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P A R T 8
Drugs acting on the cardiovascular system
■■
Erythropoiesis-stimulating drugs are used to act like
erythropoietin and stimulate the bone marrow to
produce more RBCs.
■■
These drugs must be given IV or by subcutaneous
injection. Individuals must have an adequate supply
of the other components of RBCs, including iron, for
these drugs to be effective.
■■
Erythropoiesis-stimulating drugs should be used with
a target haemoglobin level of no more than 12 g/dL.
Higher levels are associated with an increased risk of
cardiovascular events and increased tumour growth
in people with cancer.
KEY POINTS
AGENTS USED FOR IRON-DEFICIENCY
ANAEMIA
Although most people get all of the iron they need
through diet, in some situations diet alone may not
be adequate. The iron preparations that are available
include ferrous fumarate (
Ferro-F-tab
), ferrous sulfate
(
Fefol, Ferro-Gradumet
), iron polymaltose (
Ferrosig,
Ferrum H
), iron sucrose (
Venofer
) and ferric pyrophos-
phate (
Accomin, Incremin Iron
[not available in New
Zealand]). See also Table 49.2
Therapeutic actions and indications
Iron preparations elevate the serum iron concentra-
tion (see Figure 49.2). They are then either converted
Haematological laboratory test variations
There are racial variations in haematological laboratory
test results:
Haemoglobin/haematocrit
—Levels in African
Americans are generally 1 g lower than in other
groups.
Serum transferrin
levels
(children aged
1–3.5 years)—The mean value for African American
children is 22 mg/100 mL higher than that for
Caucasian children. (This may be because African
Americans have lower haematocrit and haemoglobin;
transferrin levels increase normally in the presence of
anaemia.)
Because of these variations, the diagnosis and
treatment of anaemia in African Americans should
be based on a different norm to that of other ethnic
groups.
Cultural considerations
BOX 49.2
TABLE 49.2
DRUGS IN FOCUS Agents used for iron-deficiency anaemia
Drug name
Dosage/route
Usual indications
ferric pyrophosphate
(Accomin, Incremin Iron)
Adult 10 mL/day PO
Paediatric >2 years: 5 mL/day PO
Paediatric <2 years: 2.5 mL/day PO
Treatment of iron-deficiency anaemia
and for people with Helicobacter pylori
overgrowth
ferrous fumarate
(Ferro-tab)
1 tab/day PO before food
Treatment of iron-deficiency anaemia
ferrous sulfate
(Ferro-Gradumet)
325 mg/day PO
Children 2–12 years: 50–100 mg/day PO
Children 6 months–2 years: 6 mg/kg per day
PO
Infants: 10–25 mg/day PO
Treatment of iron-deficiency anaemia
iron polymaltose complex
(Ferrosig, Ferrum H)
2 mL IM alternate days, using Z-track
technique
Treatment of iron-deficiency anaemia
(parenteral)
iron sucrose (Venofer)
100 mg one to three times per week given IV
during dialysis sessions, slowly over 1 minute
Treatment of iron deficiency in people
undergoing chronic haemodialysis or
non-dialysis people with renal failure
who are also receiving supplemental
erythropoietin therapy
Safe medication administration
Z-track injections
The Z-track method is used when injecting iron to reduce
the risk of subcutaneous staining and irritation. It is a good
idea to review the method of giving Z-track injections
before giving one. The area to be injected is prepped for the
injection. Place your gloved finger on the skin surface and
pull the skin and the subcutaneous layers out of alignment
with the muscle lying beneath. Try to move the skin about
1 cm. Insert the needle at a 90-degree angle at the point
where you originally placed your finger. Inject the drug and
then withdraw the needle. Remove your finger from the skin,
which will allow the layers to slide back into their normal
position. The track that the needle made when inserting
into the muscle is now broken by the layers, and the drug is
trapped in the muscle (see Figure 49.4).
