NURS 6015 LATEST QUESTIONS AND ANSWERS.
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MODULE 9: HEMATOLOGICAL SYSTEM DRUGS
Drugs for Anemia
Drugs for Bleeding Disorders
Drugs for Hematopoiesis
Reversal Agents
Ferrous Sulfate (Feosol)
Anemia
Classification: Iron preparation.
Mechanism of Action: Replenishes body iron stores needed for hemoglobin and
myoglobin production, improving oxygen transport and preventing anemia.
Therapeutic Use: Treats irondeficiency anemia.
Medication Administration: Oral tablets, capsules, or liquid.
Contraindications/Precautions: Avoid in individuals with hemochromatosis,
hemosiderosis, or hemolytic anemia. Use cautiously in patients with GI conditions like
ulcers or inflammatory bowel disease.
Adverse Effects:
Common: Nausea, constipation, dark stools, abdominal discomfort.
Serious: GI bleeding, anaphylaxis (rare with oral formulations)
.
Patient Education: Take on an empty stomach for better absorption, with vitamin C
(like orange juice) to enhance absorption. Avoid taking with calciumrich foods or
antacids. Increase fluid and fiber intake to prevent constipation.
Effectiveness: Hemoglobin levels improve; fatigue and other anemia symptoms
decrease.
Cyanocobalamin (Nascobal)
Anemia
Classification: Vitamin B12 supplement.
Mechanism of Action: Replenishes B12, essential for DNA synthesis, red blood cell
production, and neurologic function.
Therapeutic Use: Treats B12 deficiency and pernicious anemia.
Medication Administration: Oral, intramuscular (IM), subcutaneous, or nasal spray.
Contraindications/Precautions: Avoid in patients with cobalt sensitivity or Leber’s
optic atrophy. Use cautiously in megaloblastic anemia of unknown cause.
Adverse Effects:
Common: Injection site pain, headache, dizziness.
Serious: Hypokalemia, anaphylaxis (rare).
Patient Education: If using the nasal spray, avoid eating or drinking hot
foods/beverages 1 hour before and after. For injections, periodic blood tests may be
needed to monitor levels.
Effectiveness: Improved energy levels, reduced anemia symptoms, and normalized
B12 lab levels.
,Folic Acid
Anemia
Classification: Vitamin supplement.
Mechanism of Action: Essential for DNA synthesis and red blood cell production.
Therapeutic Use: Prevents and treats folate deficiency anemia; used in pregnancy to
prevent neural tube defects.
Medication Administration: Oral tablets, capsules, or injectable.
Contraindications/Precautions: Avoid in untreated vitamin B12 deficiency (may mask
symptoms).
Adverse Effects:
Common: Rare with appropriate dosing; nausea or rash possible.
Serious: Allergic reactions (very rare).
Patient Education: Take as prescribed, especially during pregnancy. Foods high in
folate include leafy greens, citrus fruits, and beans.
Effectiveness: Improved symptoms of anemia and normalized lab values.
Heparin
Bleeding Disorders
Classification: Factor Xa/Thrombin inhibitor.
Mechanism of Action: Activates antithrombin, which inhibits thrombin and factor Xa,
preventing clot formation.
Therapeutic Use: Prophylaxis and treatment of thromboembolic disorders, such as
deep vein thrombosis (DVT) and pulmonary embolism (PE).
Medication Administration: Subcutaneous or intravenous (IV) injection.
Contraindications/Precautions: Avoid in patients with active bleeding, severe
thrombocytopenia, or a history of heparin induced thrombocytopenia (HIT).
Adverse Effects:
Common: Bleeding, bruising, pain at injection site.
Serious: HIT, severe bleeding.
Patient Education: Monitor for signs of bleeding (e.g., gums, stool) and report them.
Avoid activities that increase bleeding risk.
Effectiveness: Prevention of new clots or worsening of existing clots.
Enoxaparin (Lovenox)
Bleeding Disorders
Classification: Low molecular weight heparin (LMWH).
Mechanism of Action: Inhibits factor Xa to prevent clot formation.
Therapeutic Use: Prevents and treats DVT and PE; used after surgeries to prevent clot
formation.
Medication Administration: Subcutaneous injection.
Contraindications/Precautions: Avoid in active bleeding or history of HIT. Use
cautiously in renal impairment and elderly.
Adverse Effects:
Common: Injection site bruising, mild bleeding.
Serious: HIT, severe bleeding.
Patient Education: Rotate injection sites to minimize bruising. Monitor for unusual
bleeding or bruising. Avoid aspirin or NSAIDs unless approved by a provider.
Effectiveness: Absence of new clots; stable anticoagulation.
, Warfarin (Coumadin)
Bleeding Disorders
Classification: Vitamin K antagonist.
Mechanism of Action: Inhibits synthesis of vitamin K-dependent clotting factors (II, VII,
IX, X).
Therapeutic Use: Long-term prevention of clots in conditions like atrial fibrillation, DVT,
PE.
Medication Administration: Oral tablets.
Contraindications/Precautions: Avoid in pregnancy, active bleeding, or severe liver
disease. Use cautiously in older adults.
Adverse Effects:
Common: Minor bleeding, nausea.
Serious: Severe bleeding, skin necrosis, purple toe syndrome.
Patient Education: Take at the same time daily. Avoid foods high in vitamin K (leafy
greens). Regular INR monitoring is essential.
Effectiveness: Therapeutic INR (usually 2-3); absence of thromboembolic events.
Aspirin (Ecotrin)
Bleeding Disorders
Classification: Salicylic.
Mechanism of Action: Irreversibly inhibits COX1 and COX2, reducing thromboxane A2
production and platelet aggregation.
Therapeutic Use: Prevents stroke, myocardial infarction (MI); reduces inflammation
and pain.
Medication Administration: Oral tablets, chewable or enteric coated.
Contraindications/Precautions: Avoid in active bleeding, peptic ulcers, or aspirin
allergy. Use cautiously in asthma or gout.
Adverse Effects:
Common: GI upset, heartburn, nausea.
Serious: GI bleeding, Reye’s syndrome (in children).
Patient Education: Take with food to reduce GI upset. Report signs of bleeding (black
stools). Avoid alcohol and NSAIDs to reduce GI risk.
Effectiveness: Reduced pain/inflammation, prevention of clot related events.
Clopidogrel (Plavix)
Bleeding Disorders
Classification: ADP inhibitor.
Mechanism of Action: Inhibits ADP receptors on platelets, preventing aggregation.
Therapeutic Use: Prevents thrombotic events in patients with recent MI, stroke, or
peripheral arterial disease.
Medication Administration: Oral tablets.
Contraindications/Precautions: Avoid in active bleeding or severe liver disease. Use
cautiously in patients with history of GI bleeding.
Adverse Effects:
Common: Bruising, diarrhea, rash.
Serious: GI bleeding, thrombotic thrombocytopenic purpura (TTP).
Patient Education: Take with or without food. Notify provider of unusual bleeding or
bruising. Avoid alcohol and over the counter NSAIDs (ibuprofen).
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MODULE 9: HEMATOLOGICAL SYSTEM DRUGS
Drugs for Anemia
Drugs for Bleeding Disorders
Drugs for Hematopoiesis
Reversal Agents
Ferrous Sulfate (Feosol)
Anemia
Classification: Iron preparation.
Mechanism of Action: Replenishes body iron stores needed for hemoglobin and
myoglobin production, improving oxygen transport and preventing anemia.
Therapeutic Use: Treats irondeficiency anemia.
Medication Administration: Oral tablets, capsules, or liquid.
Contraindications/Precautions: Avoid in individuals with hemochromatosis,
hemosiderosis, or hemolytic anemia. Use cautiously in patients with GI conditions like
ulcers or inflammatory bowel disease.
Adverse Effects:
Common: Nausea, constipation, dark stools, abdominal discomfort.
Serious: GI bleeding, anaphylaxis (rare with oral formulations)
.
Patient Education: Take on an empty stomach for better absorption, with vitamin C
(like orange juice) to enhance absorption. Avoid taking with calciumrich foods or
antacids. Increase fluid and fiber intake to prevent constipation.
Effectiveness: Hemoglobin levels improve; fatigue and other anemia symptoms
decrease.
Cyanocobalamin (Nascobal)
Anemia
Classification: Vitamin B12 supplement.
Mechanism of Action: Replenishes B12, essential for DNA synthesis, red blood cell
production, and neurologic function.
Therapeutic Use: Treats B12 deficiency and pernicious anemia.
Medication Administration: Oral, intramuscular (IM), subcutaneous, or nasal spray.
Contraindications/Precautions: Avoid in patients with cobalt sensitivity or Leber’s
optic atrophy. Use cautiously in megaloblastic anemia of unknown cause.
Adverse Effects:
Common: Injection site pain, headache, dizziness.
Serious: Hypokalemia, anaphylaxis (rare).
Patient Education: If using the nasal spray, avoid eating or drinking hot
foods/beverages 1 hour before and after. For injections, periodic blood tests may be
needed to monitor levels.
Effectiveness: Improved energy levels, reduced anemia symptoms, and normalized
B12 lab levels.
,Folic Acid
Anemia
Classification: Vitamin supplement.
Mechanism of Action: Essential for DNA synthesis and red blood cell production.
Therapeutic Use: Prevents and treats folate deficiency anemia; used in pregnancy to
prevent neural tube defects.
Medication Administration: Oral tablets, capsules, or injectable.
Contraindications/Precautions: Avoid in untreated vitamin B12 deficiency (may mask
symptoms).
Adverse Effects:
Common: Rare with appropriate dosing; nausea or rash possible.
Serious: Allergic reactions (very rare).
Patient Education: Take as prescribed, especially during pregnancy. Foods high in
folate include leafy greens, citrus fruits, and beans.
Effectiveness: Improved symptoms of anemia and normalized lab values.
Heparin
Bleeding Disorders
Classification: Factor Xa/Thrombin inhibitor.
Mechanism of Action: Activates antithrombin, which inhibits thrombin and factor Xa,
preventing clot formation.
Therapeutic Use: Prophylaxis and treatment of thromboembolic disorders, such as
deep vein thrombosis (DVT) and pulmonary embolism (PE).
Medication Administration: Subcutaneous or intravenous (IV) injection.
Contraindications/Precautions: Avoid in patients with active bleeding, severe
thrombocytopenia, or a history of heparin induced thrombocytopenia (HIT).
Adverse Effects:
Common: Bleeding, bruising, pain at injection site.
Serious: HIT, severe bleeding.
Patient Education: Monitor for signs of bleeding (e.g., gums, stool) and report them.
Avoid activities that increase bleeding risk.
Effectiveness: Prevention of new clots or worsening of existing clots.
Enoxaparin (Lovenox)
Bleeding Disorders
Classification: Low molecular weight heparin (LMWH).
Mechanism of Action: Inhibits factor Xa to prevent clot formation.
Therapeutic Use: Prevents and treats DVT and PE; used after surgeries to prevent clot
formation.
Medication Administration: Subcutaneous injection.
Contraindications/Precautions: Avoid in active bleeding or history of HIT. Use
cautiously in renal impairment and elderly.
Adverse Effects:
Common: Injection site bruising, mild bleeding.
Serious: HIT, severe bleeding.
Patient Education: Rotate injection sites to minimize bruising. Monitor for unusual
bleeding or bruising. Avoid aspirin or NSAIDs unless approved by a provider.
Effectiveness: Absence of new clots; stable anticoagulation.
, Warfarin (Coumadin)
Bleeding Disorders
Classification: Vitamin K antagonist.
Mechanism of Action: Inhibits synthesis of vitamin K-dependent clotting factors (II, VII,
IX, X).
Therapeutic Use: Long-term prevention of clots in conditions like atrial fibrillation, DVT,
PE.
Medication Administration: Oral tablets.
Contraindications/Precautions: Avoid in pregnancy, active bleeding, or severe liver
disease. Use cautiously in older adults.
Adverse Effects:
Common: Minor bleeding, nausea.
Serious: Severe bleeding, skin necrosis, purple toe syndrome.
Patient Education: Take at the same time daily. Avoid foods high in vitamin K (leafy
greens). Regular INR monitoring is essential.
Effectiveness: Therapeutic INR (usually 2-3); absence of thromboembolic events.
Aspirin (Ecotrin)
Bleeding Disorders
Classification: Salicylic.
Mechanism of Action: Irreversibly inhibits COX1 and COX2, reducing thromboxane A2
production and platelet aggregation.
Therapeutic Use: Prevents stroke, myocardial infarction (MI); reduces inflammation
and pain.
Medication Administration: Oral tablets, chewable or enteric coated.
Contraindications/Precautions: Avoid in active bleeding, peptic ulcers, or aspirin
allergy. Use cautiously in asthma or gout.
Adverse Effects:
Common: GI upset, heartburn, nausea.
Serious: GI bleeding, Reye’s syndrome (in children).
Patient Education: Take with food to reduce GI upset. Report signs of bleeding (black
stools). Avoid alcohol and NSAIDs to reduce GI risk.
Effectiveness: Reduced pain/inflammation, prevention of clot related events.
Clopidogrel (Plavix)
Bleeding Disorders
Classification: ADP inhibitor.
Mechanism of Action: Inhibits ADP receptors on platelets, preventing aggregation.
Therapeutic Use: Prevents thrombotic events in patients with recent MI, stroke, or
peripheral arterial disease.
Medication Administration: Oral tablets.
Contraindications/Precautions: Avoid in active bleeding or severe liver disease. Use
cautiously in patients with history of GI bleeding.
Adverse Effects:
Common: Bruising, diarrhea, rash.
Serious: GI bleeding, thrombotic thrombocytopenic purpura (TTP).
Patient Education: Take with or without food. Notify provider of unusual bleeding or
bruising. Avoid alcohol and over the counter NSAIDs (ibuprofen).
