Iron preparations: Nursing pharmacology

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.

If your client experiences gastrointestinal side effects, such as nausea, vomiting, or abdominal pain, let them know they can take their iron with certain foods, but they should avoid taking it with dietary fiber, eggs, milk, coffee, or tea, as these can decrease the absorption of iron.

If constipation occurs, advise them to increase their fluids and dietary fiber from whole grains, fruits, vegetables and legumes; and increase their physical activity as tolerated.

In addition, advise them that eating more iron-rich foods, such as lean red meats, green leafy vegetables, and fortified cereals, can also help to increase their iron levels.

Next, explain how the iron can turn their stools dark green or black, and that this discoloration is harmless. Lastly, if a liquid iron preparation is prescribed, teach your client that they can avoid staining their teeth by diluting the iron with water or juice, drinking it through a straw, and immediately rinsing or brushing their teeth afterwards.

Next, review with your client the early symptoms of iron toxicity, such as nausea, vomiting, diarrhea, and abdominal pain.

If they experience any of these symptoms, advise them to contact their healthcare provider immediately. In addition, be sure to stress the importance of keeping any iron supplement out of the reach of children, in order to prevent potentially fatal iron poisoning.Alright, before administering an intravenous iron preparation, such as iron dextran, be sure to confirm a patent IV is in place, and that there is emergency equipment and injectable epinephrine readily available in the event of an anaphylactic reaction.

Then, administer the prescribed test dose and observe for signs of anaphylaxis, such as flushing, difficulty breathing, a weak, rapid pulse, or hypotension, for at least 15 minutes before administering the remaining amount.

Prompt your client to let you know if any burning or pain is felt, and establish a new IV site if this occurs. On the other hand, if you are administering the iron dextran intramuscularly, be sure to use the Z-track method to prevent the medication from leaking into the surrounding tissues and causing irritation.

After administration, monitor the injection site for tissue staining, irritation, and pain. Finally, throughout iron preparation therapy, continue to monitor your client for side effects and evaluate for the therapeutic effects, including improved symptoms of anemia, as well as an increase in the hemoglobin and hematocrit values.

Alright, as a quick recap... Iron preparations are used to treat iron deficiency anemia and are typically administered orally, but clients unable to tolerate or absorb oral medications can receive iron intravenously or intramuscularly.

Once administered, the iron is used by the body to make hemoglobin for red blood cells. Side effects of oral iron preparations can include a metallic taste, staining of the teeth, and gastrointestinal symptoms like nausea, constipation, and dark stools.

On the other hand, intravenous and intramuscular forms of iron preparations can cause anaphylaxis, phlebitis, and injection site pain or tissue staining.Iron preparations should be used cautiously in clients with peptic ulcer disease, gastroenteritis, inflammatory bowel disease, and regional enteritis.

Nursing considerations while caring for a client receiving iron preparations include performing a focused assessment, monitoring for side effects, and evaluating the therapeutic response.

Finally, client teaching includes safe self-administration, as well as recognition and