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Ana Barreras Lopez
Specific goals of treatment
The goal of treating anemia of any cause is to correct the hemoglobin deficit in order to increase oxygen at the tissue level. This is a frequent complication in those individuum with chronic kidney disease and the main cause is a deficit in erythropoietin and iron. With the use of erythropoiesis stimulant agents (ESAs) the production of red blood cells increases. Also, is important to supply the correct amount of iron in order to make efficient and functional erythrocytes (Anemia in Chronic Kidney Disease, 2022).
What drug therapy would you prescribed? Why?
I will use Epoetin alfa (Epogen, Procrit) as ESAs starting with 100 units per Kg subcutaneous three times a week. This dose can be adjusted as needed according evolution and laboratory results. This is a version of human erythropoietin (EPO) that stimulates the production of red blood cells by bone narrow. Maintenance of systemic and cellular iron level is crucial. Is recommended 100 to 200 mg of elemental iron daily divided in two or more doses. However, extended releases tablets are also available for once daily dosage (Mikhail et al., 2017).
What are the parameters for monitoring success of therapy?
To determine the severity of anemia the best marker is the hemoglobin level (Hb). The ESAs agent dosage is determinate by this value taking into account increases from the last dosage. To monitor progression is important to periodically repeat complete blood count, folate, Vitamin B12, iron, and serum ferritin levels. Iron storages reserves should be 200 ng/ml and Hb levels between 11.0 – 12 g/dl. At the beginning of therapy, the Hb levels should be monitoring weekly until stable, then can be change to a monthly basis (Gafter-Gvili et al., 2019).
Discuss specific patient education based on the prescribed therapy.
Being consistent with the medication regimen and periodic monitoring of hematological indicators is of vital importance to success. This drug may cause heart attack, heart failure, and blood clots. That is why patients should be educated in recognizing the symptoms that accompany these events such as: chest pain, cool pale extremity, stroke alert, numbness unilateral, loss of consciousness, high blood pressure, fever, dizziness, nausea, etc. Training on self-administration if a prefilled syringe will be use. Use a new needle and syringe each time, do not overdose, if you use a multidose vial it should be refrigerated after use and throw away after 21 days of use. Do no shake. Do not use if change of color occurs or particles are visible. Follow instruction of eat an iron rich diet with eggs, cereals, meats, and vegetables. These substances can be consumed as supplements. Take supplements with food to avoid stomach problems but always remember that milk, caffeine, antacids or calcium supplements can decrease absorption of iron, Vitamin C increases absorption of iron (F
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