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Iron preparations: Nursing Pharmacology

Notes

Notes

IRON PREPARATIONS
DRUG NAME
ferrous sulfate (Feosol, Fer-Gen-Sol), ferrous gluconate (Fergon), ferrous fumarate (Femiron, Feostat)
iron sucrose (Venofer), ferumoxytol (Feraheme)
iron dextran (INFeD, Pri-Dextra, Dexferrum)
CLASS
Iron preparations
MECHANISM OF ACTION
Replenish iron stores and promote hemoglobin synthesis
INDICATIONS
Iron deficiency anemia due to:
  • Nutritional iron deficiency
  • Pregnancy
  • Breastfeeding
  • Bleeding
  • Chronic kidney disease
ROUTE(S) OF ADMINISTRATION
PO
IV
IM, IV
SIDE EFFECTS
  • Metallic taste
  • Temporary staining of teeth enamel
  • Nausea
  • Vomiting
  • Abdominal pain
  • Flatulence
  • Constipation
  • Dark, tarry stool
  • Skin staining
  • Phlebitis
  • Boxed warning: anaphylactic reactions
  • Skin staining
  • Phlebitis

CONTRAINDICATIONS AND CAUTIONS
  • Hemochromatosis
  • Thalassemia
  • Hemolytic anemia
  • Peptic ulcer disease
  • Gastritis
  • Inflammatory bowel disease
  • Regional enteritis
NURSING CONSIDERATIONS: IRON PREPARATIONS
ferrous sulfate (Feosol, Fer-Gen-Sol), ferrous gluconate (Fergon), ferrous fumarate (Femiron, Feostat)
iron sucrose (Venofer), ferumoxytol (Feraheme)
iron dextran (INFeD, Pri-Dextra, Dexferrum)
Assessment and monitoring: All iron preparations
Assess
  • Signs and symptoms of iron deficiency anemia; e.g., pallor, tachycardia, dyspnea, and fatigue
  • Laboratory test results: CBC, hemoglobin, hematocrit, iron level, ferritin, total iron-binding capacity

Monitor
  • Evidence of increased oxygen-carrying capacity of RBCs
  • Increased hemoglobin and hematocrit
  • Side effects
  • Toxicity
  • Anaphylaxis

Client education: All iron preparations
  • Purpose of medication: helps relieve symptoms of anemia by providing iron to make hemoglobin for red blood cells, increase the oxygen-carrying capacity of blood
PO
Client education

  • Take medication between meals with orange juice or vitamin C supplement
    • Increases iron absorption; decreases metallic taste
    • May take medication with food to decrease gastrointestinal side effects
    • Avoid taking medication with dietary fiber, eggs, milk, coffee, or tea
  • Remain upright for at least 30 minutes after administration
    • Decreases irritation to esophagus
  • Liquid preparations
    • Avoid teeth staining
      • Dilute iron with water or juice
      • Use a straw
      • Rinse or brush immediately afterwards
  • Include iron-rich foods in diet; e.g., lean red meats, green leafy vegetables, fortified cereals
  • Stools may turn dark green or black
    • Discoloration is harmless
  • Constipation
    • Increase fluids, dietary fiber, physical activity as tolerated
  • Early symptoms of iron toxicity; e.g., nausea, vomiting, diarrhea, abdominal pain
    • Seek medical attention immediately
  • Keep iron supplements out of the reach of children
    • Common cause of fatal poisoning
IV / IM 
Assessment, interventions, and monitoring
IV
  • Confirm a patent IV
  • Emergency equipment and injectable epinephrine readily available
  • Administer prescribed test dose
    • Observe for signs of anaphylaxis for at least 15 minutes; e.g., flushing, difficulty breathing, a weak, rapid pulse, hypotension
    • New IV site if burning or pain occurs
    • Monitor for tissue staining; phlebitis

IM
  • Use Z-track method
    • Prevents medication leakage and irritation
    • Monitor injection site for tissue staining, irritation, and pain
Memory Anchors and Partner Content
Transcript

Iron preparations are medications that contain iron, and can be used to treat iron deficiency anemia. This is defined as a state of low red blood cells or hemoglobin in the blood, which could result from nutritional iron deficiency, chronic kidney disease, blood loss or hemorrhage, and during pregnancy or breastfeeding, in which there’s an increased demand for iron and for red blood cells production.

Most often, iron preparations can be given orally, such as ferrous sulfate, ferrous gluconate, and ferrous fumarate.

In clients who don't tolerate oral iron preparations for their side effects or because of gastrointestinal malabsorption, iron preparations can be given intravenously, such as iron sucrose and ferumoxytol, as well as intramuscularly, such as iron dextran.

Now, most of the iron in oral preparations is lost with stool, while some of it is stored inside the intestinal cells as ferritin.

When the body’s iron demand increases, active transport channels shuttle this stored iron to the blood, where it binds to its carrier protein, transferrin.

On the other hand, intravenous and intramuscular iron preparations bypass intestinal absorption and go straight to the blood.

Regardless of the route of administration, once iron is in the blood, it can then be stored inside macrophages as ferritin, or transported to various tissues like the bone marrow, where it’s used for hemoglobin synthesis, and ultimately for red blood cell production.

Now, the main side effects of oral iron preparations include metallic taste, temporary staining of teeth enamel as well as gastrointestinal symptoms such as nausea, vomiting, abdominal pain, flatulence, constipation, and dark stools.

In addition, oral iron preparations may impair the absorption of other medications, such as with antacids, tetracyclines, and quinolones.

On the other hand, intravenous and intramuscular iron preparations may cause staining of the skin around the injection site, as well as phlebitis, where the vein becomes inflamed. Finally, as a boxed warning, intravenous preparations may cause anaphylactic-type reactions.

Now, iron preparations are contraindicated in clients with conditions that can lead to elevated iron levels, such as hemochromatosis, thalassemia, and hemolytic anemia.

In addition, oral iron preparations should be used with caution in clients with peptic ulcer disease, gastroenteritis, inflammatory bowel disease, and regional enteritis, as iron can cause more irritation to the intestines.

Finally, as a boxed warning, intravenous and intramuscular preparations should only be used in clients who can’t tolerate oral iron.

Okay, if a client who is diagnosed with iron deficiency anemia is prescribed an iron preparation, first perform a focused assessment for signs and symptoms like pallor, tachycardia, dyspnea, and fatigue.

Then, review their recent laboratory test results, including CBC, hemoglobin, hematocrit, and iron panel, which includes iron level, ferritin, and total iron-binding capacity or TIBC.

Now, for oral iron preparations like ferrous sulfate, explain to your client how the supplemental iron can be used by their body to produce hemoglobin for red blood cells; these cells can then carry oxygen in the blood to tissues, thereby helping relieve your client’s symptoms.

Then, teach your client to take their oral iron preparation between meals, along with orange juice or a vitamin C supplement, in order to increase iron absorption and to decrease the metallic taste.

Advise your client to remain upright for at least 30 minutes after administration in order to avoid irritation to their esophagus.

Sources
  1. "Iron Supplementation" StatPearls (July 9, 2021)
  2. "Focus on Nursing Pharmacology" LWW (2019)
  3. "Pharmacology" Elsevier Health Sciences (2014)
  4. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  6. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
  7. "Lewis's Medical-Surgical Nursing" Mosby (2019)
  8. "Iron dextran complex (Rx)" Medscape ()
  9. "Ferumoxytol (Rx)" Medscape ()
  10. "Iron Supplement (Oral Route, Parenteral Route)"  (2021)