Project #105540 - Responses

Wk  9 Responses

 

Initial Discussion:

 

Pharmacotherapy for Hematologic Disorders

 

In the 1970s, the average lifespan for patients diagnosed with sickle cell disease was 14 years. Today, the average lifespan has increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for many other hematologic disorders such as hemophilia and cancer continue to improve as well. This can be attributed to advancements in medical care—specifically drug therapy and treatment. When managing drug therapies for patients, it is essential to continuously examine current treatments and evaluate the impact of patient factors on drug effectiveness. To prepare for your role as an advanced practice nurse, you must become familiar with common drug treatments for various hematologic disorders seen in clinical settings.

 

To prepare:

 

Select one of the following hematologic disorders: anemia, hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or white blood cell disorders. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.

 

Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

 

Post on or before Day 3 a description of the hematologic disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

 

 

Response # 1 To  Lori

 

Anemia

Anemia is a condition caused by a lack of hemoglobin for women which is less than 12.0 gram and for men less than 13.5 grams.  Anemia is caused by blood loss and inhibited red blood cell production.  It results in a patient feeling tired, pale, loss of consciousness, tachycardia, and dyspnea.  The diagnosis of anemia is made typically by running a CBC, hct, hgb, and relating a patients symptoms to the results of bloodwork (Mayo, 1998-2016).

A major cause of anemia is due to poor iron intake or blood loss.  This condition occurs frequently in women and is closely related to menses.  Other causes are related to constant small bleeding such as ulcerations in the stomach, colon polyps, and dietary deficiencies (Arcangelo & Peterson, 2013).

Treatment of anemia depends on the type of anemia the patient has.  Iron deficiency anemia is treated by folic acid and vitamin D.  Sickle cell anemia requires the administration of oxygen, pain medication (oxycodone, hydrocodone), iv fluid, in extreme cases blood transfusion, and folic acid (Drugs.2012).   Treatment of aplastic anemia requires the use of blood transfusions, stem cells to rebuild bone marrow, cyclosporine, thymoglobulin, and methoprednisone, neupogen which stimulates bone marrow, radiation, and chemotherapy (Mayo Clinic, 1998-2016).

Anemia/Elderly                                                         

Anemia is common in the elderly, actually affecting 80% of all seniors.  The cause of this is typically due to Vitamin B12 deficiency, folate deficiency, and myelodysplastic syndrome.  The most common treatment of anemia in elderly patients is erythropoietin 50 to 100 units/kg given tid.   Also included in the treatment is iron supplements, 50 to 100mg tid, a common side effect is constipation with administration of this medication.  Treatment should also include Senna/Colace taken every day as well as increasing fluid intake to help treat the patient’s constipation due to the treatment (Smith, 2000).

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.  

Drugs.com. (2012). Retrieved from http://www.drugs.com

Smith, D. (2000).  Anemia in the Elderly.  American Family Physicians 62(7):1565-1572.

 

Response # 2 to Kecia

 

Thalassemia: Drug Therapy

            Huether and McCance (2012) report significant findings as it relates to thalassemia. Thalassemia is a hematologic disorder that affects the oxygen-carrying blood cells. There are two distinct classes of thalassemia hematologic disorders. The two categories of thalassemia are beta-thalassemia and alpha-thalassemia. Beta-thalassemia (major and minor) and alpha-thalassemia (major and minor) exhibit similarity in hemoglobin reduction. However, there is a noticeable difference between the clinical signs and symptoms. Beta-thalassemia minor presents with mild to moderate microcytic hypochromic anemia, mild splenomegaly, bronze coloring of the skin, and hyperplasia of bone marrow. With beta-thalassemia, the person may present with severe anemia. The lab results of severe anemia will correlate to a significant observation of cardiovascular burden with a high-output of congestive heart failure. The other classification of thalassemia is alpha-thalassemia.

            Alpha-thalassemia also classifies into two diverse categories. However, alpha-thalassemia clinical manifestations are, somewhat, similar to beta-thalassemia. Persons who inherit the mild form of alpha-thalassemia minor may present as asymptomatic. Classical symptoms of alpha-thalassemia minor are mild microcytic-hypochromic reticulocytosis, bone marrow hyperplasia, an increase serum iron concentration, and moderate splenomegaly. Alpha-major signs and symptoms are similar to beta-thalassemia but milder. Alpha-thalassemia clinical manifestations relate to mild microcytic-hypochromic anemia, enlargement of the liver and spleen, and bone marrow hyperplasia (Huether and McCance, 2012).  

Factor Relationship

            Mayo Clinic (1998-2016) reports findings as it relates to the significance of factors of thalassemia. The prevalence of thalassemia correlates with the appearance of a mutant hemoglobin gene. A persons’ risk increases with a family history of this hematologic disorder. For this reason, thalassemia has a tendency to transmit from parents to children. Second, diagnosis of thalassemia, most often, presents with a particular ancestry. This ancestry includes people of Italian, Greek, Middle Eastern, Asia, and African descent. The confirmation of this disorder is accessible through an evaluation of blood test. The blood test usually reveals red blood cells that are low in number, smaller than normal, pale, and variable size and shape. Most importantly, a noticeable uneven distribution of red blood cells is apparent. The unequal distribution visualizes as a bull’s eye appearance with a microscopic inspection. After diagnosis an implementation of treatment is necessary.

 Drug therapy: Reducing Negative Side Effects

            Mayo Clinic (1998-2016) with thalassemia minor, signs and symptoms are mild. Treatment measures, if any, are little. However, on occasions, the person may need a blood transfusion. Blood transfusions are necessary after surgery or after having a baby. This medical measurement is significant for the management of the possible thalassemia complications. For beta-thalassemia intermediate, the person may need treatment for iron overload. Most people with beta-thalassemia do not require a blood transfusion because it can contribute to an iron overload. On the other hand, people with beta-thalassemia may exhibit with an increase of digestive absorption of iron. This increase digestive absorption leads to an excess of iron. For this reason, an oral medication of deferasirox (Exjade) may help to remove iron excess. Moderate to severe (alpha and beta) treatments are frequent blood transfusions and stem cell transplant.   

            Drug.com. (2016) Provides and overview of side effects as it relates to the oral administration of deferasirox (Exjade). Exjade has a tendency to cause renal failure, hepatic failure, and gastrointestinal hemorrhage. Health care professionals must attain a baseline study of serum creatinine and serum creatinine clearance before and during therapy to reduce the chance of renal failure. A dose reduction, interruption or discontinuation are considerations for the prevention of hepatic failure. To avoid hepatic failure, the professional must measures serum transaminases and bilirubin in all patients before initiating treatment. Liver function test is important every two weeks during the first month of treatment, and, at least, every month after that. Avoiding deferasirox therapy with patients who have a diagnosis of severe hepatic impairment will reduce the chance of hepatic failure.  To prevent gastrointestinal hemorrhage, the health care provider must consider the fatalities that associate with elderly patients who have an hematologic advancement malignancy or a low platelet count. It is of medical importance that the health care professional discontinues deferasirox with suspicion of gastrointestinal ulcers or gastrointestinal hemorrhage.  

References

Drugs.com (2016). Exjade: side effects. Retrieved from. http://www.drugs.com/pro/exjade.html  

Huether, S. E., McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.).

            St. Louis, MO: Mosby.

Mayo Clinic. (1998-2016). Thalassemia: risk factors. Retrieved from

http://www.mayoclinic.org/diseases-conditions/thalassemia/basics/risk-factors/con-20030316

 

 

 

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Due By (Pacific Time) 01/28/2016 12:00 pm
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