blood and nutrition

Question 1

what is G6PD deficiency?

Answer 1

A defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely.

Question 2

what patient groups is G6PD deficiency most common in?

Answer 2

Africans, asians, oceania, and south europe
Men

Question 3

Consequences of G6PD

Answer 3

acute haemolytic anaemia

Question 4

What food should be avoided ?

Answer 4

fava beans (broad beans)

Question 5

What drugs have a DEFINITE RISK and should be avoided in G6PD deficiency?

Answer 5

BOLD- exam q
NITRO, FLUROQUINOLONES (cipro, olfloxacin, norfloxacin), SULPHONAMIDES (co-trimox), QUINOLONES (nalidixic acid)

others= dapsone, methylthionium chloride, primaquine, rasburicase

Question 6

What drugs have a POSSIBLE RISK and should be avoided in G6PD deficiency?

Answer 6

SULFONYLUREAS, ASPIRIN

chloroquine, menadione, quinine, napthalene (in mothballs?)

Question 7

treatments of anaemia associated with Vit b12 deficiency/pernicious anaemia?

Answer 7

hydroxycobalamin
cyanocobalamin

Question 8

how often should hydroxycobalamin be administered?

Answer 8

every 12 weeks

Question 9

what type of anaemia does folic acid treat?

Answer 9

megaloblastic anaemia (normally vit b12 or folic acid)

Question 10

what is pernicious anaemia

Answer 10

lack of gastric intrinsic factor which results from an autoimmune gastritis which causes malabsorption of vit B12

Question 11

indications of folic acid

Answer 11

pregnancy (prevention of neural tube defects)
poor nutrition
con current antiepileptics/methotrexate

Question 12

dose of folic acid for low and high risk pregnant women

Answer 12

low= 400mcg
high= 5mg

Question 13

When are Epoetins used to treat anaemias?

Answer 13

• erythropoietin deficiency in CKI
• symptomatic anaemia in patients receiving cytotoxic chemotherapy
• EPO- beta used for prevention of anaemia in pre-term neonates with a low birth weight

Question 14

What can be used to treat sickle cell disease?

Answer 14

Hydroxycarbamide (reduces frequency of crises and for blood transfusions)

Question 15

Counselling for hydroxycarbamide

Answer 15

cytotoxic- blood disorders
- effective contraception before and throughout treatment
- causes photosensitivity- protect skin from sunlight

Question 16

when is folinic acid used to treat anaemias

Answer 16

megaloblastic anaemia associated with cytotoxics

Question 17

what disease is treated with zinc?

Answer 17

wilsons disease

Question 18

Indications for TPN

Answer 18

• malnourishment
• chemotherapy
• radiation therapy
• major surgery
• prolonged disorders of GI tract
• Coma, trauma
• Patients
• some pts with renal or kidney failure

Question 19

what is included in TPN?

Answer 19

amino acids
glucose
fat
electrolytes
trace elements
vitamins
(nutriflex)

Question 20

what AA should be avoided in penyletonuria?

Answer 20

aspartame

Question 21

symptoms of penyletonuria

Answer 21

moldy smell to breath, temors, seizures, eczema and brain damage

Question 22

symptoms of hyper and hypokalaemia

Answer 22

hyper- arrythmia, muscle weakness, N&V, weak pulse, SOB

Hypo- Arrythmia, MUSCLE TWITCHING, cramps, weakness, paralysis

Question 23

symptoms of hyper and hyponatraemia

Answer 23

hypo- 3 Cs (coma, confusion and convulsions), N&V, headache, low BP

hyper- extreme thirst, dry mouth, dehydration, diabetes insipidus (polydipsia and polyuria)

Question 24

symptoms of hyper and hypocalcaemia

Answer 24

hyper- arrythmia, dehydration, coma, polyuria

hypo- muscle cramps

Question 25

symptoms of hyper and hypomagnesemia

Answer 25

hypo- ECG changes, Nystagmus, confusion and seizures, cramps

hyper-constipation, confusion, flushing, headache.

Question 26

Hyperphosphataemia symptoms

Answer 26

myscle crams, bone pain, joint pain

Question 27

symptoms of hyper and hypoglycaemia

Answer 27

hypo- hunger, fast HR, shaking, sweating, anxiety, confusion, dizziness

hyper- increased thirst/dry mouth, increased urination, blurred vision, unintentional weight loss

Question 28

What is used to treat Rickets

Answer 28

oral phosphate supplements + vitamin D (like osteoporosis- hypophasphataemic vit D resistant)

• caciferol (D2), colecalciferol (D3), alfacalcidol (renal impairment), calcitriol

Question 29

What conditions require phosphate treatement?

Answer 29

osteoporosis?
alcohol dependence
severe ketoacidosis

Question 30

What is acute porphyria

Answer 30

inability to produce haem (iron)

Question 31

treatment of acute porphyrias?

Answer 31

haem arginate IV infusion

Question 32

signs and symptoms of acute porphrias?

Answer 32

SEVERE ABDO PAIN, pain in chest/legs/back, constipation or diarrhoea, N&V, RED/BROWN URINE, muscle pain/paralysis/weakness

Question 33

Drugs to avoid in acute porphyria?

Answer 33

• amiodarone
• Antiepileptics- carbamazepine, ethosuximide, valproate, topiramate, phenytoin
• ABX- chloramphenicol, clindamycin, erythromycin, nitrofurantoin, trimethoprim, co-trimox
• Sulfonyureas- (except gipizide and glimepiride)
• RL CCBs- diltiazem and verapamil
• Diuretics/MRA- indapamide, spironolactone
• Contraceptives and HRT
• Griseofulvin
• Nitrazepam
• Risperidone
• Tricyclics
• sulfonamides- co-trimox and sulfasalazine

Question 34

In high doses, which vitamin can be harmful to unborn babies?

Answer 34

Vitamin A (avoid liver or liver products- Pate´

Question 35

treatment of wernickes encephalopathy and korsakoff’s psychosis?

Answer 35

severe- IV vitamin B then oral thiamine

Question 36

What drugs require co-administration of Pyridoxine (B6)

Answer 36

isoniazid (TB)
penicillamine

Question 37

What is scurvy and what are the symptoms?

Answer 37

deficiency in Vit B

bleeding gums, anaemia, myalgia

Question 38

Individuals at risk of Vit D deficiency?

Answer 38

• dark skin (less efficient at synthesising VIT D)
• > 65
• low or no sun exposure
• pregnant & BF
• Under 4

Question 39

What can be given to prevent Vit K deficiency?

Answer 39

oral menadiol sodium phosphate