Which important factors should be considered prior to initiating ferrous sulfate therapy? - The use of antacids; the absorption of oral iron formulations
... [Show More] 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.
Are there other intravenous iron options other than iron dextran? - Ferumoxytol, iron sucrose, and sodium ferric gluconate are alternative options to iron dextran. Each of these products carries a risk of significant infusion-type reactions, but may be better tolerated by patients.
Which alternative options can be pursued for DVT treatment other than Warfarin? - Appropriate alternative options include rivaroxaban 15 mg twice daily for 21 days, then
20 mg daily with food; apixaban 10 mg twice daily for 7 days, then 5 mg twice daily; or dabigatran 150 mg twice daily
If creatinine clearance (CrCl) decreased to less than 30 mL per minute, which treatment options would be available? - Rivaroxaban and apixaban (anti-Xa inhibitors) dosing regimens are significantly impacted by renal function and CrCl; establishing a baseline renal function, and continued monitoring are key to safe and effective use
The anti-Xa inhibitors - target the first step of the common pathway, where the intrinsic and extrinsic pathways combine
If a pt is currently anticoagulated and in need of transition to a DOAC (direct oral anticoagulant), rivaroxaban therapy can be initiated when: - the INR is less than 3
If a pt is currently anticoagulated and in need of transition to a DOAC (direct oral anticoagulant), apixaban and dabigatran cannot be initiated: - until the INR is less than 2
Heparin and Low-Molecular Weight Heparins - Short-acting anticoagulants that are used in the initial period of anticoagulation, as well as to bridge patients to a therapeutic level of warfarin [Show Less]