Chapter 24: growth factors
Erythropoietic growth factors
o Epoetin alfa, erythropoietin, darbepoetin alfa, long-acting
erythropoietin
o Action: act on bone marrow to increase production of RBCs
o Use:
Epoetin alfa: anemia related to CKD, anemia caused by
chemo, to increase erythrocyte counts for those who will
undergo elective surgery, anemia caused by taking
zidovudine (HIV/AIDS med)
Darbepoetin alpha: CKD and pt’s who have anemia caused
by chemo
o Side effects: HTN, risk for thrombotic event, DVT, headache,
bodyaches,
o Pregnancy: only if benefit > risk
o Lactation: safe
o Contraindications: uncontrolled HTN, cancers due to possible
increase in tumor growth
Leukopoietic growth factors
o Filgrastim, pegfilgrastim
o Action: stimulate bone marrow to increase production of
neutrophils
o Use: decrease risk of infection for those with neutropenia from
cancer or other condition, to build up number of hematopoietic
stem cells prior to harvesting for autologous transplant
o Side effects: elevation of plasma uric acid, elevation of lactate,
alkaline phosphatase, bone pain, leukocytosis, splenomegaly,
risk for splenic rupture
o Pregnancy: only if benefits > risks
o Lactation: use with caution
o Contraindications: sensitive to Escherichia coli protein,
o Cautions: cancer of bone marrow, sickle cell disease, respiratory
disease, breastfeeding, children
Granulocyte-macrophage colony-stimulating factor
o Sargramostim
o Action: acts on the bone marrow to increase WBCs
o Use: hastens bone marrow function after bone marrow
transplant, used in tx of failed bone marrow transplant, older
adults with acute myelogenous leukemia,
o Side effects: diarrhea, weakness, rash, malaise, bone pain,
leukocytosis, thrombytosis,
o Pregnancy: safety not established
o Lactation: caution
o Contraindications: allergic to yeast and certain other products
, o Cautions: lung/cardiac/kidney/liver disease, hypoxia, peripheral
edema, pleural or pericardial effusion, cancer of bone marrow
Chapter 25: blood and blood products
Whole blood
o Action: increase circulating blood volume
o Use: replacement after blood loss from traumatic injuries or
surgery, volume expansion in pt’s who have burn injury,
dehydration or shock
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reaction, circulatory
overload, hyperkalemia, transfusion-associated graft-vs-host
disease, sepsis
Packed RBCs
o Action: increase number of RBCs
o Use: severe anemia, hemoglobinopathies, medication-induced
hemolytic anemia, erythroblastosis fetalis
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reactions, hyperkalemia,
transfusion-associated graft-vs-host disease, sepsis
Platelet concentrate
o Action: increase platelet counts
o Use: thrombocytopenia, active bleeding
o Reaction types: febrile nonhemolytic reaction, mild allergic
reaction, sepsis
Fresh frozen plasma (FFP)
o Action: replaces coagulation factors
o Use: active bleeding, massive hemorrhage, extensive burns,
shock, DIC, antithrombin III deficiency, thrombotic
thrombocytopenia purpura, reversal of warfarin, replacement
therapy for factors II, V, VII, IX, X, XI
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, circulatory overload, mild allergic
reaction, sepsis
Apheresed granulocytes
o Action: replaces neutrophils and granulocytes
o Use: severe neutropenia, life-threatening bacterial/fungal
infection not responding to abx therapy, neonatal sepsis,
neutrophil dysfunction
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reaction, circulatory
overload, sepsis
Albumin
o Action: expands circulating blood volume
, o Use: hypovomeia, hypoalbuminemia, burns, adult respiratory
distress, cardiopulmonary bypass surgery, hemolytic disease of
newborn
o Reaction: risk for fluid volume excess
Reactions:
o Acute hemolytic reactions: chills, fever, low back pain,
tachycardia, tachypnea, hypotension,
o Febrile nonhemolytic reaction, fever, headache:
Due to pt antibodies against the donor’s wbc
Chills, headache, flushing, anxiety, muscle pain, increasing
temp
o Anaphylactic reaction: anxiety, urticaria, wheezing, shock,
cardiac arrest
o Mild allergic reaction: flushing, itching, urticaria,
o Circulatory overload: cough, SOB, crackles, HTN, tachycardia,
distended neck veins
o Sepsis: rapid onset of child, fever, vomiting, diarrhea,
hypotension, shock
o Hyperkalemia due to lysis of blood cells: bradycardia,
hypotension, irregular heartbeat, paresthesia of extremities,
muscle twitching, potassium > 5.0
o Transfusion-associated graft-vs-host disease: rare and occurring
1-2 weeks after transfusion
Contraindication: hypersensitivity reactions
Chapter 26: Peptic Ulcer disease
Antibiotics:
o Amoxicillin, bismuth, clarithromycin, metronidazole,
tetracycline, tinidazole
o Action: eradication of H. pylori bacteria
o Use: combo of 2-3 abx for 14 days to increase effectiveness and
minimize the development of medication resistance
Histamine 2-receptor antagonists
o Cimetidine, famotidine, nizatidine
o Action: block h2 receptors which suppresses secretion of gastric
acid and lowers the concentration of H+ in the stomach
o Use: ulcers, GERD, hypersecretory conditions, used with anx to
treat ulcers caused y H. pylori
o Side effects:
Cimetidine: decreased libido, gynecomastia, impotence,
lethargy, hallucinations, confusion, restlessness, n/v/d,
constipation,
o Pregnancy and lactation: use with caution
o Interactions:
, Warfarin, phenytoin, theophylline, lidocaine: high med
level of these meds
Antacids: decreased absorptions of H2 receptor
antagonists
Smoking: decreases effectiveness
Proton Pump inhibitors
o Omeprazole, pantoprazole, lansoprazole, dexlansoprazole,
rabeprazole, esomeprazole
o Action: block basal and stimulated acid production, reduces
gastric acid secretion by irreversibility imbibing the enzyme that
produces gastric acid
o Use: gastric/duodenal ulcers, erosive esophagitis, gerd,
hypersecretory conditions, prevention of stress ulcers
o Side effects: pneumonia, osteoporosis, fractures, rebound acid
hypersecretion, hypomagnesemia, C. diff associated diarrhea
o Pregnancy: misoprostol contraindicated
o Lactation:
Misoprostol and pantoprazole: contraindicated
Omeprazole: only if benefits > risks
o Reproductive: avoid pregnancy during use
o Contraindications: hypersensitivity to medication, rilpivirine
during lactation
o Cautions: dysphagia, liver disease, copd,
o Interactions:
Digoxin, methotrexate, diazepam, tacrolimus, antifungal
agents, phenytoin levels: this med level increase when
taking with omeprazole
Ketoconazole, itraconazole, atazanavir: absorption
decreased when taken with PPI
Clopidogrel: decreased effects when taken with PPI
Mucosal Protectant
o Sucralfate
o Action: gives a protective barriers to cover the ulcer
o Use: acute duodenal ulcers and maintenance therapy
o Side effects: constipation
o Pregnancy and lactation: safe
o Contraindications: hypersensitivity to medication
o Cautions: kidney disease, DM
o Interactions:
Phenytoin, digoxin, warfarin, ciprofloxacin: absorption of
these meds decreased
Antacids: interfere with effects of sucralfate
Antacids
o Aluminum hydroxide, magnesium hydroxide, calcium carbonate
Erythropoietic growth factors
o Epoetin alfa, erythropoietin, darbepoetin alfa, long-acting
erythropoietin
o Action: act on bone marrow to increase production of RBCs
o Use:
Epoetin alfa: anemia related to CKD, anemia caused by
chemo, to increase erythrocyte counts for those who will
undergo elective surgery, anemia caused by taking
zidovudine (HIV/AIDS med)
Darbepoetin alpha: CKD and pt’s who have anemia caused
by chemo
o Side effects: HTN, risk for thrombotic event, DVT, headache,
bodyaches,
o Pregnancy: only if benefit > risk
o Lactation: safe
o Contraindications: uncontrolled HTN, cancers due to possible
increase in tumor growth
Leukopoietic growth factors
o Filgrastim, pegfilgrastim
o Action: stimulate bone marrow to increase production of
neutrophils
o Use: decrease risk of infection for those with neutropenia from
cancer or other condition, to build up number of hematopoietic
stem cells prior to harvesting for autologous transplant
o Side effects: elevation of plasma uric acid, elevation of lactate,
alkaline phosphatase, bone pain, leukocytosis, splenomegaly,
risk for splenic rupture
o Pregnancy: only if benefits > risks
o Lactation: use with caution
o Contraindications: sensitive to Escherichia coli protein,
o Cautions: cancer of bone marrow, sickle cell disease, respiratory
disease, breastfeeding, children
Granulocyte-macrophage colony-stimulating factor
o Sargramostim
o Action: acts on the bone marrow to increase WBCs
o Use: hastens bone marrow function after bone marrow
transplant, used in tx of failed bone marrow transplant, older
adults with acute myelogenous leukemia,
o Side effects: diarrhea, weakness, rash, malaise, bone pain,
leukocytosis, thrombytosis,
o Pregnancy: safety not established
o Lactation: caution
o Contraindications: allergic to yeast and certain other products
, o Cautions: lung/cardiac/kidney/liver disease, hypoxia, peripheral
edema, pleural or pericardial effusion, cancer of bone marrow
Chapter 25: blood and blood products
Whole blood
o Action: increase circulating blood volume
o Use: replacement after blood loss from traumatic injuries or
surgery, volume expansion in pt’s who have burn injury,
dehydration or shock
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reaction, circulatory
overload, hyperkalemia, transfusion-associated graft-vs-host
disease, sepsis
Packed RBCs
o Action: increase number of RBCs
o Use: severe anemia, hemoglobinopathies, medication-induced
hemolytic anemia, erythroblastosis fetalis
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reactions, hyperkalemia,
transfusion-associated graft-vs-host disease, sepsis
Platelet concentrate
o Action: increase platelet counts
o Use: thrombocytopenia, active bleeding
o Reaction types: febrile nonhemolytic reaction, mild allergic
reaction, sepsis
Fresh frozen plasma (FFP)
o Action: replaces coagulation factors
o Use: active bleeding, massive hemorrhage, extensive burns,
shock, DIC, antithrombin III deficiency, thrombotic
thrombocytopenia purpura, reversal of warfarin, replacement
therapy for factors II, V, VII, IX, X, XI
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, circulatory overload, mild allergic
reaction, sepsis
Apheresed granulocytes
o Action: replaces neutrophils and granulocytes
o Use: severe neutropenia, life-threatening bacterial/fungal
infection not responding to abx therapy, neonatal sepsis,
neutrophil dysfunction
o Reaction types: acute hemolytic reaction, febrile nonhemolytic
reaction, anaphylaxis, mild allergic reaction, circulatory
overload, sepsis
Albumin
o Action: expands circulating blood volume
, o Use: hypovomeia, hypoalbuminemia, burns, adult respiratory
distress, cardiopulmonary bypass surgery, hemolytic disease of
newborn
o Reaction: risk for fluid volume excess
Reactions:
o Acute hemolytic reactions: chills, fever, low back pain,
tachycardia, tachypnea, hypotension,
o Febrile nonhemolytic reaction, fever, headache:
Due to pt antibodies against the donor’s wbc
Chills, headache, flushing, anxiety, muscle pain, increasing
temp
o Anaphylactic reaction: anxiety, urticaria, wheezing, shock,
cardiac arrest
o Mild allergic reaction: flushing, itching, urticaria,
o Circulatory overload: cough, SOB, crackles, HTN, tachycardia,
distended neck veins
o Sepsis: rapid onset of child, fever, vomiting, diarrhea,
hypotension, shock
o Hyperkalemia due to lysis of blood cells: bradycardia,
hypotension, irregular heartbeat, paresthesia of extremities,
muscle twitching, potassium > 5.0
o Transfusion-associated graft-vs-host disease: rare and occurring
1-2 weeks after transfusion
Contraindication: hypersensitivity reactions
Chapter 26: Peptic Ulcer disease
Antibiotics:
o Amoxicillin, bismuth, clarithromycin, metronidazole,
tetracycline, tinidazole
o Action: eradication of H. pylori bacteria
o Use: combo of 2-3 abx for 14 days to increase effectiveness and
minimize the development of medication resistance
Histamine 2-receptor antagonists
o Cimetidine, famotidine, nizatidine
o Action: block h2 receptors which suppresses secretion of gastric
acid and lowers the concentration of H+ in the stomach
o Use: ulcers, GERD, hypersecretory conditions, used with anx to
treat ulcers caused y H. pylori
o Side effects:
Cimetidine: decreased libido, gynecomastia, impotence,
lethargy, hallucinations, confusion, restlessness, n/v/d,
constipation,
o Pregnancy and lactation: use with caution
o Interactions:
, Warfarin, phenytoin, theophylline, lidocaine: high med
level of these meds
Antacids: decreased absorptions of H2 receptor
antagonists
Smoking: decreases effectiveness
Proton Pump inhibitors
o Omeprazole, pantoprazole, lansoprazole, dexlansoprazole,
rabeprazole, esomeprazole
o Action: block basal and stimulated acid production, reduces
gastric acid secretion by irreversibility imbibing the enzyme that
produces gastric acid
o Use: gastric/duodenal ulcers, erosive esophagitis, gerd,
hypersecretory conditions, prevention of stress ulcers
o Side effects: pneumonia, osteoporosis, fractures, rebound acid
hypersecretion, hypomagnesemia, C. diff associated diarrhea
o Pregnancy: misoprostol contraindicated
o Lactation:
Misoprostol and pantoprazole: contraindicated
Omeprazole: only if benefits > risks
o Reproductive: avoid pregnancy during use
o Contraindications: hypersensitivity to medication, rilpivirine
during lactation
o Cautions: dysphagia, liver disease, copd,
o Interactions:
Digoxin, methotrexate, diazepam, tacrolimus, antifungal
agents, phenytoin levels: this med level increase when
taking with omeprazole
Ketoconazole, itraconazole, atazanavir: absorption
decreased when taken with PPI
Clopidogrel: decreased effects when taken with PPI
Mucosal Protectant
o Sucralfate
o Action: gives a protective barriers to cover the ulcer
o Use: acute duodenal ulcers and maintenance therapy
o Side effects: constipation
o Pregnancy and lactation: safe
o Contraindications: hypersensitivity to medication
o Cautions: kidney disease, DM
o Interactions:
Phenytoin, digoxin, warfarin, ciprofloxacin: absorption of
these meds decreased
Antacids: interfere with effects of sucralfate
Antacids
o Aluminum hydroxide, magnesium hydroxide, calcium carbonate
