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Blood and Blood forming organs Flashcards

1
Q

what 2 drugs are given in sickle cell disease to help make new RBCs and reduce frequecy of sickle cell crises?

A

folate supplementation to help make RBCs
hydroxycarbamide to reduce crises

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2
Q

what deficiency is an inborn error of carbohydrate metabolism?
what does this predispose people to?
what drugs have this risk?

A

glucose-6-phosphate dehydrogenase deficiency
predisposes people to haemolytic anaemia
drugs with risk = dapsone, sulphonamides, nitrofurantoin, quinolones, rasburicase

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3
Q

when is prophylaxis for iron deficency anaemia required?

A
  • malabsoprtion
  • gastrectomcy
  • menorrhagia
  • chronic renal failure, haemodialysis
  • pregnancy
  • low birth weight
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4
Q

how should you counsel patients to take iron tablets?

A

take with or after food to reduce GI SE
take with glass of orange jouce as vitamin c aid absorption
continue for 3 months after blood levels return to normal

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5
Q

what’s the MHRA advice regarding IV iron?

A
  1. take cuase with every IV dose, test doses not recommended
  2. monitor for 30mins after each injection
  3. high risk in allergies (asthma, eczema, inflammatory conditions)
  4. avoid in pregancy, especially 1st trimester
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6
Q

what is megoblastic anaemia caused by?

A

B12 or folic acid deficiency

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7
Q

what are the symptoms of megoblastic anaemia?

A

nimbness, tingling hands and feet muscle weakness, depresison

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8
Q

what are the 2 causes of B12 deficiency in megoblastic anaemia?
how does this influence route of treatment?

A
  1. dietary deficency - PO hydroxycobalamin
  2. malabsorption - Chron’s, gastrectomy - IM hydroxocobalamin
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9
Q

what are the causes of folate deficiency and how long is the treatment?
can you give folic acid alone for undiagnosed megablastic anaemia?

A

causes = poor diet, pregnancy, methotrexate, malabsorption
treatment in folic acid OD for 4 months
never give folic acid alone for undiagnosed anaemia due to risk of neuropathy of spinal cord

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10
Q

what drug is used in iron posioning?

A

desferrioxamine

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11
Q

what drug is used prevent neutropenia - used to redcue duration of chemotherapy-induced neutropenia?

A

filgrastim

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12
Q

name 3 symptoms of hypernatramia

A

convulsions
thrist
postural hypotension
tachycardia
hypovolaemia

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13
Q

what drugs can cause hypernatraemia? (C LOSS)

A

Corticosteroids
Lithium
Oral contraceptives
Sodium Bicarbonate
Sodium content in IV abx

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14
Q

what’s an alternative cause to hypernatraemia than drugs?

A

volume depletion e.g., diabetes inspidus - give IV glucose

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15
Q

name 3 symptoms of hyponatraemia

A

drowsiness
confucion
headaches
cramps
N&V

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16
Q

what drugs can cause hyponatraemia? ALDC

A

Antidepressants
Loop and thiazide diuretics
Desmopressin
Carbamazapine

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17
Q

how do you manage mild-moderate and severe hyponatraemia?

A

mild-moderate = PO NaCL/NaCO3, add glucose if water depletion
severe = IV saline

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18
Q

what’s the risk of giving IV saline?

A

osmotic demyelinationsyndrome

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19
Q

what does oral rehydration therapy contain?

A

K+, Na+, glucose

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20
Q

what is metabolic acidosis signified by?

A

high chloride (hyperchloraemia), large anoin gap

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21
Q

what do you give to treat metabolic acidosis?

A

sodium bicarbonate
or potassium bicarbonate if caused by low potassium

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22
Q

what can you give to manage high calcium?
what do you give for hypercalcaemia of malignancy?
what do you give for hypoercalcaemia caused by hyperparathyroidism - what if pt has renal failure?

A

bisphosphonates ot corticosteroids
hypercalcaemia of malignancy = calcitonin
if caused by hypoerparathyroidism = cinalcet
if pt has renal failure - give paracalcitol

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23
Q

what do you give to treat hypoercalciuria?

A

benfroflumethiazide, increase fluid intake and reduce deitary calcium

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24
Q

what is hypercalciuria?

A

high calcium in urine

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25
what's the main cause of hypocalcaemia?
osteoporosis
26
how do you manage mild-oderate hypocalcaemia and severe acute hypocalaemia?
mild-moderate = vit d + calcium supplements severe acute = slow IV calcium gluconate
27
in what type of pts is hypomagnesaemia common? what other electrolyte imbalances can this lead to? how it is managed?
alcoholics can lead to hypO Ca2+, K+, Na+ managed with IV/IM magnesium sulphate
28
how do you manage hyperphosphateaemia and hypophosphataemia?
high posphate = calcium-containing preperations (sevelmar = phosphate binder) low phosphate = IV phosphate
29
what drugs can cause hyperkalaemia? (HADBEANS)
Heparin Ace i Digoxin Beta blockers Eplerenone Amiloride NSAIDs Spironolactone
30
how do you treat mild-moderate hyperkalaemia compared to severe hyperkalaemia? at what level is it classed as severe hyperkalaemia?
mild-moderate = clacium resonium severe = slow IV calcium gluconate --> IV insulin, glucose, and salbutamol can be given in addition severe = >6.5mmol/l
31
sodium bicarbonate can be given as part of the severe hyperkalaemia treatment to correct compounding acidosis, why must it be given via a seperate line?
due to risk of precipitation and thrombosis
32
what are the symptoms of hypokalaemia?
muscle hypotonia, arrhythmias
33
what drugs can cause hypokalaemia? (ABCDE I)
Diuretics erythromycin/clarithromycin Insulin B2 agonsit aminophylline/ Theophylline Corticosteroids
34
how do you treat mild hypokalaemia compared to severe hypokalaemia? what if hypokalameia was caused by diuretic?
mild = oral slow potassium chloride severe = IV potassium chloride if caused by diuretic then potassium-sparing diuretic preferred
35
what are acute porphyrias? what is used in their treatment?
genetic defect in haem biosynthesis haem arginate
36
what are the fat soluble vitamin?
A, D, E, K
37
what are the water soluble vitamins?
B, C
38
what vitamin is retinol? what does retinol deficiency present as? what are the sources?
vitamin A occular effects, dry eyes, risk of infection due to bad immune system , bad skin sources = liver pates, fish liver oil, raw eggs
39
what vitamin is ascorbic acid? what does deficency present as? sources?
vitamin c scurvy, gingivitis oranges, tomatoes, peppers
40
what vitamin is colecalciferol? what does deficiency look like? what versions do you need to give in renal impairment? sources?
vitamin D rickets give hydroxylated version in renal impairment source = sun, UV
41
what vitamin is tocopherol? what does it do? what are the benefits? what are the sources?
vitamin E inhibits platelet aggregation - increased bleeding with warfarin powerful antioxidant, healthy skin & eyes sources = plant oils, nuts and seeds
42
what vitamin is phytomedadione? why is this given to all new born babies? what is the water soluble version and why would this be given? sources?
vitamin K given to all new born babies to prevent neonatal haemorrhage menadiol given in liver impairment sources = green leafy veg
43
what is vitamin B1? what's it used to treat? name some sources
thiamine used in Wernicke's encephalopathy wholegrain, fortified cerals
44
what's vitamin B2? name some benefits and some sources
riboflavin benefits = healthy skin, nerves, eyes sources = eggs, milk, rice
45
what's vitamin B3? name some sources
niacin meat, fish, eggs, milk
46
whats vitamin B6? what's is used for? name some sources
pyridoxine prevents peripheral neuropathy, given with isoniazid/penicillamine sources = chicken, veg, fortified cereals
47
what's vitamin B7? what's it essential for? name some sources
biotin essential for fat metabolism sources = veg, whole cereals
48
whats vitambin B12? what's it used to treat? sources?
cobalamin/hydroxycobalamin treats megoblastic anaemia - common deficiency in vegans sources = meat, salmon
49
why do pregnant women take folic acid? what dose do they take and how long for? what about the dose for women in high risk groups (antiepileptic meds, diabetic, sickle cell)
to redcue risk of neural tube defects (spina bifida) 400mcg before conception until week 12 of pregnancy women in high risk groups = 5mg for 12wks sickle cell disease - give throughout entire pregnancy
50
what is haemolytic anaemia? what do you need to do to the folate in the system?
where the blood cells break need to increase folate levels with folic acid
51
what is hydroxycarbamide used for?
sickle cell anaemia - helps with pain
52
what ethnicity is G6PD deficency most common in?
africa and asia (more commin in males)
53
what does a G6PD deficiency make people susceptible to?
developing acute haemolytic anaemia (RBC destruction)
54
what drugs need to be avoided in patients with G6PD deficiency and why? what drugs carry a lower risk?
dapsone and other sulfones, fluoroquinolones, nitrofurantoin, quinolones risk of haemolysis lower risk = aspirin, chloroquiine, mendadoine, quinine, sulfonylureas
55
when might prophylaxis iron be used?
- malabsorption - periods - pregnancy - post gastroectomy - haemodialysis - management of low birth weight infants
56
why ins't MR iron used often?
becuase it reduces absoprtion
57
what are the main SE of iron to look out for?
constipation/diarrohea balck tarry stools
58
in what condition would you stop iron supplements?
c diff as can cause diarrohea
59
when is iron best absorbed?
with orange juice and before food
60
how long do you need to continue iron once someones Hb is in range?
3 more months
61
whats the antidote for iron ?
desferrioxamine
62
what are the MHRA warning for parenteral iron?
serious hypersenstivity reactions with IV iron - need appropriately trained staff and resus must be available, monitor for hypersensitvity for at leat 30mins post administration
63
what causes megoblastic anaemia?
either B12 or folate deficiency
64
how long do you treat anaemia with hydroxycobalamin?
at intervals of up to 3 months
65
how do you treat folate deficiecny?
4 months of 5mg
66
in emergancies of megoblastic anameia how do you decide the cause
you dont- just treat with both (folate and B12) - treating with folate alone if undiagnosed can cause neuropathy
67
what pateints would be at risk of neural tube defects in pregnancy?
smoking sickle cell diabetes obestiy AED anti-malarials
68
whats used to reduce the risk of neutropenia?
all the grastims - they stimulate neutrophil production so reduce chemotherapy induced neutropenia and feribrile neutropenia filgrastim, lenograstim etc
69
whats 1st and 2nd line for hyperphosphate?
1. calcium acetate 2. selevemer

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