Blood and Nutrition Flashcards by Ofonmbuk Urom

State when to offer Iron to patient

It should only be given in the presence of a demonstratable iron deficiency state

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

State the underlying cause of anaemia to be excluded before starting treatment

Gastric erosion
Gastrointestinal cancer

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What’s the preferred route of administration for Iron salt?

Mouth( oral route)

How well did you know this?

Not at all

Perfectly

What’s the oral dose of elemental iron for Iron Deficiency Anaemia

100-200mg daily( usually dried ferrous sulphate)

How well did you know this?

Not at all

Perfectly

What’s the content of ferrous Iron in ferrous fumarate 210mg

65mg

How well did you know this?

Not at all

Perfectly

What’s the content of ferrous iron in ferrous gluconate 300mg

35mg

How well did you know this?

Not at all

Perfectly

What’s the content of ferrous iron in ferrous sulphate 300mg

60mg

How well did you know this?

Not at all

Perfectly

What’s the content of ferrous iron in ferrous sulfate dried 200mg

65mg

How well did you know this?

Not at all

Perfectly

Compound preparation of iron contains

Iron and folic acid

How well did you know this?

Not at all

Perfectly

Compound preparation in used for…

It’s used in pregnancy in women who are high risk of developing iron and folic acid deficiency

How well did you know this?

Not at all

Perfectly

Whats the role of ascorbic acid in iron preparation

To aid absorption of iron

How well did you know this?

Not at all

Perfectly

Facts about MR preparations of Iron

Licensed for OD
Have no therapeutic advantage and should not be used

How well did you know this?

Not at all

Perfectly

List examples of parental Iron

Iron dextran
Iron sucrose
Ferric carboxymaltose
Iron Isomaltoside 1000

How well did you know this?

Not at all

Perfectly

State when parenteral Iron is given

Oral therapy is unsuccessful
Adherence issues
Continuing blood loss
Malabsorption
Chemotherapy induced anaemia
Haemodialysis patient

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Some side effects of Iron

GI irritation, nausea and epigastric pain
Constipation or diarrhoea

How well did you know this?

Not at all

Perfectly

What preparation of oral Iron can exacerbate diarrhoea in patients with IBS

MR preparations

How well did you know this?

Not at all

Perfectly

Counselling for pts on Iron

Take after food to reduce GI side effects if needed
Best absorbed on empty stomach
discolouration of stool

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

G6PD deficiency is prevalence in

African, Asians, Oceania and South Europe
Most common in men than women

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

List drugs with POSSIBLE Risk of haemodialysis in some G6PD deficient individual

Sulfonylureas
Aspirin
Chloroquine
Menadione
Quinine
Naphthalene

How well did you know this?

Not at all

Perfectly

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?

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