Cyanocobalamin Drug Study PDF

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Drug Study by Catherine Espinosa

Generic Name: Cyanocobalamin

Trade Name(s): Nascobal, Rubramin PC

Drug Classification: Therapeutic: antianemics, vitamins (Vitamin B12 Preparations) Pharmacologic: water soluble vitamins Therapeutic Uses: Corrects manifestations of pernicious anemia (megaloblastic indices, GI lesions, and neurologic damage). Corrects Vitamin B12 deficiency. Reverses symptoms of cyanide toxicity (Cyanokit only)

Possible Routes of Administration: PO (oral products are not recommended due to poor absorption), IM, Intranasal Maximum Dosage/24 hours: PO: Vitamin B12 deficiency: 1000 mcg/day, Pernicious anemia (for hematologic remission only): 1000-2000 mcg/day, IM: Vitamin B12 deficiency: 30 mcg/day for 5-10 days, then 100-200 mcg/month. Pernicious anemia: 1000 mcg/month, Intranasal: Vitamin B12 deficiency: 500 mcg (one spray) in one nostril once weekly. Pernicious anemia (for hematologic remission only) - 500 mcg (one spray) in one nostril once weekly

Usual Dosage and Frequency: IM: Vitamin B12 deficiency: 30 mcg/day for 5-10 days, then 100200 mcg/month, Pernicious anemia: 100 mcg/day for 6-7 days

This Patient’s Dose and Frequency_____________

Mechanism of Action: Necessary coenzyme for metabolic processes including fat and carbohydrate metabolism and protein synthesis. Required for production of cell production and hematopoesis

Adverse Effects: headache, diarrhea, itching, hypokalemia, thrombocytosis, pulmonary edema, pain at IM site, ANAPHYLAXIS

Nursing Implications: • Assess patient for signs of vitamin B12 deficiency (pallor, neuropathy, psychosis; red inflamed tongue) before and periodically during therapy. • Lab Test Considerations: Monitor plasma folic acid, vitamin B12, and iron levels, Hgb, Hct before treatment, 1 mo after start therapy and then every 3-6 mo. Evaluate serum potassium level in patients receiving vitamin B12 for pernicious anemia for hypokalemia during the first 48 hr treatment. Serum potassium and platelet counts should be monitored routinely during the course of therapy. •

PO: Administer with meals to increase absorption

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Intranasal: Dose should not be administered within 1 hr of hot food or liquids (nasal secretions may decrease the effectiveness of the nasal spray)

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IM: Vials should be protected from the light

Patient Teaching: •

Encourage patient to comply with diet recommendations of health care professional.

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Foods high in Vitamin B12 include meats, seafood, egg yolk, and fermented cheeses

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Inform patients with pernicious anemia of the life long need for vitamin B12 replacement

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Intranasal: Instruct patient in proper administration and technique

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Intermittent infusion: Advise patient that skin redness may last up to 2 wks an their urine may remain red up to 5 wks after drug administration...