Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (224 page)
DexFerrum, INFeD
Func. class.:
Hematinic
Chem. class.:
Ferric hydroxide complex with dextran
Iron is carried by transferrin to the bone marrow, where it is incorporated into hemoglobin
Iron-deficiency anemia
Black Box Warning:
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, neonates, infants <4 mo, children, acute renal disease, asthma, rheumatoid arthritis (IV), ankylosing spondylitis, lupus, hypotension, all anemias excluding iron-deficiency anemia, hepatic/cardiac/renal disease
Calculator
•
Total dose in ml = [0.0442 × (desired Hb − observed Hb) × LBW] + (0.26 × LBW)
• Adult and child: IM
0.5 ml as a test dose by
Z
-track then no more than the total dose including test dose following/day:
• Adult/adolescent/child >15 kg: IM
100 mg/day
• Child (10-15 kg): IM
100 mg/kg
• Child/infant >4 mo (5-9.9 kg): IM
50 mg/day
• Infant >4 mo (<5 kg): IM
25 mg/day
Available forms:
Inj 50 mg/ml (2-ml, 10-ml vials)
•
D/C oral iron before parenteral; give only after test dose of 25 mg by preferred route; wait at least 1 hr before giving remaining portion
•
IM deeply in large muscle mass; use
Z
-track method, 19-20G 2-3–in needle; ensure needle long enough to place product deep in muscle; change needles after withdrawing product and before injecting to prevent skin, tissue staining
Only with EPINEPHrine available in case of anaphylactic reaction during dose
•
IV after flushing with 10 ml 0.9% NaCl; give undiluted; may be diluted in 50-250 ml NS for inf; give ≤1 ml (50 mg) over ≥1 min; flush line after use with 10 ml 0.9% NaCl; patient should remain recumbent for 1/2-1 hr
•
IV inj requires single-dose vial without preservative; verify on label that IV use approved
CNS:
Headache, paresthesia, dizziness, shivering, weakness,
seizures
CV:
Chest pain,
shock,
hypotension, tachycardia
GI:
Nausea
, vomiting, metallic taste, abdominal pain
HEMA:
Leukocytosis
INTEG:
Rash, pruritus, urticaria, fever, sweating, chills, brown skin discolor
ation, pain at inj site, necrosis, sterile abscesses, phlebitis
OTHER:
Anaphylaxis
RESP:
Dyspnea
IM:
Excreted in feces, urine, bile, breast milk; crosses placenta; most absorbed through lymphatics; can be gradually absorbed over weeks/months from fixed locations
Increase:
toxicity—oral iron; do not use
Decrease:
reticulocyte response—chloramphenicol
False increase:
serum bilirubin
False decrease:
serum calcium
False positive:
99m
Tc diphosphate bone scan, iron test (large doses >2 ml)
•
Observe for 1 hr after test dose
•
Blood studies: Hct, Hgb, reticulocytes, transferrin, plasma iron concentrations, ferritin, total iron binding, bilirubin before treatment, at least monthly
Black Box Warning:
Allergy: anaphylaxis, rash, pruritus, fever, chills, wheezing; notify prescriber immediately, keep emergency equipment available
•
Cardiac status: anginal pain, hypotension, tachycardia
•
Nutrition: amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs)
•
Cause of iron loss or anemia, including use of salicylates, sulfonamides
•
Toxicity:
nausea, vomiting, diarrhea, fever, abdominal pain (early symptoms), cyanotic-looking lips, nailbeds, seizures, CV collapse (late symptoms)
•
Storage at room temp in cool environment
•
Recumbent position 30 min after IV inj to prevent orthostatic hypotension
•
Therapeutic response: increased serum iron levels, Hct, Hgb
•
That iron poisoning may occur if increased beyond recommended level; not to take oral iron preparation or vitamins containing iron
•
That delayed reaction may occur 1-2 days after administration and last 3-4 days (IV), 3-7 days (IM); to report fever, chills, malaise, muscle, joint aches, nausea, vomiting, backache
•
To avoid breastfeeding
•
That stools may become dark
Discontinue product, treat allergic reaction, give diphenhydrAMINE or EPINEPHrine as needed, give iron-chelating product for acute poisoning
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Venofer
Func. class.:
Hematinic
Chem. class.:
Ferric hydroxide complex with dextran
Iron is carried by transferrin to the bone marrow, where it is incorporated into hemoglobin
Iron-deficiency anemia
Unlabeled uses:
Dystrophic epidermolysis bullosa (DEB)
Hypersensitivity, all anemias excluding iron-deficiency anemia, iron overload
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, abdominal pain, anaphylactic shock, arthralgia, chest pain, cough, diarrhea, dizziness, dyspnea, edema, increased LFTs, fever, headache, heart failure, hypo/hypertension, infection, MS pain nausea/vomiting, seizures, weakness
Calculator
• Adult: IV
5 ml (100 mg of elemental iron) given during dialysis; most will need 1000 mg of elemental iron over 10 sequential dialysis sessions
• Child ≥2 yr/adolescents: IV
0.5 mg/kg by slow IV inj over 5 min (undiluted) or diluted in 25 ml of 0.9% NaCl, give over 5-60 min, max 100 mg every 2 wk × 12 wk
Available forms:
Inj 20 mg/ml
Only with EPINEPHrine, Solu-medrol available in case of anaphylactic reaction during dose
•
Do not use if particulate is present or if discolored
•
Give directly in dialysis line by slow inj or inf; give by slow inj at 1 ml/min (5 min/vial); inf dilute each vial exclusively in ≤100 ml 0.9% NaCl, give at 100 mg of iron/15 min; discard unused portions
•
Do not use with IV products
CNS:
Headache, dizziness
CV:
Chest pain, hypo/hypertension, hypervolemia,
heart failure
GI:
Nausea, vomiting, abdominal pain
INTEG:
Rash, pruritus, urticaria, fever, sweating, chills
OTHER:
Anaphylaxis,
hyperglycemia
RESP:
Dyspnea, pneumonia, cough
Excreted in urine, half-life 6 hr
Increase:
toxicity—oral iron, dimercaprol, do not use
Decrease:
iron sucrose effect—chloramphenicol
Increase:
glucose
•
Blood studies: Hct, Hgb, reticulocytes, transferrin, plasma iron concentrations, ferritin, total iron binding; bilirubin before treatment, at least monthly
•
Allergy, anaphylaxis: rash, pruritus, fever, chills, wheezing; notify prescriber immediately, keep emergency equipment available
•
Cardiac status: hypo/hypertension, hypervolemia
•
Toxicity:
nausea, vomiting, diarrhea, fever, abdominal pain (early symptoms), cyanotic-looking lips, nailbeds, seizures, CV collapse (late symptoms)
•
Storage at room temp in cool environment, do not freeze
•
Therapeutic response: increased serum iron levels, Hct, Hgb
•
To report itching, rash, chest pain, headache, vertigo, nausea, vomiting, abdominal pain, joint/muscle pain, numbness, tingling
•
That iron poisoning may occur if dosage increased beyond recommended level; not to take oral iron preparation
Discontinue product, treat allergic reaction, give diphenhydrAMINE or EPINEPHrine as needed, give iron-chelating product for acute poisoning