blood and nutrition Flashcards
what is G6PD deficiency?
A defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely.
what patient groups is G6PD deficiency most common in?
Africans, asians, oceania, and south europe
Men
Consequences of G6PD
acute haemolytic anaemia
What food should be avoided ?
fava beans (broad beans)
What drugs have a DEFINITE RISK and should be avoided in G6PD deficiency?
BOLD- exam q
NITRO, FLUROQUINOLONES (cipro, olfloxacin, norfloxacin), SULPHONAMIDES (co-trimox), QUINOLONES (nalidixic acid)
others= dapsone, methylthionium chloride, primaquine, rasburicase
What drugs have a POSSIBLE RISK and should be avoided in G6PD deficiency?
SULFONYLUREAS, ASPIRIN
chloroquine, menadione, quinine, napthalene (in mothballs?)
treatments of anaemia associated with Vit b12 deficiency/pernicious anaemia?
hydroxycobalamin
cyanocobalamin
how often should hydroxycobalamin be administered?
every 12 weeks
what type of anaemia does folic acid treat?
megaloblastic anaemia (normally vit b12 or folic acid)
what is pernicious anaemia
lack of gastric intrinsic factor which results from an autoimmune gastritis which causes malabsorption of vit B12
indications of folic acid
pregnancy (prevention of neural tube defects)
poor nutrition
con current antiepileptics/methotrexate
dose of folic acid for low and high risk pregnant women
low= 400mcg
high= 5mg
When are Epoetins used to treat anaemias?
- 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
What can be used to treat sickle cell disease?
Hydroxycarbamide (reduces frequency of crises and for blood transfusions)
Counselling for hydroxycarbamide
cytotoxic- blood disorders
- effective contraception before and throughout treatment
- causes photosensitivity- protect skin from sunlight
when is folinic acid used to treat anaemias
megaloblastic anaemia associated with cytotoxics
what disease is treated with zinc?
wilsons disease
Indications for TPN
- malnourishment
- chemotherapy
- radiation therapy
- major surgery
- prolonged disorders of GI tract
- Coma, trauma
- Patients
- some pts with renal or kidney failure
what is included in TPN?
amino acids
glucose
fat
electrolytes
trace elements
vitamins
(nutriflex)
what AA should be avoided in penyletonuria?
aspartame
symptoms of penyletonuria
moldy smell to breath, temors, seizures, eczema and brain damage
symptoms of hyper and hypokalaemia
hyper- arrythmia, muscle weakness, N&V, weak pulse, SOB
Hypo- Arrythmia, MUSCLE TWITCHING, cramps, weakness, paralysis
symptoms of hyper and hyponatraemia
hypo- 3 Cs (coma, confusion and convulsions), N&V, headache, low BP
hyper- extreme thirst, dry mouth, dehydration, diabetes insipidus (polydipsia and polyuria)
symptoms of hyper and hypocalcaemia
hyper- arrythmia, dehydration, coma, polyuria
hypo- muscle cramps
symptoms of hyper and hypomagnesemia
hypo- ECG changes, Nystagmus, confusion and seizures, cramps
hyper-constipation, confusion, flushing, headache.
Hyperphosphataemia symptoms
myscle crams, bone pain, joint pain
symptoms of hyper and hypoglycaemia
hypo- hunger, fast HR, shaking, sweating, anxiety, confusion, dizziness
hyper- increased thirst/dry mouth, increased urination, blurred vision, unintentional weight loss
What is used to treat Rickets
oral phosphate supplements + vitamin D (like osteoporosis- hypophasphataemic vit D resistant)
- caciferol (D2), colecalciferol (D3), alfacalcidol (renal impairment), calcitriol
What conditions require phosphate treatement?
osteoporosis?
alcohol dependence
severe ketoacidosis
What is acute porphyria
inability to produce haem (iron)
treatment of acute porphyrias?
haem arginate IV infusion
signs and symptoms of acute porphrias?
SEVERE ABDO PAIN, pain in chest/legs/back, constipation or diarrhoea, N&V, RED/BROWN URINE, muscle pain/paralysis/weakness
Drugs to avoid in acute porphyria?
- 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
In high doses, which vitamin can be harmful to unborn babies?
Vitamin A (avoid liver or liver products- Pate´
treatment of wernickes encephalopathy and korsakoff’s psychosis?
severe- IV vitamin B then oral thiamine
What drugs require co-administration of Pyridoxine (B6)
isoniazid (TB)
penicillamine
What is scurvy and what are the symptoms?
deficiency in Vit B
bleeding gums, anaemia, myalgia
Individuals at risk of Vit D deficiency?
- dark skin (less efficient at synthesising VIT D)
- > 65
- low or no sun exposure
- pregnant & BF
- Under 4
What can be given to prevent Vit K deficiency?
oral menadiol sodium phosphate
