Blood and Blood forming organs Flashcards
what 2 drugs are given in sickle cell disease to help make new RBCs and reduce frequecy of sickle cell crises?
folate supplementation to help make RBCs
hydroxycarbamide to reduce crises
what deficiency is an inborn error of carbohydrate metabolism?
what does this predispose people to?
what drugs have this risk?
glucose-6-phosphate dehydrogenase deficiency
predisposes people to haemolytic anaemia
drugs with risk = dapsone, sulphonamides, nitrofurantoin, quinolones, rasburicase
when is prophylaxis for iron deficency anaemia required?
- malabsoprtion
- gastrectomcy
- menorrhagia
- chronic renal failure, haemodialysis
- pregnancy
- low birth weight
how should you counsel patients to take iron tablets?
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
what’s the MHRA advice regarding IV iron?
- take cuase with every IV dose, test doses not recommended
- monitor for 30mins after each injection
- high risk in allergies (asthma, eczema, inflammatory conditions)
- avoid in pregancy, especially 1st trimester
what is megoblastic anaemia caused by?
B12 or folic acid deficiency
what are the symptoms of megoblastic anaemia?
nimbness, tingling hands and feet muscle weakness, depresison
what are the 2 causes of B12 deficiency in megoblastic anaemia?
how does this influence route of treatment?
- dietary deficency - PO hydroxycobalamin
- malabsorption - Chron’s, gastrectomy - IM hydroxocobalamin
what are the causes of folate deficiency and how long is the treatment?
can you give folic acid alone for undiagnosed megablastic anaemia?
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
what drug is used in iron posioning?
desferrioxamine
what drug is used prevent neutropenia - used to redcue duration of chemotherapy-induced neutropenia?
filgrastim
name 3 symptoms of hypernatramia
convulsions
thrist
postural hypotension
tachycardia
hypovolaemia
what drugs can cause hypernatraemia? (C LOSS)
Corticosteroids
Lithium
Oral contraceptives
Sodium Bicarbonate
Sodium content in IV abx
what’s an alternative cause to hypernatraemia than drugs?
volume depletion e.g., diabetes inspidus - give IV glucose
name 3 symptoms of hyponatraemia
drowsiness
confucion
headaches
cramps
N&V
what drugs can cause hyponatraemia? ALDC
Antidepressants
Loop and thiazide diuretics
Desmopressin
Carbamazapine
how do you manage mild-moderate and severe hyponatraemia?
mild-moderate = PO NaCL/NaCO3, add glucose if water depletion
severe = IV saline
what’s the risk of giving IV saline?
osmotic demyelinationsyndrome
what does oral rehydration therapy contain?
K+, Na+, glucose
what is metabolic acidosis signified by?
high chloride (hyperchloraemia), large anoin gap
what do you give to treat metabolic acidosis?
sodium bicarbonate
or potassium bicarbonate if caused by low potassium
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?
bisphosphonates ot corticosteroids
hypercalcaemia of malignancy = calcitonin
if caused by hypoerparathyroidism = cinalcet
if pt has renal failure - give paracalcitol
what do you give to treat hypoercalciuria?
benfroflumethiazide, increase fluid intake and reduce deitary calcium
what is hypercalciuria?
high calcium in urine
what’s the main cause of hypocalcaemia?
osteoporosis
how do you manage mild-oderate hypocalcaemia and severe acute hypocalaemia?
mild-moderate = vit d + calcium supplements
severe acute = slow IV calcium gluconate
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
how do you manage hyperphosphateaemia and hypophosphataemia?
high posphate = calcium-containing preperations (sevelmar = phosphate binder)
low phosphate = IV phosphate
what drugs can cause hyperkalaemia? (HADBEANS)
Heparin
Ace i
Digoxin
Beta blockers
Eplerenone
Amiloride
NSAIDs
Spironolactone
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
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
what are the symptoms of hypokalaemia?
muscle hypotonia, arrhythmias
what drugs can cause hypokalaemia? (ABCDE I)
Diuretics
erythromycin/clarithromycin
Insulin
B2 agonsit
aminophylline/ Theophylline
Corticosteroids
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
what are acute porphyrias?
what is used in their treatment?
genetic defect in haem biosynthesis
haem arginate
what are the fat soluble vitamin?
A, D, E, K
what are the water soluble vitamins?
B, C
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
what vitamin is ascorbic acid?
what does deficency present as?
sources?
vitamin c
scurvy, gingivitis
oranges, tomatoes, peppers
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
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
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
what is vitamin B1?
what’s it used to treat?
name some sources
thiamine
used in Wernicke’s encephalopathy
wholegrain, fortified cerals
what’s vitamin B2?
name some benefits and some sources
riboflavin
benefits = healthy skin, nerves, eyes
sources = eggs, milk, rice
what’s vitamin B3?
name some sources
niacin
meat, fish, eggs, milk
whats vitamin B6?
what’s is used for?
name some sources
pyridoxine
prevents peripheral neuropathy, given with isoniazid/penicillamine
sources = chicken, veg, fortified cereals
what’s vitamin B7?
what’s it essential for?
name some sources
biotin
essential for fat metabolism
sources = veg, whole cereals
whats vitambin B12?
what’s it used to treat?
sources?
cobalamin/hydroxycobalamin
treats megoblastic anaemia - common deficiency in vegans
sources = meat, salmon
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
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
what is hydroxycarbamide used for?
sickle cell anaemia - helps with pain
what ethnicity is G6PD deficency most common in?
africa and asia (more commin in males)
what does a G6PD deficiency make people susceptible to?
developing acute haemolytic anaemia (RBC destruction)
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
when might prophylaxis iron be used?
- malabsorption
- periods
- pregnancy
- post gastroectomy
- haemodialysis
- management of low birth weight infants
why ins’t MR iron used often?
becuase it reduces absoprtion
what are the main SE of iron to look out for?
constipation/diarrohea
balck tarry stools
in what condition would you stop iron supplements?
c diff as can cause diarrohea
when is iron best absorbed?
with orange juice and before food
how long do you need to continue iron once someones Hb is in range?
3 more months
whats the antidote for iron ?
desferrioxamine
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
what causes megoblastic anaemia?
either B12 or folate deficiency
how long do you treat anaemia with hydroxycobalamin?
at intervals of up to 3 months
how do you treat folate deficiecny?
4 months of 5mg
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
what pateints would be at risk of neural tube defects in pregnancy?
smoking
sickle cell
diabetes
obestiy
AED
anti-malarials
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
whats 1st and 2nd line for hyperphosphate?
- calcium acetate
- selevemer
