine
Masks B12 deficiency in high doses
Increased risk of developing colorectal or prostate cancer (long-term use)
57. What instructions should be provided for a client taking Folic Acid?
Answer: Report rash as it may indicate sensitivity
Encourage clients to eat a diet high in folic acid
58. What contraindications are there for the use of Folic Acid?
Answer: Vitamin B12 deficiency (after initial stabilization)
Other types of anemia
Neonates
59. What are potential interactions for Folic Acid?
Answer: Folic acid therapy can mask the symptoms of B12 deficiency; clients who a have B12
deficiency must take adequate doses of cyanocobalamin.
Oral contraceptives, corticosteroids, or methotrexate may cause manifestations of folic acid
deficiency, but will not be affected by administering folic acid.
60. What interventions should be planned for a client taking Folic Acid?
Answer: Encourage clients to eat a diet high in folic acid
Monitor for signs of megaloblastic anemia as well as plasma folic acid levels.
61. What precautions are there for the use of Folic Acid?
Answer: Vitamin B12 deficiency (after initial stabilization)
Other types of anemia
Neonates
62. What are the therapeutic uses for Folic Acid?
Answer: Megaloblastic (macrocytic) anemia
Folate deficiency (alcoholism)
Prevent neural tube defects in developing fetus
63. What administration considerations apply to ferrous sulfate, iron dextran?
Answer: Ferrous sulfate (Feosol) Liquid preparations
dilute in another compatible liquid give through a straw rinse with water
Spread doses evenly across waking hours to maximize the production of RBCs
Give the drug on an empty stomach for best absorption
Make sure clients do not crush or chew the sustained release forms Expect to discontinue the
drug when anemia resolves (usually 1 to 2 months).
Recommend foods high in iron (liver, egg, yolks, muscle meats, wholegrain cereals, leafy green
vegetables).
Ensure dose of selected preparation is adequate in regard to providing needed amount of
elemental iron
Monitor Hgb, Hct, and reticulocyte count
Iron dextran (INFeD)
Give test dose first - follow with prescribed dose 1 hour later due to possibility of anaphylaxis
Have epinephrine available for hypersensitivity reaction.
Administer using 2- to 3-inch-long needle using Z-track technique. Give prescribed IV doses no
faster than 50 mg/min or dilute the dose for intermittent infusion in 200 to 1,000 milliliters of
0.9% NaCl (normal saline) (NS) and infuse over 1 to 6 hr, depending upon concentration.
Monitor blood pressure closely due to risk for hypotension
Do not take oral form of iron when receiving iron dextran
Monitor Hgb, Hct, and reticulocyte count
64. What are adverse drug reactions associated with ferrous sulfate, iron dextran?
Answer: Nausea, constipation, epigastric pain, diarrhea
Metallic taste in mouth (iron dextran)
Staining of teeth (liquid form)
Fatal iron toxicity (overdose in children)
Iron dextran-Anaphylactic reactions or seizures
65. What is the brand/trade names for ferrous sulfate and iron dextran?
Answer: ferrous sulfate: Feosol iron dextran: INFeD
66. What instructions should be provided for a client taking ferrous sulfate, iron dextran?
Answer: Take it with food to minimize gastrointestinal effects but understand that this reduces
absorption.
These effects diminish as drug therapy continues.
Report persistent gastric irritation.
Expect dark green or black stools (harmless discoloration).
For constipation, increase exercise and fluid and fiber intake.
Recommend client suck on hard candy or chew gum for metallic taste in mouth
Dilute liquid forms with water and drink it through a straw; use a dropper to give it to infants.
Check the label; some liquid forms are compatible with milk and juice; some are not.
Rinse the mouth after taking it.
Store iron preparations in childproof containers and away from children's reach. Use a locked
cabinet if necessary.
67. What contraindications are there for the use of ferrous sulfate, iron dextran?
Answer: Hemolytic anemia
Severe liver disease, alcoholism, severe renal impairment
Peptic ulcer disease, ulcerative colitis, regional enteritis
Hemochromatosis
68. What are potential interactions for ferrous sulfate, iron dextran?
Answer: Antacids reduce absorption.
Vitamin C increases absorption, but also increases the risk of gastrointestinal effects.
Absorption of tetracyclines, fluoroquinolones, bisphosphonates and penicillamine, will decrease
when administered with iron supplements. Concurrent use with ACE Inhibitors may increase the
risk of anaphylactic reaction with iron dextran
69. What interventions should be planned for a client taking ferrous sulfate, iron dextran?
Answer: Recommend taking it with food for severe symptoms (understanding doing so reduces
absorption).
Monitor bowel patterns.
Give client hard candy to suck on or gum to chew for metallic taste in mouth
Monitor for staining.
Administer only recommended dose to children and to prevent accidental overdosage, place all
lead products in childproof containers out of reach of children. Monitor for toxicity: severe
gastrointestinal symptoms, shock, acidosis, and liver and heart failure.
For toxicity, administer a chelating agent, deferoxamine (Desferal), parenterally.
70. What precautions are there for the use of ferrous sulfate, iron dextran?
Answer: Liver disease
Gastrointestinal disorders
71. What are the therapeutic uses for ferrous sulfate, iron dextran?
Answer: Iron-deficiency anemia and prevention of irondeficiency anemia for clients at risk
(infants, children, pregnancy, ongoing blood loss)
72. What administration considerations apply to filgrastim?
Answer: Obtain a baseline CBC with differential and platelet count and monitor twice weekly
thereafter.
Administer filgrastim by intermittent or continuous IV infusion or subcutaneous injection.
Do not shake vials or mix with other drugs.
Use each vial for one dose.
Do not administer within 24 hr of cytotoxic chemotherapy.
73. What are adverse drug reactions associated with filgrastim?
Answer: Leukocytosis
Bone pain and fever
Splenomegaly (long-term use)
74. What is the brand/trade name for filgrastim?
Answer: Neupogen
75. What instructions should be provided for a client taking filgrastim?
Answer: Report bone pain or fever.
Report abdominal pain or fullness.
76. What contraindications are there for the use of filgrastim?
Answer: Sensitivity to Escherichia coli-derived proteins
Acute respiratory distress syndrome
Current chemotherapy, radiation
77. What are potential interactions for filgrastim?
Answer: Filgrastim interferes with the action of cytotoxic drugs.
Lithium potentiates release of neutrophils
78. What interventions should be planned for a client taking filgrastim?
Answer: Monitor CBC twice a week during treatment.
Give a lower dose or stop treatment for a WBC above 10,000/mm3.
Monitor the degree of bone pain.
Monitor temperature.
Give acetaminophen (Tylenol) or opioid analgesics.
Monitor for spleen enlargement.
79. What precautions are there for the use of filgrastim?
Answer: Bone marrow cancer
Pre-existing cardia disease
80. What are the therapeutic uses for filgrastim?
Answer: Reduction of infection risk with bone marrow transplantation, severe chronic
neutropenia, or myelosuppressive chemotherapy
81. What administration considerations apply to vitamin B12, cyanocobalamin?
Answer: Give orally, subcutaneously, IM, or intranasally
Confirm gastric absorption of B12 via Schilling test (for oral dosing) Most clients can absorb
adequate amounts of vitamin B12 if large oral doses are given
Give oral forms with food to enhance absorption
Give intranasally or parenterally to clients who have malabsorption syndrome
Give intranasally 1 hr before or after clients eat hot foods to avoid removal from nasal passages
before absorption
Obtain baseline vitamin B12, Hgb, Hct, RBC, and reticulocyte count.
Monitor every 3 to 6 months thereafter
Expect lifelong treatment for clients who have irreversible B12 deficiencies, such as pernicious
anemia, usually parenterally. With oral forms, high doses are essential
Encourage dietary intake of foods high in vitamin B12 (dairy products, enriched cereal, egg
yolks, some seafood)
82. What are adverse drug reactions associated with vitamin B12, cyanocobalamin?
Answer: Erythema
Hypertension
Hypokalemia
83. What is the brand/trade name for vitamin B12, cyanocobalamin?
Answer: Nascobal
84. What instructions should be provided for a client taking vitamin B12, cyanocobalamin?
Answer: Report muscle weakness, nausea, palpitations, or paresthesia.
85. What contraindications are there for the use of vitamin B12, cyanocobalamin?
Answer: Sensitivity to vitamin B12, other cobalamins
Hereditary optic nerve atrophy
Renal dysfunction
Concurrent infections
86. What are potential interactions for vitamin B12, cyanocobalamin?
Answer: Folic acid can mask the symptoms of B12 deficiency; clients must take adequate doses
of cyanocobalamin.
Chloramphenicol (Chloromycetin) decreases effectiveness.
Alcohol, cimetidine, (Tagamet), colchicine (Colcrys), and aminosalicylic acid (Paser) reduce the
absorption of oral forms.
Ascorbic acid (vitamin C) alters the stability of oral forms.
87. What interventions should be planned for a client taking vitamin B12, cyanocobalamin?
Answer: Monitor potassium levels.
Monitor for potassium deficiency (muscle weakness, cardiac dysrhythmias).
88. What precautions are there for the use of vitamin B12, cyanocobalamin?
Answer: Cardiovascular disease
Pulmonary disease
Other types of anemia
Concurrent folic acid use
89. What are the therapeutic uses for vitamin B12, cyanocobalamin?
Answer: Pernicious anemia (lack of intrinsic factor) Vitamin B12 deficiency (due to either
malabsorption or dietary deficiency)
90. What administration considerations apply to alteplase?
Answer: Administer via IV infusion.
Give thrombolytic agents ASAP within onset of symptoms (less than 2 hr for MI, 3-4.5 hr for
CVA).
Obtain baseline platelet counts, Hgb, Hct, aPTT, PT, INR, and fibrinogen levels, and monitor
periodically.
Obtain baseline vital signs and monitor continuously.
Ensure adequate IV access for emergency drugs; have emergency equipment available.
Following thrombolytic therapy, administer heparin or aspirin to reduce the risk of repeat
thrombosis.
Use a special form (Cathflo Activase) to open occluded IV catheters.
91. What are adverse drug reactions associated with alteplase?
Answer: Bleeding (intracranial, needle puncture sites, wounds)
92. What is the brand/trade names for alteplase?
Answer: Activase, Cathflo Activase
93. What instructions should be provided for a client taking alteplase?
Answer: Report any unusual or prolonged bleeding.
Report of headache, or unilateral weakness.
94. What contraindications are there for the use of alteplase?
Answer: Prior intracranial hemorrhage (hemorrhagic cerebrovascular accidents) Known
structural cerebral vascular lesion (arteriovenous malformation, aneurysm)
Suspected aortic dissection
Active internal bleeding
History of significant closed head or facial trauma in the past 3 months
Acute pericarditis
Brain tumor
95. What are potential interactions for alteplase?
Answer: Drugs that enhance bleeding (NSAIDs, heparin, warfarin [Coumadin], thrombolytics,
and antiplatelets) increase bleeding risk.
96. What interventions should be planned for a client taking alteplase?
Answer: Limit venipuncture and injections.
Apply pressure dressings to recent wounds.
Monitor vital signs and signs of intracranial bleeding (level of consciousness, headache,
unilateral weakness)
Monitor aPTT, PT, INR, bleeding time, Hgb, and Hct.
For severe bleeding, discontinue the drug and administer blood products. If bleeding continues,
administer aminocaproic acid (Amicar).
97. What precautions are there for the use of alteplase?
Answer: Severe hypertension
Recent ischemic stroke (6 months prior to start of treatment)
Recent major surgery (2 to 4 weeks prior to start of treatment)
Active peptic ulcer disease
98. What are the therapeutic uses for alteplase?
Answer: Acute myocardial infarction
Deep-vein thrombosis
Massive pulmonary emboli
Ischemic cerebrovascular accidents
Reestablishing patency of occluded central IV catheters
99. What administration considerations apply to oprelvekin?
Answer: Obtain a baseline CBC with differential and platelet count plus measure serum
electrolytes and monitor periodically thereafter
Administer subcutaneously once daily 4 to 6 hr after chemotherapy. Continue therapy until
platelet counts are above 50,000/mm3, but no longer than 21 days.
Do not shake vials or mix with other drugs.
Use each vial for one dose.
Allow 2 days after treatment before beginning the next chemotherapy course.
100. What are adverse drug reactions associated with oprelvekin?
Answer: Cardiac dysrhythmias (atrial fibrillation and flutter, tachycardia)
Fluid retention
Allergic reactions
Conjunctival injection, transient blurring of vision, papilledema
101. What is the brand/trade names for oprelvekin?
Answer: Interleukin-11, Neumega
102. What instructions should be provided for a client taking oprelvekin?
Answer: Report palpitations, rapid pulse, and dizziness.
Report swelling of feet and legs and difficulty breathing.
Report swelling, hives, difficult breathing, and chest pain.
Report blurred vision
103. What contraindications are there for the use of oprelvekin?
Answer: Myeloid cancers
104. What are potential interactions for oprelvekin?
Answer: None
105. What interventions should be planned for a client taking oprelvekin?
Answer: Monitor vital signs, heart rate, and ECG.
Stop the drug for dysrhythmias.
Monitor fluid intake and output and weight.
Monitor for peripheral edema and dyspnea.
Stop the drug for significant symptoms.
Monitor for rash, flushing, fever, hypotension, chest pain, edema, and dyspnea.
Stop the drug for indications of an allergic reaction.
Stop the drug for significant ophthalmic manifestations.
106. What precautions are there for the use of oprelvekin?
Answer: Pleural effusion
Heart failure
107. What are the therapeutic uses for oprelvekin?
Aswer: Thrombocytopenia from myelosuppressive chemotherapy for nonmyeloid cancers
