Blood and Nutrition Flashcards
State when to offer Iron to patient
It should only be given in the presence of a demonstratable iron deficiency state
What is Iron Deficiency Anaemia
Fewer RBCs than normal or less haemoglobin than normal
Less oxygen carried round the body
Iron is required to make Haemoglobin
State the underlying cause of anaemia to be excluded before starting treatment
Gastric erosion
Gastrointestinal cancer
State the conditions that require iron prophylaxis
Pregnancy
Menorrhagia
Malabsorption
Haemodialysis patients
Management of low birth weight infant such as preterm neonates
After subtotal or total gastrectomy
What’s the preferred route of administration for Iron salt?
Mouth( oral route)
What’s the oral dose of elemental iron for Iron Deficiency Anaemia
100-200mg daily( usually dried ferrous sulphate)
What’s the content of ferrous Iron in ferrous fumarate 210mg
65mg
What’s the content of ferrous iron in ferrous gluconate 300mg
35mg
What’s the content of ferrous iron in ferrous sulphate 300mg
60mg
What’s the content of ferrous iron in ferrous sulfate dried 200mg
65mg
Compound preparation of iron contains
Iron and folic acid
Compound preparation in used for…
It’s used in pregnancy in women who are high risk of developing iron and folic acid deficiency
Whats the role of ascorbic acid in iron preparation
To aid absorption of iron
Facts about MR preparations of Iron
Licensed for OD
Have no therapeutic advantage and should not be used
List examples of parental Iron
Iron dextran
Iron sucrose
Ferric carboxymaltose
Iron Isomaltoside 1000
State when parenteral Iron is given
Oral therapy is unsuccessful
Adherence issues
Continuing blood loss
Malabsorption
Chemotherapy induced anaemia
Haemodialysis patient
Symptoms of Iron Deficiency
Tiredness
Struggling to concentrate
Memory problems
Reduce ability to exercise
Hair losing it condition, possible hair loss
Brittle nails, break, change shape and colour
Cuts and grazes taking ages to heal
A sore tongue
Sores at the corner of your mouth
Some side effects of Iron
GI irritation, nausea and epigastric pain
Constipation or diarrhoea
What preparation of oral Iron can exacerbate diarrhoea in patients with IBS
MR preparations
Counselling for pts on Iron
Take after food to reduce GI side effects if needed
Best absorbed on empty stomach
discolouration of stool
What’s G6PD ( Glucose 6 phosphate dehydrogenase)deficiency
A genetic condition where individuals are susceptible to developing acute hemolytic anaemia when they take a number of drugs and also when they eat Fava beans
G6PD deficiency is prevalence in
African, Asians, Oceania and South Europe
Most common in men than women
List drugs that have DEFINITE Risk of haemolysis in most G6PD deficient individuals
Dapsone and other sulfones
Nitrofurantoin
Fluroquinolones
Sulphanamide ( Co-trimoxazole
Methylthioninium chloride
Primaquine
Quinolones
Rasburicase
List drugs with POSSIBLE Risk of haemodialysis in some G6PD deficient individual
Sulfonylureas
Aspirin
Chloroquine
Menadione
Quinine
Naphthalene
Whats hydroxycobalamin injections used for
Prophylaxis of anaemia associated with vit B12 deficiency, pernicious anaemia
Given at 3 months intervals
What’s megaloblastic anaemia
Anaemia due to lack of either vit B12 or folic acid
Or due to pernicious Anaemia
Folic acid needed for around 4months until replenish body stores
What’s is pernicious anaemia
Lack of gastric intrinsic factor resulting from an autoimmune gastritis causes malabsorption of vit B12
Indication of folic acid
Given in pregnancy
Poor nutrition
AED
Methotrexate
Used in folate deficient megaloblastic anaemia as well as prophylaxis
Why is folic acid taking in pregnancy
It’s taken to prevent neural tube defects
High risk couples ( if one partner had the defect, family hx or other malabsorption state such as sickle cell, diabetes, AED)
Dose of folic acid for women at low risk of neural tube defect
400mcg daily before conception and until week 12
Dose of folic acid for women at high risk of neural tube defect
5mg daily until week 12
What are epoteins used for
Treat anaemia associated with erythropoietin deficiency in chronic kidney injury
What’s the indication of EPO-beta
Prevention of anaemia in pre term neonates with low birth weight
What is sickle cell disease
Structural abnormality of hb deformed less flexible RBC
Reduced oxygen to organs and severe pain
Drug used in the management of sickle cell disease
Hydroxycarbamide
Used to reduce frequency of crises and for blood transfusion
What are the chronic complications of sickle cell
Skin Ulceration
Renal failure
Increased risk of infections
Indication of folinic acid
Effective in the treatment of folate deficient megaloblastic anaemia but generally used with cytotoxic
It’s given as calcium folate
Facts about Magnesium ( electrolytes)
Involves in energy production
Not well absorbed from GI
Largest stores are in skeleton
What’s the side effect of Magnesium
Diarrhea ( occur at higher doses)
Interrupt tx and restart tx at lower dose if side effect occurs
State when to give zinc supplements
Only give Zinc supplements when there is good evidence of deficiency or in zn losing condition
Indication of Zinc
Used to treat Wilsons disease
Zinc deficiency occurs in..
Inadequate diet, malabsorption, trauma, burns, protein losing conditions
What conditions require TPN
Undernourished patients for surgery
Chemotherapy
Radiation therapy
Major surgery
Prolonged disorder of GI tract
Coma, trauma, refusal to eat,
Some pt with Renal or kidney failure
What is included in TPN
Amino acids
Glucose
Fat
Electrolytes
Trace elements
Vitamins
Eg Nutriflex
What are special diets?
Preparations which have been modified to eliminate a particular constituent from a food eg (gluten free]
What’s phenylketonuria
Inability to metabolise phenylalanine
How to manage PKU
Restrict dietary intake of phenylalanine
What contributes to phenylalanine intake
Aspartame
Symptoms of PKU
Moldy smell to breath, tremors , epilepsy, eczema, brain damage
See photo for electrolytes state
Fav
What drug is licensed for the tx of hypophosphataemia for pt on haemodialysis and peritoneal dialysis
Sevelamer and lanthanum
Phosphate depletion occur in severe …
Ketoacidosis
Phosphate infusion is occasionally used in..
Alcohol dependence
Oral phosphate supplements and vit D is required in small number of pts with….
Hypophosphataemic vit D resistant rickets
What is acute Porphyria
Metabolic disorder of haem biosynthesis
Treatment of acute porphyrias
Haem arginate IV infusion
Symptoms of acute Porphyria
Severe abdominal pain
Pain in the chest, legs or back
Constipation or diarrhoea
Nausea and Vomiting
Red or brown urine
Muscle pain, tingling, numbness, weakness or paralysis
What’s vit A ( Retinol)used for
Keeps skin healthy
Helps vision in dim light
Helps boost immune system
Good sources of Vit A
Cheese eggs, oily fish, liver and liver products
State why Vit A should be avoided in pregnancy
Too much vit Harmful to unborn babies
Should pregnant women eat liver?
No
Vit B deficiency is treated with
Thiamine(B1), riboflavin (B2) and nicotinamide
What are the severe deficiency state of Vitamin B
Wernicke’s encephalopathy and Korsakoff psychoses
How to tx wernike’s encephalopathy and Korsakoff’s psychosis especially in chronic alcoholism
I.V vitamin B followed by oral thiamine
What VITAMIN is deficient in patients treated with Isoniazid or penicillamine
PYRIDOXINE (B6)
Function of Vitamin C
Essential in scurvy
Symptoms of vitamin C deficiency
Bleeding gums
Use of vit D
Prevention and treatment of rickets
Examples of Vitamin D
Ergocalciferol( calciferol, vitamin D2)
Cholecalciferol ( vitamin D3) alfacalcidol and calcitriol)
What causes vit D deficiency
Limited exposure to sunlight or diet deficiency
A synthetic vit D analogue used to prevent and treat secondary hyperparathyroididm associated with chronic renal failure
Paricalcitol
Individuals at risk of Vitamin D deficiency
Dark skin( African, afro carribean, South Asian Origin)
Individual >65yrs
Individual with low or no exposure to sunlight
Pregnant and Breastfeeding women esp teenagers and young women
Children under 4
Facts about Vitamin E ( Tocopherol)
No evidence of value in adults
Very low amounts may be linked to neuromuscular activities in young children
Uses of vitamin k
Production of blood clotting factors
Proteins for normal calcification of bones
A water soluble synthetic vitamin k given orally to prevent vitamin k deficiency is called
MENADIOL SODIUM PHOSPHATE
Antidote for oral coumarin Anticoagulant is
Vit K
Examples of fat soluble vitamins
ADEK
What’s neural tube defect
Congenital defect caused by incomplete closure of neural tube within 28days of conception
List examples of neural tube defect
Spina bifida
Encephalocele
Anencephally
Main risk factors
Maternal folate deficiency
Maternal vit B12 deficiency
Previous hx of infant with neural defects
Smoking obesity , diabetes and use of AED
Neural tube defect prevention in pregnancy
Supplement with folic acid before conception and until week 12 of pregnancy
High dose recommended for women at higher risk
