Pharmacotherapeutics For Advanced Nursing Practice (Demler & Rhoads)

Which important factors should be considered prior to initiating ferrous sulfate therapy? The use of antacids; the absorption of oral iron formulations is decreased by medications that increase the pH of the stomach. With Todd's history of GERD, it would be important to find out if he is currently on medications to relieve his symptoms, as proton-pump inhibitors, histamine-2 receptor antagonists, and antacids may reduce the absorption of oral iron products. After two weeks of taking ferrous sulfate, Todd returns to the clinic with complaints of stomach upset, and no longer wants to stay on this medication. Which options does this patient have for therapy? Continue the iron replacement, but take it with a small snack or meal; GI adverse effects are common with oral iron therapy. Although it is recommended to take doses on an empty stomach, patients may experience fewer GI effects if they take the doses with a small snack or meal. Other options to consider include taking lower doses at more frequent intervals. Which monitoring is needed for iron replacement therapy? Pt should be monitored closely for all adverse effects, including GI irritation, nausea, vomiting, diarrhea, and constipation; laboratory levels, such as hemoglobin, total iron, iron-binding capacity, and percent saturation, should be monitored for clinical improvement. Which factors should be considered prior to initiating iron dextran therapy for a patient? The labeling for iron dextran carries a black box warning about anaphylactic reactions. While this medication may be an appropriate option, it should be administered under the supervision of medical personnel (it is typically given during hemodialysis). How should the first dose of iron dextran be administered? Partial parenteral test dose; dosing should begin with a 0.5 mL test dose to monitor for anaphylactic reactions. Caution should be used, as anaphylactic reactions may occur during the test dose, and successful administration of the test dose does not rule out the possibility of anaphylactic reactions during the regular dose.