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Victor BNF Notes > Blood and Nutrition > Flashcards

Blood and Nutrition Flashcards

1
Q

What is sickle cell

A

deformed red cells

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2
Q

What causes sickle cell

A

structural abnormalities of haemoglobin

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3
Q

What can hydroxycarbamide do in sickle cell

A
  • reduce frequency of crisis
  • reduce need for transfusions
  • effects may not be seen for months
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4
Q

What is G6PD

A

Glucose-6-phosphate dehydrogenase

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5
Q

In which ethnic groups and gender is G6PD deficiency common in

A
  • African
  • Asian
  • Oceania
  • Southern Europe
  • male
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6
Q

What are patients with G6PD deficiency at risk of developing when giving some common drugs

A

Haemolytic Anaemia

(destruction of red cells is faster than production)

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7
Q

What is Haemolytic Anaemia risk related to in the medication

A

Dose

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8
Q

Which medication are a definite risk of Haemolytic Anaemia with G6PD deficiency

A
  • Nitrofurantoin
  • Ciprofloxacin
  • Co-trimoxazole
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9
Q

Which medication may pose definite risk of Haemolytic Anaemia with G6PD deficiency

A
  • Aspirin
  • Quinine
  • Gliclazide
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10
Q

How to treat iron deficiency

A

Oral Iron (unless good reason for other route)

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11
Q

What is the difference between iron salts when choosing the best treatment

A
  • side effects
  • cost
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12
Q

What is normal dose and salt for elemental iron in iron deficiency

A
  • 100 to 200mg daily
  • Ferrous Sulphate
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13
Q

Oral iron gastrointestinal side effects

A
  • nausea
  • pain
  • diarrhoea
  • constipation
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14
Q

When to take oral iron

A
  • best absorbed on empty stomach
  • can be taken after food is side effects are a problem
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15
Q

What can oral iron do to stools

A

discolour
- dark black
- dark green

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16
Q

How is iron prescribed for patients who are in deficit

A
  • given for 1 month to reach body required levels
  • given for further 3 months to replenish iron stores
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17
Q

When does parental iron provide a faster haemoglobin response than oral iron

A

only in:
- severe renal failure
- patients receiving dialysis

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18
Q

Why should parental iron only be administered when needed and by trained staff

A

because parental iron has been reported to produce serious hypersensitivity reactions

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19
Q

When to monitor patients for hypersensitivity reactions when administering parental iron

A
  • During
  • 30 mins after administration
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20
Q

What increases the risk of hypersensitivity reactions to parental iron

A
  • allergies
  • immune conditions
  • inflammatory conditions
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21
Q

When should you avoid parental iron

A

1st trimester

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22
Q

What is megaloblastic anaemia

A
  • large blood cells
  • less blood cells
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23
Q

What causes megaloblastic anaemia

A

lack of either:
- Vitamin B12
or…
- Folate

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24
Q

When should megaloblastic anaemia treatment start

A

when test results are back and confirm diagnosis

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25
Q

In which people are vitamin b12 deficiencies common in

A
  • vegetarians
  • patients who have had total of partial gastronomy
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26
Q

What is 1 prophylaxis for total or partial gastronomy

A
  • vitamin b12

(as likely to be deficient in that)

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27
Q

Apart from dietary deficiency, what other causes of vitamin b12 deficiency is there

A

malabsorption

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28
Q

Example of parental Vitamin b12

A

Hydroxocobalamin

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29
Q

What is the regimen for vitamin b12 deficiency treatment

A
  • frequent IM injections to replenish body stores
  • then maintenance treatment initiated
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30
Q

What are reasons for folate deficiency

A
  • poor diet
  • pregnancy
  • anti-epileptic drugs
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31
Q

What is a dietary source for folic acid

A

broccoli

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32
Q

Folate deficiency treatment

A
  • daily folic acid
  • for 4 months
  • to replenish stores
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33
Q

What is neutropenia

A

bone marrow not being able to make enough neutrophils

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34
Q

Treatment for neutropenia

A

Recombinant human granulocyte-colony stimulating factors (GCSF)
(stimulate neutrophil production)

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35
Q

Examples of Recombinant human granulocyte-colony stimulating factors (GCSF)

A
  • Filgrastim
  • Lenograstim
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36
Q

Which Recombinant human granulocyte-colony stimulating factors (GCSF) should be avoided in pregnancy

A

Lenograstim

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37
Q

What drugs cause bone marrow suppression

A
  • Carbimazole
  • Clozapine
  • Co-trimoxazole
  • Sulfasalazine
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38
Q

What is the normal plasma level for sodium

A

142mmol/L

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39
Q

What is the normal plasma level for potassium

A

4.5mmol/L

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40
Q

What is the normal plasma level for bicarbonate

A

26 mmol/L

41
Q

What is the normal plasma level for chloride

A

103mmol/L

42
Q

What is the normal plasma level for calcium

A

2.5mmol/L

43
Q

Which two drugs can induce arrhythmias with potassium deficiency

A
  • digoxin
  • anti-arrhythmic drugs
44
Q

In which patients do you need to compensate for potassium loss

A
  • kidney problems
  • liver cirrhosis
  • severe heart failure
  • excessive loss of potassium in stool
  • elderly
45
Q

What drugs can induce potassium loss

A

corticosteroids

46
Q

if using diuretic to treat hypertension, is a potassium supplement needed

A

no

47
Q

When would you use IV potassium

A
  • severe hypokalaemia
  • not enough can be taken by mouth
48
Q

What is hyperkalaemia

A

serum potassium >5mmol/L

49
Q

Drugs that can cause hyperkalaemia

A
  • Enalapril
  • Ramipril
  • Losartan
  • Ciclosporin
50
Q

How do you treat hyperkalaemia

A

Calcium gluconate 10% slow IV
(to protect heart)

51
Q

Alternative IV treatment for hyperkalaemia

A

Soluble insulin (5 to 10 units) with 50ml glucose 50%

given over 5 to 15 mins

52
Q

When are calcium supplements usually required

A

when dietary calcium intake is deficient

53
Q

For which group of patients is calcium dietary requirement greater

A
  • Childhood
  • Pregnancy
  • Lactation
  • Old age (greater calcium malabsorption)
54
Q

In which condition is calcium recommended intake is doubled

A

osteoporosis
- because of the increased rate of bone loss

55
Q

What IV injection is used in severe acute hypocalcaemia

A

slow IV injection of Calcium Gluconate 10%

56
Q

What treatments are required in persistent hypocalcaemia

A
  • Calcium supplements
  • Vitamin D supplements (colecalciferole)
57
Q

How should you correct concurrent hypomagnesaemia

A

magnesium sulphate supplement

58
Q

What are the 4 treatment options for correcting hypercalcaemia

A
  • correct dehydration with Sodium Chloride 0.9 IV
  • Stop drugs which promote increased potassium
  • Restrict dietary calcium
  • Use drugs that inhibit mobilisation of calcium from the skeleton
59
Q

What drugs can cause hypercalcaemia

A
  • Vitmain D
  • Thiazides
60
Q

What drugs inhibit mobilisation of calcium from the skeleton

A
  • Bisphosphonates
  • Pamidronate Sodium
61
Q

Example of drugs that reduces calcium serum levels

A
  • corticosteroids
  • Bisphosphonates
  • Pamidronate Sodium
62
Q

Which salt is not absorbed well in the GI tract

A

Magnesium salts

63
Q

Why is magnesium retained in renal failure

A

as magnesium is secreted by kidney

64
Q

What are the most common causes of hypoagnesemia

A

magnesium loss from
- diarrhoea
- stoma
- fistula (connect between 2 organs)
- alcoholism

65
Q

How is magnesium given usually

A
  • IV infusion
  • IM injection (painful)
66
Q

What injection is used for emergency treatment of arrhythmias

A

Magnesium Sulphate IM injection

67
Q

What can lead to zinc deficiency

A
  • dietary deficiency
  • malabsorption
68
Q

How can excessive zinc loss occur

A
  • trauma
  • burns
  • protein losing conditions
69
Q

How is zinc deficncy treated

A

Zinc supplement given until goes to normal

70
Q

When should you continue zinc supplements

A

if
- severe malabsorption
- metabolic disorders
- Zinc losing states

then continue supplement

71
Q

What are Acute porphyria’s

A

group of disorders characterised by enzymatic deficiency in the haem biosynthetic pathway.

hereditary

72
Q

How to treat Acute porphyria’s

A

Haem Arginate

73
Q

Which drugs should be avoided in patients with Acute porphyria’s

A
  • Antidepressants
  • Antihistamines
  • CCB + Contraceptives
  • alcohol
  • amiodarone
  • clindamycin
  • cocaine
  • erythromycin
  • gliclazide
  • nitrofurantoin
  • phenytoin
  • spironolactone
  • trimethoprim
  • valproate
74
Q

What vitamin at high concentrations can cause birth defects during pregnancy

A

vitamin A

75
Q

What can vitamin A deficiency cause

A
  • ocular effects
  • increase susceptibility to infection
76
Q

What main type of vitamin B is usually deficient

A

B12

77
Q

What is another name for vitamin B1

A

Thiamine

78
Q

What does vitamin B1 metabolise

A

carbohydrates

79
Q

What would you use thiamine for

A

treatment of:
- alcoholic encephalopathy
- vitamin b1 deficiency

80
Q

What is vitamin B6 called

A

pyridoxine

81
Q

When might vitamin B6 deficiency occur

A

when using isoniazid therapy to treat tuberculosis

82
Q

Thiamine (B1) safety information

A

Although parental use can cause serious adverse reactions:
- this should not prevent parental use
- should be by infusion over 30 mins
- have anaphylaxis treatment around

83
Q

Pyridoxine (B6) safety information

A
  • Pyridoxine 10mg daily is considered safe
  • Pyridoxine 200mg daily is unsafe for long term and can cause neuropathy
84
Q

What is vitamin C known as

A

Ascorbic acid

85
Q

When is vitamin C therapy essential in

A

Scurvy

86
Q

What is scurvy

A

severe signs of malnutrition
- clogged hair follicles
- old wounds can reopen

87
Q

What can severe scurvy cause

A
  • gingival swelling and bleeding

(uncommon)

(this can indicate leukaemia)

88
Q

How to treat vitamin D deficiency

A

Colecalciferol (vitamin D)

89
Q

How can vitamin D deficiency be caused

A
  • not enough sunlight
  • insufficient dietary
  • malabsorption
  • chronic liver disease
90
Q

What organ does vitamin D need to work

A

hydroxylation by the kidney to its active form

91
Q

What are examples of vitamin D activated versions

A
  • Alacalcidol
  • Calcitrol

(hydroxylated derivatives)

92
Q

Why would someone need vitamin D hydroxylated derivatives instead of normal vitamin D

A

because they have severe renal impairment

93
Q

Why would someone be deficient of vitamin K

A
  • fat malabsorption
  • biliary obstruction
  • liver problems
94
Q

why does fat malabsorption cause vitamin K deficiency

A

as vitamin K is fat soluble, so needs fat to be absorbed

95
Q

What are neural tube defects

A

a category of neurological disorders related to malformations of the spinal cord

96
Q

What can help prevent neural tube defects

A

Folic Acid before and during pregnancy

97
Q

What is the dose of folic acid for the prevention of neural tube defects in women with low risk

A

40mcg before conception and until 12 weeks of pregnancy

98
Q

What is the dose of folic acid for the prevention of neural tube defects in women with high risk

A

5mg until 12 weeks pregnant

Victor BNF Notes (25 decks)

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