NCLEX Review Guide: Medications to Treat Anemia

Oral Iron Preparations

• Ferrous sulfate, ferrous gluconate, and ferrous fumarate are first-line treatments for iron deficiency anemia with ferrous sulfate being most commonly prescribed.
• Administer on empty stomach for optimal absorption, but give with food if GI upset occurs to improve tolerance.
• Vitamin C enhances iron absorption while calcium, antacids, and dairy products decrease absorption significantly.

Parenteral Iron

• Iron dextran, iron sucrose, and ferric gluconate are used when oral iron is ineffective or contraindicated due to severe malabsorption.
• Test dose required for iron dextran due to risk of anaphylactic reactions, while iron sucrose has lower allergic potential.

1. Administer test dose and monitor for 30 minutes for allergic reactions
2. Use Z-track method for IM injection to prevent skin staining
3. Monitor vital signs during IV infusion and watch for hypotension
4. Have epinephrine readily available for anaphylactic reactions

Cyanocobalamin (Vitamin B12)

• Used to treat pernicious anemia and B12 deficiency caused by lack of intrinsic factor or dietary insufficiency.
• Available in oral, sublingual, nasal spray, and injectable forms with lifelong therapy often required for pernicious anemia.

Folic Acid (Folate)

• Essential for DNA synthesis and red blood cell formation, particularly important during pregnancy to prevent neural tube defects.
• Never give folate alone in B12 deficiency as it can mask symptoms while allowing neurological damage to progress.

Epoetin Alfa and Darbepoetin

• Synthetic forms of erythropoietin used primarily in chronic kidney disease and chemotherapy-induced anemia to stimulate red blood cell production.
• Target hemoglobin levels of 10-12 g/dL to reduce need for transfusions while avoiding cardiovascular complications from higher levels.