Blood and Nutrition Flashcards
What is sickle cell
deformed red cells
What causes sickle cell
structural abnormalities of haemoglobin
What can hydroxycarbamide do in sickle cell
- reduce frequency of crisis
- reduce need for transfusions
- effects may not be seen for months
What is G6PD
Glucose-6-phosphate dehydrogenase
In which ethnic groups and gender is G6PD deficiency common in
- African
- Asian
- Oceania
- Southern Europe
- male
What are patients with G6PD deficiency at risk of developing when giving some common drugs
Haemolytic Anaemia
(destruction of red cells is faster than production)
What is Haemolytic Anaemia risk related to in the medication
Dose
Which medication are a definite risk of Haemolytic Anaemia with G6PD deficiency
- Nitrofurantoin
- Ciprofloxacin
- Co-trimoxazole
Which medication may pose definite risk of Haemolytic Anaemia with G6PD deficiency
- Aspirin
- Quinine
- Gliclazide
How to treat iron deficiency
Oral Iron (unless good reason for other route)
What is the difference between iron salts when choosing the best treatment
- side effects
- cost
What is normal dose and salt for elemental iron in iron deficiency
- 100 to 200mg daily
- Ferrous Sulphate
Oral iron gastrointestinal side effects
- nausea
- pain
- diarrhoea
- constipation
When to take oral iron
- best absorbed on empty stomach
- can be taken after food is side effects are a problem
What can oral iron do to stools
discolour
- dark black
- dark green
How is iron prescribed for patients who are in deficit
- given for 1 month to reach body required levels
- given for further 3 months to replenish iron stores
When does parental iron provide a faster haemoglobin response than oral iron
only in:
- severe renal failure
- patients receiving dialysis
Why should parental iron only be administered when needed and by trained staff
because parental iron has been reported to produce serious hypersensitivity reactions
When to monitor patients for hypersensitivity reactions when administering parental iron
- During
- 30 mins after administration
What increases the risk of hypersensitivity reactions to parental iron
- allergies
- immune conditions
- inflammatory conditions
When should you avoid parental iron
1st trimester
What is megaloblastic anaemia
- large blood cells
- less blood cells
What causes megaloblastic anaemia
lack of either:
- Vitamin B12
or…
- Folate
When should megaloblastic anaemia treatment start
when test results are back and confirm diagnosis
In which people are vitamin b12 deficiencies common in
- vegetarians
- patients who have had total of partial gastronomy
What is 1 prophylaxis for total or partial gastronomy
- vitamin b12
(as likely to be deficient in that)
Apart from dietary deficiency, what other causes of vitamin b12 deficiency is there
malabsorption
Example of parental Vitamin b12
Hydroxocobalamin
What is the regimen for vitamin b12 deficiency treatment
- frequent IM injections to replenish body stores
- then maintenance treatment initiated
What are reasons for folate deficiency
- poor diet
- pregnancy
- anti-epileptic drugs
What is a dietary source for folic acid
broccoli
Folate deficiency treatment
- daily folic acid
- for 4 months
- to replenish stores
What is neutropenia
bone marrow not being able to make enough neutrophils
Treatment for neutropenia
Recombinant human granulocyte-colony stimulating factors (GCSF)
(stimulate neutrophil production)
Examples of Recombinant human granulocyte-colony stimulating factors (GCSF)
- Filgrastim
- Lenograstim
Which Recombinant human granulocyte-colony stimulating factors (GCSF) should be avoided in pregnancy
Lenograstim
What drugs cause bone marrow suppression
- Carbimazole
- Clozapine
- Co-trimoxazole
- Sulfasalazine
What is the normal plasma level for sodium
142mmol/L
What is the normal plasma level for potassium
4.5mmol/L
What is the normal plasma level for bicarbonate
26 mmol/L
What is the normal plasma level for chloride
103mmol/L
What is the normal plasma level for calcium
2.5mmol/L
Which two drugs can induce arrhythmias with potassium deficiency
- digoxin
- anti-arrhythmic drugs
In which patients do you need to compensate for potassium loss
- kidney problems
- liver cirrhosis
- severe heart failure
- excessive loss of potassium in stool
- elderly
What drugs can induce potassium loss
corticosteroids
if using diuretic to treat hypertension, is a potassium supplement needed
no
When would you use IV potassium
- severe hypokalaemia
- not enough can be taken by mouth
What is hyperkalaemia
serum potassium >5mmol/L
Drugs that can cause hyperkalaemia
- Enalapril
- Ramipril
- Losartan
- Ciclosporin
How do you treat hyperkalaemia
Calcium gluconate 10% slow IV
(to protect heart)
Alternative IV treatment for hyperkalaemia
Soluble insulin (5 to 10 units) with 50ml glucose 50%
given over 5 to 15 mins
When are calcium supplements usually required
when dietary calcium intake is deficient
For which group of patients is calcium dietary requirement greater
- Childhood
- Pregnancy
- Lactation
- Old age (greater calcium malabsorption)
In which condition is calcium recommended intake is doubled
osteoporosis
- because of the increased rate of bone loss
What IV injection is used in severe acute hypocalcaemia
slow IV injection of Calcium Gluconate 10%
What treatments are required in persistent hypocalcaemia
- Calcium supplements
- Vitamin D supplements (colecalciferole)
How should you correct concurrent hypomagnesaemia
magnesium sulphate supplement
What are the 4 treatment options for correcting hypercalcaemia
- 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
What drugs can cause hypercalcaemia
- Vitmain D
- Thiazides
What drugs inhibit mobilisation of calcium from the skeleton
- Bisphosphonates
- Pamidronate Sodium
Example of drugs that reduces calcium serum levels
- corticosteroids
- Bisphosphonates
- Pamidronate Sodium
Which salt is not absorbed well in the GI tract
Magnesium salts
Why is magnesium retained in renal failure
as magnesium is secreted by kidney
What are the most common causes of hypoagnesemia
magnesium loss from
- diarrhoea
- stoma
- fistula (connect between 2 organs)
- alcoholism
How is magnesium given usually
- IV infusion
- IM injection (painful)
What injection is used for emergency treatment of arrhythmias
Magnesium Sulphate IM injection
What can lead to zinc deficiency
- dietary deficiency
- malabsorption
How can excessive zinc loss occur
- trauma
- burns
- protein losing conditions
How is zinc deficncy treated
Zinc supplement given until goes to normal
When should you continue zinc supplements
if
- severe malabsorption
- metabolic disorders
- Zinc losing states
then continue supplement
What are Acute porphyria’s
group of disorders characterised by enzymatic deficiency in the haem biosynthetic pathway.
hereditary
How to treat Acute porphyria’s
Haem Arginate
Which drugs should be avoided in patients with Acute porphyria’s
- Antidepressants
- Antihistamines
- CCB + Contraceptives
- alcohol
- amiodarone
- clindamycin
- cocaine
- erythromycin
- gliclazide
- nitrofurantoin
- phenytoin
- spironolactone
- trimethoprim
- valproate
What vitamin at high concentrations can cause birth defects during pregnancy
vitamin A
What can vitamin A deficiency cause
- ocular effects
- increase susceptibility to infection
What main type of vitamin B is usually deficient
B12
What is another name for vitamin B1
Thiamine
What does vitamin B1 metabolise
carbohydrates
What would you use thiamine for
treatment of:
- alcoholic encephalopathy
- vitamin b1 deficiency
What is vitamin B6 called
pyridoxine
When might vitamin B6 deficiency occur
when using isoniazid therapy to treat tuberculosis
Thiamine (B1) safety information
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
Pyridoxine (B6) safety information
- Pyridoxine 10mg daily is considered safe
- Pyridoxine 200mg daily is unsafe for long term and can cause neuropathy
What is vitamin C known as
Ascorbic acid
When is vitamin C therapy essential in
Scurvy
What is scurvy
severe signs of malnutrition
- clogged hair follicles
- old wounds can reopen
What can severe scurvy cause
- gingival swelling and bleeding
(uncommon)
(this can indicate leukaemia)
How to treat vitamin D deficiency
Colecalciferol (vitamin D)
How can vitamin D deficiency be caused
- not enough sunlight
- insufficient dietary
- malabsorption
- chronic liver disease
What organ does vitamin D need to work
hydroxylation by the kidney to its active form
What are examples of vitamin D activated versions
- Alacalcidol
- Calcitrol
(hydroxylated derivatives)
Why would someone need vitamin D hydroxylated derivatives instead of normal vitamin D
because they have severe renal impairment
Why would someone be deficient of vitamin K
- fat malabsorption
- biliary obstruction
- liver problems
why does fat malabsorption cause vitamin K deficiency
as vitamin K is fat soluble, so needs fat to be absorbed
What are neural tube defects
a category of neurological disorders related to malformations of the spinal cord
What can help prevent neural tube defects
Folic Acid before and during pregnancy
What is the dose of folic acid for the prevention of neural tube defects in women with low risk
40mcg before conception and until 12 weeks of pregnancy
What is the dose of folic acid for the prevention of neural tube defects in women with high risk
5mg until 12 weeks pregnant
