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GPhC Exam > Blood and Nutrition > Flashcards

Blood and Nutrition Flashcards

1
Q

Sickle cell anaemia description

A

Deformed, less flexible red blood cells

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2
Q

Acute complications of sickle cell anaemia

A
  • sickle cell crisis - restricted blood supply to organs
  • hospitalisation - fluid replacement, analgesia, tx infections
  • complications: anaemia, leg ulcers, renal failure, susceptibility to infections
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3
Q

Haemolytic anaemia treatment

A

increase folate - give folic acid supplementation

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4
Q

Treatment of sickle cell anaemia complications

A

hydroxycarbamide - reduces frequency of painful crises and reduces transfusion requirements

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5
Q

G6PR (glucose-6-phosphate dehydrogenase) deficiency anaemia

A
  • common in Africa and Asia, more common in males
  • susceptible to developing acute haemolytic anaemia (haemolysis = RBC destruction)
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6
Q

Drugs with definite risk of haemolysis in G6PR deficient people

A
  • dapsone and other sulfones
  • fluoroquinolone/quinolones
  • nitrofurantoin
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7
Q

Drugs with possible risk of haemolysis in G6PD deficient people

A
  • aspirin
  • chloroquine
  • menadione
  • quinine
  • sulfonylureas
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8
Q

What is megaloblastic anemia

A

Either a B12 or folate deficiency - 1st step = establish cause

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9
Q

Vit B12 deficiency treatment

A

Hydroxycobalamin initiated with frequent IM injections to replenish stores then
hydroxycobalamin 3 monthly

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10
Q

Folate deficiency treatment

A
  • due to poor nutrition, pregnancy, or antiepileptics (phenytoin, carbamazepine, phenobarbital)
  • folic acid daily for 4 months
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11
Q

Megaloblastic anaemia deficiency emergency

A
  • give hydroxycobalamin and folic acid together while plasma assay results are waiting
  • don’t give folic acid alone if undiagnosed - may cause neuropathy
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12
Q

Folic acid doses

A
  • regular pregnancy: 400mcg OD from before conception to week 12
  • risk of NTD: 5mg OD from before conception to week 12
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13
Q

Risk factors for neural tubular defects

A
  • smoking
  • sickle cell anaemia
  • diabetes
  • obesity
  • anti-epileptics
  • anti-malarials
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14
Q

Iron deficiency anaemia symptoms

A

tiredness, SOB, palpitations, pale skin

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15
Q

When is prophylaxis with iron appropriate in IDA

A

malabsorption, menorrhagia, pregnancy, after total/subtotal gastrectomy, in haemodialysis patient, in management of low birth-weight infants e.g. preterm neonates

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16
Q

Precautions before treating IDA with iron

A
  • must show iron deficiency to treat with iron
  • exclude underlying cause e.g. gastric erosion, GI cancer
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17
Q

Oral iron types and dose

A
  • fumarate, gluconate, sulfate, sulfate (dried)
  • daily elemental iron dose = 100 to 200mg per day
  • usually sulfate (dried)
  • sulfate (dried) can be MR too (reduced absorption)
  • when Hb in range - continued for 3 months
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18
Q

Oral iron side effects

A
  • constipation/diarrhoea, black tarry stools
  • stop in C. diff due to diarrhoea
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19
Q

Oral iron absorption

A
  • with vitamin C (orange juice) to aid absorption
  • before food to aid absorption
  • after food to reduce side effects
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20
Q

Iron toxicity treatment

A

desferrioxamine

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21
Q

Parenteral iron types

A

dextran, sucrose, carboxymaltose, densomaltose

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22
Q

When should parenteral iron be used

A
  • oral not tolerated/doesn’t work
  • chemo-induced anaemia
  • chronic renal failure who are receiving haemodialysis
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23
Q

Parenteral iron MHRA warning

A
  • serious hypersensitivity reactions
  • appropriately trained staff and resuscitation must be available
  • monitor for reaction for at least 30 minutes after every administration
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24
Q

What is neutropenia

A
  • low neutrophil count (<1.5 x 10^9/L)
  • increased risk of infection and sepsis, especially in chemotherapy
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25
Q

Treatment for neutropenia

A
  • recombinant human granulocyte-colony stimulating factor (rhG-CSF)
  • e.g. filgrastim, lenograstim, pegfilgrastim, lipefilgrastim
  • stimulates neutrophil production do decreased duration of chemo-induced neutropenia so reduces incidence of febrile neutropenia
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26
Q

Normal ranges for electrolytes in mmol/L

A
  • Calcium: 2.2 - 2.6
  • Magnesium: 0.6 - 1
  • Phosphate: 0.87-1.45
  • Potassium: 3.5 - 5.3
  • Sodium: 133 - 146
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27
Q

Hypokalaemia side effects

A

muscle cramps, rhabdomyolysis, fatigue, palpitations, arrhythmias

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28
Q

Hyperkalaemia side effects

A

fatigue, numbness, nausea, SOB, chest pain, palpitations

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29
Q

Hyponatraemia side effects

A

nausea, headache, confusion, fatigue, irritability, seizures

30
Q

Hypernatraemia side effects

A

thirst, fatigue, confusion

31
Q

Hypocalcaemia side effects

A

muscle cramps, confusion, depressed, forgetful

32
Q

Hypercalcaemia side effects

A

nausea, lethargy, muscle cramps, confusion, arrhythmias

33
Q

Hyponatraemia and Lithium interaction

A

Hyponatraemia predisposes patient to lithium toxicity

34
Q

Drugs that cause Hyponatraemia

A

Carbamazapine
Diuretics
Desmopressin/vasopressin
SSRIs
Certain Drugs Ditch Salt

35
Q

Drugs that cause Hypernatraemia

A

Sodium bicarbonate/chloride
Corticosteroids
Effervescent formulations
Oestrogens/androgens
Salty CEO

36
Q

Hyponatraemia treatment

A

mild - mod = oral supplements (sodium chloride/bicarbonate)
severe = IV NaCl

37
Q

Hypernatraemia treatment

A

dietary: reduce salt intake

38
Q

Drugs that cause hypokalaemia

A

Aminophylline/theophylline
Beta agonists
Corticosteroids
Diuretics (loop/thiazide)
Erythro/clarithromycin
Insulin
ABCDEI

39
Q

Drugs that cause hyperkalaemia

A

Trimethoprim
Heparin
ACEi/ARBs
NSAIDs
K-Sparing diuretics
Beta - blockers
THANKS B

40
Q

Potassium imbalance causes:

A

cardiac side effects e.g. arrhythmias

41
Q

Hypokalaemia and digoxin interaction

A

Hypokalaemia predisposes patients to digoxin toxicity

42
Q

Hypokalaemia treatment

A

mild - mod = oral replacement (sando K)
severe = IV KCl in NaCl
K replaced cautiously in renal impairment - risk of hyperkalaemia secondary to renal impairment

43
Q

Hyperkalaemia treatment

A

mild - mod = ion exchange resins to remove excess K (calcium resonium)
acute sever (>6.5) = urgent tx:
- IV calcium chloride 10%/ calcium glauconate 10%
- IV soluble insulin (5-10 units) with 50mL glucose - 50% given over 5-15 minutes
- salbutamol nebulisation or slow IV injection
- drugs exacerbating hyperkalaemia reviewed/stopped

44
Q

Use of magnesium

A
  • essential in enzyme systems, energy generation - stored in skeleton
  • excreted by kidney so retained in renal failure = hypermagnesaemia
45
Q

Drugs causing hypomagnesaemia

A

PPIs, diuretics

46
Q

hypomagnesaemia treatment

A

mild = oral magnesium
symptomatic = IV/IM magnesium sulfate (IM=painful)

47
Q

hypermagnesaemia treatment

A

muscle weakness and arrhythmias
calcium glutinate injection used for management of magnesium toxicity

48
Q

hypocalcaemia cause and treatment

A
  • from reduced dietary calcium
  • tx with calcium supplements and vitamin D
  • in osteoporosis - double the recommended amount of calcium to reduce rate of bone loss
  • severe = initial slow IV calcium glauconite with plasma calcium and ECG monitoring - repeat if needed or follow with continuous IV infusion to prevent recurrence
49
Q

Drugs causing hypocalcaemia

A

rifampicin, phenytoin, phenobarbital, bisphosphonates

50
Q

Drugs causing hypercalcaemia

A

thiazide diuretics, lithium, vit D

51
Q

hypercalcaemia treatment

A

severe:
- correct dehydration with IV NaCl 0.9%
- stop drugs causing hyper, restrict dietary
- bisphosphinates and pamidronate disodium used
- corticosteroids if due to sarcoidosis or with vit D toxicity
- calcitonin in hyper associated with malignancy

52
Q

Hypercalciurea treatment

A
  • increase fluid intake and give bendroflumethiazide
  • decrease dietary calcium but not severe restriction (harmful)
53
Q

What is hyperparathyroidism

A

increase in parathyroid hormone= hypercalcaemia, hypercalciurea and hypophosphataemia

54
Q

hyperparathyroidism symptoms

A

thirst, polyurea, constipation, fatigue, memory impaired, CVD, kidney stones, osteoporosis
- affects 2x women than men, common in women 50 - 60 yrs

55
Q

1st line treatment of primary hyperparathyroidism

A

parathyroidectomy surgery
assess CVD risk and fracture risk

56
Q

hyperparathyroidism drug treatment

A
  • cincalcet if surgery unsuccessful/declined
  • in 2ndory care - measure vit D - supplement if needed
  • bisphosphonates to reduce fracture risk
57
Q

Hypophosphataemia cause and treatment

A
  • alcohol dependence or severe DKA
  • oral supplements
58
Q

Hyperphosphataemia treatment

A
  • phosphate binders (calcium or non-calcium based)
  • stage 4/5 CKD = manage diet and dialysis before starting tx
    1. calcium acetate
    2. sevelamer
    3. CaCO3 (calcium based) or sucroferric oxyhydroxide (non-calcium based)
59
Q

What is acute porphyrias

A

a metabolic, hereditary disorder of haem biosynthesis.
Causes severe pain in belly, chest, legs or back, digestive problems, confusion, red/brown urine.

60
Q

Drugs that can induce acute porphyria crises

A

amiodarone, carbamazepine, chloramphenicol, clindamycin, diltiazem, erythromycin, indapamide, isoniazid, mefenamic acid, methyldopa, nitrofurantoin, phenytoin, rifampicin, risperidone, spironolactone, tamoxifen, topiramate, trimethoprim, valproate, verapamil

61
Q

acute porphyria treatment

A

mod - severe = IV haem arginate

62
Q

Name the fat soluble vitamins

A

DEAK

63
Q

Vitamin A

A
  • is retinol
  • deficiency = ocular defects and increase risk of infections
  • avoid in pregnancy (teratogenic)
  • is in cheese, eggs, oily fish, milk, yogurt, liver products e.g. paté
64
Q

Vitamin D

A
  • is ergocalciferol (D2), cholecalciferol (D3), alfacalcidol, calcitriol
  • deficiency = rickets, from reduced sun and diet intake
  • vit D dose = 10mcg (400 units)
  • is in oily fish, red meat, liver, egg yolk, fortified foods e.g. cereal
65
Q

Vitamin E

A
  • is tocopherol
  • deficiency = neuromuscular abnormalities
  • is in plant oils, nuts, seeds, wheatgerm
66
Q

Vitamin K

A
  • is phytomenadione
  • blood clotting factors - reversal agent for warfarin
  • menadiol (water-soluble derivative) given orally in malabsorption syndromes
  • is in green leafy veg, veg oils, cereal grains
67
Q

Name the water soluble vitamins

A

BC

68
Q

Vitamin B

A
  • B1 (thiamine) = deficiency = wernickes encephalopathy
  • B2 (riboflavin) = keeps skin, eyes and nervous system healthy
  • B6 (pyridoxine) = to treat isoniazid associated peripheral neuropathy
  • B12 (hydroxocobalamin) = treatment of megaloblastic anaemia
  • is in meats, cereals and vegetables
69
Q

Vitamin C

A
  • is ascorbic acid
  • deficiency = scurvy
  • helps with wound healing and maintains healthy skin, blood vessels, bone and cartilage
  • is in oranges, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
70
Q

IV nutrition 2 methods

A
  1. supplemental parenteral nutrition - addition to ordinary feeding
  2. TPN - sole source of nutrition
71
Q

How is IV nutrition given

A

via central venous catheter (central line) or a peripheral vein

72
Q

What does IV nutrition contain

A

amino acids, glucose, fat, electrolytes, trace elements, vitamins
- proteins as synthetic L-amino acids - source of energy
- preferred card: glucose (infused through central venous catheter to avoid thrombosis)
- phosphate - for phosphorylation of glucose and preventing hypophosphataemia
- fructose and sorbitol - prevents hyperosmolar hyperglycaemic non-ketotic acidosis
- fat emulsions - high energy to fluid volume ratio (not to mix in additives)

GPhC Exam (22 decks)

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