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Chapter 11 - Eye > 9. Blood > Flashcards

9. Blood Flashcards

1
Q

What are the normal ranges for potassium and sodium?

A

Potassium 3.5-5.0 mmol/L

Sodium 135-145 mmol/L

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2
Q

What are the normal ranges for calcium and magnesium?

A

Calcium (total) 2.2 - 2.6 mmol/L

Calcium (ionised) 1.19 - 1.37 mmol/L

Magnesium 0.7 - 1.00 mmol/L

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3
Q

What is used for acute severe hyperkalaemia?
(3)
more than 6.5mmol/L or presence of ECG changes

A

Calcium gluconate 10% by slow intravenous injection to protect against myocardial excitability

5-10 units of soluble insulin with 50ml glucose 50% given over 5 to 15mins

Unlicensed use - salbutamol

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4
Q

Sodium bicarbonate can be used to correct acidosis in hyperkalaemia. Why should it not be administered in the same line as calcium?

A

risk of precipitation

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5
Q

What can be used in mild or moderate hyperkalaemia without ECG changes?

A

Ion -exchange resins

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6
Q

What is used for hyponatraemia?

A

sodium chloride usually given intravenously

in mild or chronic - oral supplements of sodium chloride or sodium bicarbonate

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7
Q

Treatment for hypokalaemia if pt cant get enough potassium orally?

A

Potassium chloride with sodium chloride infusion

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8
Q

Why shouldn’t glucose be given with potassium replacement therapy?

A

glucose can further decrease plasma potassium concentration

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9
Q

What is used for severe metabolic acidosis (pH <7.1)?

A

Sodium bicarbonate

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10
Q

ORT - once reconstituted how long after can u use any unused solution?

A

Should be discarded no later than 1 hour after prep unless store in fridge - can for up to 24 hours

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11
Q

Name some drugs that can cause hypERnatramia? (9)

A
  1. Lithium
  2. Phenytoin
  3. Lactulose
  4. Corticosteroids
  5. Anabolic steroids
  6. Androgens
  7. Oestrogens
  8. Oral contraceptives
  9. Sodium bicarbonate
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12
Q

Lithium can cause diabetes insipidus-like syndrome within 2 weeks of starting therapy and causes hypernatraemia. Is this reversible?

A

Yes upon stopping

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13
Q

Name some drugs that can cause hypOnatramia? (14)

A
  1. Desmopressin
  2. Oxytocin
  3. Carbamazepine
  4. Chlorpropamide (sulfonylurea)
  5. Amitriptyline & other tricyclic antidepressants
  6. ACE inhibitors
  7. Diuretics
  8. Heparin
  9. Lithium - by damaging renal
  10. NSAIDs
  11. Miconazole
  12. Vasopressin
  13. Opiates
  14. Amphotericin (antifungal)
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14
Q

Name some drugs that can cause hypERkalaemia? (12)

A
  1. Separate and COMBINED USE OF Potassium sparing diuretics - spironolactone, amiloride, triamterene & ACE inhibitors
  2. NSAIDs
  3. Digoxin (in acute overdose)
  4. Heparin
  5. Isoniazid
  6. Lithium
  7. Penicillin’s (potassium salt)
  8. Potassium supplements
  9. Tetracycline
  10. Beta blockers
  11. Tacrolimus
  12. Trimethoprim & co-trimoxazole
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15
Q

Name some drugs that can cause hypOkalaemia? (14)

A
  1. Gentamicin
  2. Thiazides
  3. Loop diuretics
  4. Glucose
  5. Insulin
  6. Corticosteroids
  7. Aspirin
  8. Laxatives
  9. Penicillin G (sodium salt)
  10. Salicylates
  11. PipTaz
  12. Terbutaline
  13. Sodium chloride/ sodium bicarbonate
  14. Amphotericin (antifungal)
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16
Q

How to manage hypERcalcaemia?

A

Correction of dehydration with normal saline

Frusemide - inhibits tubular reabsorption of calcium

17
Q

Name some drugs that can cause hypOcalcaemia? (7)

A
  1. Bisphosphonates
  2. Phenytoin
  3. Frusemide
  4. Calcitonin
  5. Phenobarbital
  6. Aminoglycoside
  7. Cisplatin
18
Q

Name some drugs that can cause hypERcalaemia? (4)

A
  1. Thiazide diuretics
  2. Lithium
  3. Tamoxifen
  4. Calcium supplements used in management of osteoporosis
19
Q

What are the 3 mechanisms that can lead to hypokalaemia? examples of what can cause them

A
  1. Transcellular movement into cells - reported with intravenous B adrenoreceptor agonists such as salbutamol. Parenteral insulin. Adrenaline/epinephrine and theophylline
  2. Loss from GI tract - chronic diarrhoea, laxative abuse
  3. Loss from kidney - primary/secondary hyperaldosteronism e.g. Cushing’s syndrome or gentamicin (nephrotoxic)
20
Q

Glucose 6 phosphate dehydrogenase deficiency is highly prevalent in individuals originating from…

A
  1. Africa
  2. Asia
  3. Oceania
  4. South Europe

More common in males than female

21
Q

Those with G6PD deficiency are more susceptible to developing which type anaemia

also when they eat..

A

acute haemolytic anaemia (red blood cells are destroyed faster than they can be made)

Fava beans

22
Q

What are the treatment options for iron deficieny anaemia

A

Oral iron salts
100mg to 200mg daily

Ferrous sulphate
Ferrous fumarate
Ferrous gluconate

Not much difference between the salts in terms of speed of work. So side effects and costs determine choice

23
Q

Some iron preparations contain ascorbic acid…why ?

A

aid the absorption of iron - but advantage is minimal

24
Q

Why should modified release of iron not be advised?

A

No therapeutic advantage

release iron gradually but the iron is carried past the first part of duodenum where absorption may be poor

25
Q

What is the MHRA warning on intravenous iron?

A

Anaphylactic/serious hypersensitive reactions - even if they been given previous dose

caution is needed. trained staff and resuscitation facilities available.

Pts closely monitored during and 30mins after administration

Higher risk in those with known allergies, asthma, eczema etc

26
Q

Can IV iron be used in pregnancy?

A

AVOID in 1st trimester

caution if benefits outweigh risks in 2nd and 3rd trimester

27
Q

When can patients take oral iron after IV dose?

A

5 days after

28
Q

Side effects of IV iron?

A 
Dizzines, headache, flushing 
Hypo or hyper tension 
Hypophosphataemia 
Skin reactions
Taste altered

Kounis syndrome - symptoms such as chest pain relating to reduced blood flow to the heart) caused by an allergic reaction

Chapter 11 - Eye (6 decks)

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