Anaemias

Question 1

Sickle-cell crisis usually requires hospitalisation, (?), (?), and treatment of any concurrent infection.

Answer 1

Fluid replacement

Analgesia

Question 2

Sickle-cell crisis usually requires hospitalisation, fluid replacement, analgesia, and treatment of any concurrent (?).

Answer 2

infection

Question 3

In patients with sickle cell, what can be given to reduce the risk of infection? (4)

Answer 3

Pneumococcal vaccine
Haemophilus influenzae type b vaccine
Annual influenza vaccine
Lifelong prophylactic penicillin

(hepatitis B vaccine should also be given if patient is not immune)

Question 4

In most forms of sickle-cell disease, varying degrees of (?) anaemia are present which is accompanied by increased erythropoiesis; this may increase folate requirements and supplementation with folic acid is recommended.

Answer 4

haemolytic

Question 5

In most forms of sickle-cell disease, varying degrees of haemolytic anaemia are present which is accompanied by increased (?); this may increase folate requirements and supplementation with folic acid is recommended.

Answer 5

erythropoiesis

Question 6

In most forms of sickle-cell disease, varying degrees of haemolytic anaemia are present which is accompanied by increased erythropoiesis; this may increase (1?) requirements and supplementation with (2?) is recommended.

Answer 6

1. folate

2. folic acid

Question 7

What drug can prevent acute chest syndrome, reduce the frequency of painful crises, and reduce transfusion requirements in sickle-cell disease?

Answer 7

Hydroxycarbamide

Question 8

How long does it take for the benefits of hydroxycarbamide in a sickle cell patient to become evident?

Answer 8

Several months

Hydroxycarbamide can prevent acute chest syndrome, reduce the frequency of painful crises, and reduce transfusion requirements in sickle-cell disease.

Question 9

Glucose 6-phosphate dehydrogenase (G6PD) deficiency is common in individuals originating from (?), (?), the (?) region, and the (?)

Answer 9

Africa
Asia
Mediterranean
Middle East

Question 10

Is G6PD more common in males or females?

Answer 10

Males

Question 11

Individuals with G6PD deficiency are susceptible to developing (?) anaemia when they take a number of common drugs or when they have an infection.

Answer 11

acute haemolytic

Question 12

What food can cause an acute haemolytic anaemia in patients with G6PD deficiency?

Answer 12

Fava beans (broad beans)

This is termed favism

Question 13

G6PD deficiency is genetically (?); susceptibility to the haemolytic risk from drugs varies; thus, a drug found to be safe in some G6PD-deficient individuals may not be equally safe in others

Answer 13

heterogeneous

Question 14

Do manufacturers routinely test drugs for their effects in G6PD-deficient inidividuals?

Answer 14

NO

Question 15

The risk and severity of haemolysis is almost always (?)-related.

Answer 15

dose-related

Question 16

Which drugs have a DEFINITE risk of haemolysis in most G6PD-deficient individuals? (8)

Answer 16

1. Dapsone and other sulfones
2. Fluoroquinolones (including ciprofloxacin, moxifloxacin, norfloxacin, and ofloxacin)
3. Methylthionium chloride
4. Nitrofurantoin
5. Primaquine
6. Quinolones
7. Rasburicase
8. Sulfonamides (including co-trimoxazole)

Question 17

Dapsone has a definite risk of (?) in most G6PD-deficient individuals

Answer 17

haemolysis

Question 18

Fluoroquinolones have a definite risk of (?) in most G6PD-deficient individuals

Answer 18

haemolysis

Question 19

Ciprofloxacin has a definite risk of (?) in most G6PD-deficient individuals

Answer 19

haemolysis

Question 20

Moxifloxacin has a definite risk of (?) in most G6PD-deficient individuals

Answer 20

haemolysis

Question 21

Norfloxacin has a definite risk of (?) in most G6PD-deficient individuals

Answer 21

haemolysis

Question 22

Ofloxacin has a definite risk of (?) in most G6PD-deficient individuals

Answer 22

haemolysis

Question 23

Methylthioninium chloride has a definite risk of (?) in most G6PD-deficient individuals

Answer 23

haemolysis

Question 24

Nitrofurantoin has a definite risk of (?) in most G6PD-deficient individuals

Answer 24

haemolysis

Question 25

Primaquine has a definite risk of (?) in most G6PD-deficient individuals

Answer 25

haemolysis

Question 26

Quinolones have a definite risk of (?) in most G6PD-deficient individuals

Answer 26

haemolysis

Question 27

Rasburicase has a definite risk of (?) in most G6PD-deficient individuals

Answer 27

haemolysis

Question 28

Sulfonamides have a definite risk of (?) in most G6PD-deficient individuals

Answer 28

haemolysis

Question 29

Co-trimoxazole has a definite risk of (?) in most G6PD-deficient individuals

Answer 29

haemolysis

Question 30

Dapsone has a definite risk of haemolysis in most (?) individuals

Answer 30

G6PD-deficient

Question 31

Fluoroquinolones have a definite risk of haemolysis in most (?) individuals

Answer 31

G6PD-deficient

Question 32

Ciprofloxacin has a definite risk of haemolysis in most (?) individuals

Answer 32

G6PD-deficient

Question 33

Moxifloxacin has a definite risk of haemolysis in most (?) individuals

Answer 33

G6PD-deficient

Question 34

Norfloxacin has a definite risk of haemolysis in most (?) individuals

Answer 34

G6PD-deficient

Question 35

Methylthioninium chloride has a definite risk of haemolysis in most (?) individuals

Answer 35

G6PD-deficient

Question 36

Nitrofurantoin has a definite risk of haemolysis in most (?) individuals

Answer 36

G6PD-deficient

Question 37

Primaquine has a definite risk of haemolysis in most (?) individuals

Answer 37

G6PD-deficient

Question 38

Quinolones have a definite risk of haemolysis in most (?) individuals

Answer 38

G6PD-deficient

Question 39

Rasburicase has a definite risk of haemolysis in most (?) individuals

Answer 39

G6PD-deficient

Question 40

Sulfonamides have a definite risk of haemolysis in most (?) individuals

Answer 40

G6PD-deficient

Question 41

Co-trimoxazole has a definite risk of haemolysis in most (?) individuals

Answer 41

G6PD-deficient

Question 42

Which drugs have a POSSIBLE risk of haemolysis in some G6PD-deficient individuals? (5)

Answer 42

``` Aspirin Chloroquine Menadione Quinine Sulfonylureas ```

Question 43

(?) in mothballs also causes haemolysis in individuals with G6PD deficiency.

Answer 43

Naphthalene

Question 44

Intravenous horse (?) globulin in combination with ciclosporin, may be used as immunosuppressive treatment for aplastic anaemia

Answer 44

antithymocyte

Question 45

Intravenous horse antithymocyte globulin in combination with (?), may be used as immunosuppressive treatment for aplastic anaemia

Answer 45

ciclosporin

Question 46

Intravenous horse antithymocyte globulin in combination with ciclosporin, may be used as immunosuppressive treatment for (?) anaemia

Answer 46

aplastic

Question 47

What drug can be used for the prevention of adverse effects associated with antithymocyte globulin treatment in aplastic anaemia?

Answer 47

Prednisolone Intravenous horse antithymocyte globulin in combination with ciclosporin, may be used as immunosuppressive treatment for aplastic anaemia

Question 48

What drug is licensed for the treatment of idiopathic sideroblastic anaemia?

Answer 48

Pyridoxine hydrochloride The dose required is usually high

Question 49

(?) (recombinant human erythropoietins) are used to treat anaemia associated with erythropoietin deficiency in chronic renal failure

Answer 49

Epoetins

Question 50

Epoetins (recombinant human erythropoietins) are used to treat anaemia associated with erythropoietin deficiency in (?)

Answer 50

chronic renal failure

Question 51

(?) is also licensed for the prevention of anaemia in preterm neonates of low birth-weight

Answer 51

Epoetin beta A therapeutic response may take several weeks

Question 52

Epoetin beta is also licensed for the prevention of anaemia in (?) neonates of low birth-weight

Answer 52

preterm

Question 53

Epoetin beta is also licensed for the prevention of anaemia in preterm neonates of (?)

Answer 53

low-birth weight

Question 54

What hyperglycosylated derivative of epoetin has a longer-half life and can be administered less frequently than epoetin?

Answer 54

Darbepoetin alfa

Question 55

Darbepoetin alfa is a hyperglycosylated derivative of epoetin; it has a (?) half-life and can be administered less frequently than epoetin.

Answer 55

longer

Question 56

Darbepoetin alfa is a hyperglycosylated derivative of epoetin; it has a longer half-life and can be administered (?) frequently than epoetin.

Answer 56

less

Question 57

(?) is a hyperglycosylated derivative of epoetin; it has a longer half-life and can be administered less frequently than epoetin.

Answer 57

Darbepoetin alfa

Question 58

Methoxy polyethylene glycol-epoetin beta is a continuous erythropoietin receptor activator that is licensed for the treatment of symptomatic (?) associated with chronic kidney disease.

Answer 58

anaemia

Question 59

Methoxy polyethylene glycol-epoetin beta is a continuous erythropoietin receptor activator that is licensed for the treatment of symptomatic anaemia associated with (?).

Answer 59

chronic kidney disease

Question 60

Methoxy polyethylene glycol-epoetin beta has a (?) duration of action than epoetin?

Answer 60

longer

Question 61

What very rare but severe cutaneous side effects are associated with epoetins?

Answer 61

Stevens-Johnson syndrome | Toxic epidermal necrolysis

Question 62

Overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase the risk of (1?) and serious (2?) events, and in patients with cancer may increase the risk of thrombosis and related complications

Answer 62

1. death | 2. cardiovascular

Question 63

Overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase the risk of death and serious cardiovascular events, and in patients with cancer may increase the risk of (?) and related complications

Answer 63

thrombosis

Question 64

In patients being treated with erythropietins, haemoglobin concentration should be maintained within the range (?)g/100 mL

Answer 64

10-12 g/100mL

Question 65

What are the contraindications to treat a patient with epoetins? (3)

Answer 65

Patients unable to receive thromboprophylaxis Pure red cell aplasia following erythropoietin therapy Uncontrolled hypertension

Question 66

What are the common side effects of epoetins? (7)

Answer 66

``` Arthralgia Embolism and thrombosis Headache Hypertension (dose-dependent) Influenza-like illness Skin reactions Stroke ```

Question 67

In isolated patients with normal or low blood pressure, a hypertensive crisis with (?)-like symptoms and generalised tonic-clonic seizures requiring immediate medical attention has occurred with epoetin.

Answer 67

encephalopathy

Question 68

In isolated patients with normal or low blood pressure, hypertensive crisis with encephalopathy-like symptoms and (?) requiring immediate medical attention has occurred with epoetin.

Answer 68

generalised tonic-clonic seizures

Question 69

What needs to be monitored in patients taking epoetins?

Answer 69

BP Reticulocyte counts Haemoglobin Electrolytes