Pharmacotherapy for Hematologic Disorders- Advanced pharmacology week 9 response 2
Type of document Essay
1 Page Double Spaced
Subject area Pharmacology
Academic Level Master
Style APA
References 3
Order description:
Please respond to Ruphinas post by Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Please use these readings and resources for at least 2 references or I dont get credit
Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Review Chapter 50, “Pharmacotherapy for Venous Thromboembolism Prevention and Treatment, Stroke Prevention in Atrial Fibrillation, and Thromboembolism Prevention with Mechanical Heart Valves” (pp. 863-886)
This chapter covers drug therapy options for three disorders requiring anticoagulants: venous thromboembolism, atrial fibrillation, and ischemic stroke. It also explains the process of initiating and managing drug therapy for patients with these disorders.
Chapter 51, “Anemias” (pp. 891-906)
This chapter examines causes of various types of anemia and associated cell alterations. It also explores types of drugs used for treatment and patient factors to consider when initiating drug therapy.
Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Optional Resources
Refer to the Optional Resources listed in Week 1.
COLLAPSE
Running head: WEEK 9 DISCUSSION POST
NURS 6521N-19 (Advanced Pharmacology)
Pharmacotherapy for Hematologic Disorders
As advanced practice nurses, the importance of understanding the hematologic conditions and its treatments are crucial in early identification, recognition, and prompt referral to prevent complications. The knowledge and understanding of the disease process and its standard treatments are essential for adequate patient education and management.
Selected Hematologic Disorder: SICKLE CELL ANEMIA
Sickle cell anemia is an anemia of inherited form, an “autosomal recessive disorder” without cure (Arcangelo, Peterson, Wilbur, & Reinhold, p. 894, 2017). A condition wherein the unoxygenated red blood cells becomes non-flexible and sticky and “shaped like sickles or crescent moons” (Mayo Clinic, 2014, p. 1). The irregular shaped of the red blood cells cause vasocclusion as it gets stuck in the small blood vessels (blocking the microvasculature) and slows down or block the blood flow causing damage to the circulation of the arterial and venous endothelium, leading to sickle cell crisis (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, Mayo Clinic, 2014). With physical stress, cold temperatures, exposure to high altitudes, infection, and high fever, sickle cell crisis occur with dehydration, hypoxia, and acidosis as the underlying causes (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Sickle cell crisis usually lasts for a week but are not resolved for several weeks to months (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Symptoms of sickle cell anemia are: anemia caused by the breakage and death of RBC resulting in shortage of RBC in the circulation; fatigue caused by anemia; episodes of pain (the primary symptom of sickle cell anemia) usually in the back, limbs, and ribs are due to the blockage of blood flow to the microvasculature; hand-foot syndrome (swelling of the hand and feet) is the first sign of sickle cell anemia in babies that is caused by the blockage of blood flow out of the hands and feet; frequent infections as sickle cells can damage the spleen (an organ that fights infection); delayed growth and puberty due to shortage of healthy RBC essential for growth and development; vision problems as the tiny blood vessels that supply blood to the eyes are plugged with sickle cells leading to retinal damage (Mayo Clinic, 2014). The patients with sickle cell anemia are high risk for infection such as Streptococcus pneumonia and Hemophilus influenza; renal failure, gallstone, chronic osteomyelitis, chronic leg ulcer, aseptic necrosis of the humeral and femoral heads, priapism, heart failure, stroke, and death (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Types of Drugs That Would Be Prescribed to Treat Symptoms
Sickle cell anemia has no cure and has no specific treatments available (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, Mayo Clinic, 2014). The goal of management is “primary prevention and treatment of complication as well as potential cure” (Arcangelo, Peterson, Wilbur, & Reinhold, p. 895, 2017).
Primary Prevention for Children with SCD: (Immunization against S. pneumoniae, H. influenza type B, hepatitis B virus, and influenza); Pneumovax is given at two months of age then two more doses six to eight weeks apart and a booster dose at the age of 12 months (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Primary Prevention for Adults with SCD: Pneumovax immunization every five years and Folic acid 1mg daily supplementation (due to accelerated erythropoiesis) (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Prophylaxis Treatment: (HYDROXYUREA-only to selected patients): The goal is to achieve a WBC between 5,000 and 8,000 WBCs/mm3 (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Hydroxyurea (start dose- 15mg/kg/day and increased by 5mg/kg/day every 12 weeks until marrow suppression is present) is a prophylaxis treatment (with no optimal regimen) to decrease the number of crises, a cytotoxic agent that acts by increasing the levels of hemoglobin F and water content of RBC as well as altering the RBC adhesion to the endothelium and increase sickle cell deformability (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Serious adverse effects are “myelosuppression and risk of cancer” with side effects of alopecia, nail pigmentation, cutaneous hyperpigmentation, and xerosis (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Studies showed that the use of hydroxyurea as prophylaxis treatment for sickle cell anemia had reduced the number of chest syndromes, and transfusions and that long-term use is safe (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Pain Management (Chronic sickle cell pain management: a combination of long-acting and short-acting opioids for breakthrough pain) (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Acetaminophen (650 mg every 4-6 hours with the maximum dose of 4,000mg/day) an analgesic, antipyretic medication with direct action to the heat-regulating center of the hypothalamus (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Contraindicated in patients with liver problems (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
NSAIDS: Ketorolac (0.5 mg/kg IV with the maximum dose of 30mg followed by 0.5mg/kg IV every 6 hours with maximum dose of 15 mg) has anti-inflammatory, analgesic and antipyretic effects that acts at the level of nociceptors where the pain impulse originates by preventing the action of cyclo-oxygenase enzymes and decreasing the synthesis of prostaglandin (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Contraindicated in patients with renal and liver problem.
Tramadol (50-100 mg every 6 hours with the maximum dose of 400 mg/day) a synthetic analgesic that binds to the opiate receptors in the CNS inhibiting the pain pathways (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Use with caution in patients with renal and hepatic impairments (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
The management of acute painful crisis includes aggressive narcotic analgesic such as morphine, hydromorphone, and Demerol (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
OPIOIDS acts by binding to the CNS opioid receptors with the primary analgesic effects caused by the binding of u and k receptors (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Opioids should be administered cautiously to patients with renal and hepatic impairments (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). A male requires higher opioid dose compared to females (Smith, 2014).
Morphine immediate release Oral (starting dose:10-15 mg every 3-4 hours PRN)
Morphine IV (starting dose: 5-10 mg every 3-4 hours PRN)
Hydromorphone Oral (starting dose: 2 mg every 4 hours PRN)
Hydromorphone IV (starting dose 0.5 mg every 4 hours PRN)
OxyContin Oral (starting dose: 10 mg every 12 hours)
Hydrocodone Oral (starting dose: 1 tablet (5 mg) every 4 hours PRN)
Factor Selected: BEHAVIOR
Smoking cigarettes cause vasoconstriction that lowers the oxygen level in the body that can lead to pain crises (sickle cell crisis) and acute chest syndrome (St. Jude Research Hospital, 2012). Smoking impacts the effect of SCD medications as it causes an “increase vascular inflammation, platelet aggregation, and expression of endothelial adhesion molecules, processes that would increase vaso-occlusion” (Cohen, DeBaun, & Field, 2010, p. 3). Using drugs such as cocaine/crack constrict the blood vessels and decreases the blood flow throughout the body, with the combination of sickle cell medications, it can lead to addiction, severe damage to the body’s vital organs, fatal overdose, and death (St. Jude Children’s Research Hospital, 2012). Drinking alcohol triggers pain crisis in patients with sickle cell anemia as alcohol can cause dehydration by frequent urination as well as potentiates the action of opioids medications causing increased risks for adverse events, overdose, and death (Gudin, Mogali, & Comer, 2013, St. Jude Children’s Research Hospital, 2012).
Measures to Reduce Negative Side Effects
Individuals with sickle cell anemia should maintain a healthy lifestyle that includes proper nutrition and hydration, enough sleep, and regular physical activity as well as alcohol and smoking cessation and avoiding second-hand smoke to prevent sickle cell crisis (National Heart, Lung, and Blood Institute, 2015). The patient and the family has to be extensively educated about the disease with emphasis on sickle cell crisis prevention, pain management and coping with pain, medication side effects, drug interactions as well as inheritance/reproductive implications of having a child especially for teenager and adult patients (Housten, Dadekian, & Jason, 2015). The emphasis on immunization as primary prevention is crucial as well as the sexual education that includes the use of protective barriers (Housten, Dadekian, & Jason, 2015). The importance of keeping regular doctor’s appointment will help reduce the number of acute problems that requires immediate care (National Heart, Lung, and Blood Institute, 2015). As advanced practice nurses, we should never under prescribe medications as sickle cell pain is real, we have to be vigilant for opioid misuse and addiction as well as watch for and manage side effects and potential lack of efficacy of the medications prescribed (Smith, 2014). The importance of neonatal screening for sickle cell anemia needs to be emphasized for early detection, referral and prevent complications (Housten, et al., 2015)
References
Arcangelo, V. P, Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Cohen, R. T., DeBaun, M. R., Field, J. J. (2010). Smoking is associated with an increased risk of acute chest syndrome and pain among adults with sickle cell disease. Retrieved from http://www.ncbi.nlm.nih.gov
Gudin, J. A., Mogali, S., & Comer, S. D. (2013). Risks, Management, and Monitoring of
Combination Opioid, Benzodiazepines, and Alcohol Use. Retrieved from http://www.ncbi.nlm.nih.gov
Housten, A. J., Dadekian, J., & Jason, D. (2015). Youth with Sickle Cell Disease: Genetic and Sexual Health Education Needs. American Journal of Health Behavior, 39(6), 856-865. Retrieved from the Walden Library databases.
Mayo Clinic. (2014). Sickle cell anemia. Retrieved from http://www.mayoclinic.org
National Heart, Lung, and Blood Institute. (2015). Living with Sickle Cell Disease. Retrieved from http://www.nhlbi.nih.gov
Smith, W. R. (2014). Treating Pain in Sickle Cell Disease with Opioids: Clinical Advances, Ethical Pitfalls. Retrieved from the Walden Library databases.
St. Jude Children’s Research Hospital. (2012). Alcohol, Street Drugs, and Sickle Cell Disease:
A Harmful Combination. Retrieved from http://www.stjude.org/sicklecell
