Hematopoietic growth factors
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Hematopoietic growth factors (brand names Procrit, Epogen, Neupogen) — Hematopoietic growth factors; Erythropoiesis-stimulating agents (epoetin, darbepoetin) and granulocyte colony-stimulating factors (filgrastim, pegfilgrastim).
Identification
- Therapeutic class: Hematopoietic growth factors.
- Pharmacologic class: Erythropoiesis-stimulating agents (epoetin, darbepoetin) and granulocyte colony-stimulating factors (filgrastim, pegfilgrastim).
Pharmacology
- Mechanism of action: Epoetin and darbepoetin stimulate red blood cell production; filgrastim and pegfilgrastim stimulate neutrophil production.
- Onset / peak / duration: Red cell response over weeks; neutrophil response over days.
- Half-life / therapeutic level: Darbepoetin and pegfilgrastim are longer acting; no routine level.
Clinical use
- Indications: Anemia of chronic kidney disease and chemotherapy (epoetin, darbepoetin); neutropenia from chemotherapy (filgrastim, pegfilgrastim).
- Usual dose, route, frequency: SubQ or IV; pegfilgrastim once per chemotherapy cycle.
- Maximum dose / adjustments: Use the lowest erythropoiesis-stimulating dose to avoid overshooting hemoglobin.
Safety
- Contraindications: Uncontrolled hypertension (epoetin), hypersensitivity.
- Black box warning: Erythropoiesis-stimulating agents carry a boxed warning for increased risk of death, serious cardiovascular events, stroke, venous thromboembolism, and tumor progression; use the lowest dose and avoid raising hemoglobin above the recommended threshold.
- Interactions: Few direct; iron status affects erythropoiesis response.
- Pregnancy / lactation: Use only if clearly needed.
- High-alert: No.
Adverse effects
- Common side effects: Hypertension and headache (epoetin), bone pain (filgrastim, pegfilgrastim), injection-site reactions.
- Serious effects to report: Thrombosis and cardiovascular events (epoetin), splenic rupture or acute respiratory distress (filgrastim, rare), severe allergic reaction.
- Antidote / reversal: Supportive care.
Nursing process
- Assessment before administration: Hemoglobin and hematocrit (epoetin), iron status, neutrophil count (filgrastim), blood pressure.
- Interventions during therapy: Do not shake the vials; monitor hemoglobin to avoid overshoot; manage filgrastim bone pain.
- Monitor: Hemoglobin and hematocrit, blood pressure, neutrophil count, signs of thrombosis.
- Evaluation / expected outcome: Improved anemia or recovered neutrophil count.
Patient teaching
- Patient teaching: Report chest pain or leg swelling (epoetin); bone pain is common with filgrastim.
- Notify provider if: Chest pain, leg swelling or pain, severe headache, left upper abdominal pain.
- Administration tips: SubQ; do not shake; rotate sites.