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Chapter 9 > Blood and nutrition > Flashcards

Blood and nutrition Flashcards

1
Q

What is sickle cell anaemia?

A

structural abnormality of haemoglobin

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2
Q

What symptoms are associated with sickle cell crisis?

A

severe pain, requires hospitalisation and blood transfusions

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3
Q

What are complications that can arise with sickle cell anaemia?

A

skin ulceration, renal failure, increased susceptibility to infections

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4
Q

What else is beneficial to these patients with sickle cell anaemia?

A

various vaccines and prophylactic penicillin required

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5
Q

Any treatment to help sickle cell anaemia?

A

hydroxycarbamide (antineoplastic) - reduces frequency of crisis. May take months for effect. Main s/E myelosuppression and skin reactions

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6
Q

Where is G6PD deficiency highly prevalent? Who is at higher risk?

A

Africa, Asia, Southern europe.

Males >females

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7
Q

Which drugs cause a DEFINITE risk to acute haemolytic anaemia? (acronym SON)

A

Quinolones, nitrofurantoin, sulphonamides

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8
Q

Which drugs cause a POSSIBLE risk to acute haemolytic anaemia? (Acronym SAQC)

A

Quinine, Sulphonylureas, chloroquine, aspirin >1g

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9
Q

Which drugs are used for hypoplastic and haemolytic anaemias?

A

anabolic steriods, pyridoxine, antilymphocyte immunoglobulin, rituximab and various corticosteriods

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10
Q

Before treating iron deficiency anaemia, what underlying causes should be ruled out?

A

gastric erosion, GI cancer

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11
Q

Which pts is prophylaxis iron prep used for?

A

menorrhagia, malabsorption, pre-term neonates, haemodialysis, pregnancy (iron and folic acid combo)

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12
Q

What is the elemental iron dose for iron-deficiency anaemia?

A

100-200mg daily

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13
Q

What is the choice of preparation decided by for iron?

A

incidence of s/e and cost

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14
Q

What are the side effects of iron?

A

GI irritation, constipation, diarrhoea, black discolouration of stools

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15
Q

What are the counselling points for someone taking iron?

A

best absorbed on empty stomach but can be taken with food to decrease GI effects, take with vitamin C (orange juice) to increase absorption.

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16
Q

How else is iron administered?

A

parenterally as iron dextran (CosmoFer) or Iron Sucrose (venofer)

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17
Q

Who can be given parenteral iron?

A

reserved for those who can tolerate oral iron such as chemotherapy-induced anaemia, chronic renal failure

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18
Q

How is the dose given for iron?

A

according to patient weight and iron deficit

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19
Q

What does the MHRA/CHM advice about injectable iron?

A

serious hypersensitivity reactions including life threatening and fatal anaphylactic reactions with IV iron. Pts should be closely monitored for at least 30 minutes after every administration.

Risk of hypersensitivity is increased in pts with known allergies, immune or inflammatory conditions or those with hx of severe asthma, eczema or other atopic allergy.

IV iron should be avoided in the first trimester of pregnancy and used in the second or third trimesters only if the benefit outweighs the potential risks for both mother and fetus.

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20
Q

What causes megaloblastic anaemia?

A

malabsorption of B12 or folate - pernicious anaemia is one of the causes of it in the UK

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21
Q

In which condition is vitamin B12 prophlactically given?

A

In gastrectomy

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22
Q

What is first line treatment vitamin B12 deficiency?

A

Hydroxocobalamin 1mg every 3mnths by IM injection

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23
Q

Why has hydroxocobalamin completely replaced cyanocobalamin?

A

Hydroxo is retained in the body longer than cyano therefore maintenance therapy can given at intervals of up to 3 months.

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24
Q

What is megaloblastic anaemia?

A

is a condition where the bone marrow produces unusually large and abnormal RBCs causing fatigue and weakness.

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25
Q

What is folic acid used for?

A

Megaloblastic anaemia, prevention of neural tube defects, methotrexate-induced SEs

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26
Q

Whats the dose of folic acid?

A

5mg OD, max 15mg OD for 4 months, which is enough time to replenish body stores.

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27
Q

Why can some pts develop folate deficiency megaloblastic anaemia?

A

can be due to poor nutrition, pregnancy or anti-epileptic drugs so folic acid must be taken daily for 4 months - replenishes body stores

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28
Q

How is folic acid given for the prevention of methotrexate induced s/e’s?

A

5mg once weekly on a different day to MTX dose

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29
Q

What condition is folinic acid given?

A

Given as calcium folinate used with cytotoxic drugs

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30
Q

What dose should be given for prevention of neural tube defects of folic acid?

A

if at low risk take 400mcg folic acid daily before conception until week 12 pregnancy
high risk groups should take 5mg folic acid

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31
Q

When is oral K+ necessary?

A

for pts taking digoxin and anti-arrhythmic drugs where K+ depletion may induce arrhythmias
in pts in whom secondary hyperaldosteronism occurs
in pts with excessive losses of K+ in faeces

32
Q

What is the range of K+?

A

3.5-5.3 mmol/L

33
Q

what is the disadvantage of K+ salts?

A

causes N/V and poor compliance is a major limitation

34
Q

What is the management of hyperkalaemia? what level can it be fatal?

A

can be fatal at >6.5mmol/L resulting from ventricular fribrillation and cardiac arrest
Use calcium gluconate 10% by IV, insulin 5-10units with 50mL glucose 50% given over 5-15 minutes or bicarbonate

35
Q

What causes hyperkalaemia?

A

renal failure, addisons disease, hypoxia or diabetic ketoacidosis, drug therapy

36
Q

What tx can help if there is mild or moderate hyperkalaemia when are there are no eCG changeS?

A

ion-exchange resins

37
Q

what levels can a pt become hypokalaemic? What symptoms do patients present with?

A 
asymptomatic 
Symptoms (< 2.5mmol/L) include muscle weakness, hypotonia, paralytic ileus, depression, confusion and arrhythmias. May be caused by persistent vomiting or diarrhoea, aldosteronism, cushings syndrome or by drug therapy
38
Q

What is the tx required for hypokalaemia?

A

K+ supplements. Check if its not drug induced e.g. thiazide and loop diuretics, corticosteriods

39
Q

When is oral rehydration therapy (ORT) used?

A

For diarrhoea

40
Q

What is the aim of ORT?

A

intestinal absorption of Na+ and H2O is enhanced by glucose (and other carbs). Replacement can be achieved by giving solutions containing sodium, potassium, and glucose or other carbs such as rice starch.

41
Q

What are the 6 things that ORT solutions should do?

A

check sheet

42
Q

What are glucose solutions mainly used for?

A

to replace water deficit

43
Q

When is calcium supplements required?

A

when dietary calcium intake is deficient

44
Q

What is the range of calcium?

A

Ca2+: 2.20-2.65 mmol/L

Adjusted (corrected) Ca2+: 2.10-2.58 mmol/L

45
Q

What occurs when a pt is hypercalcaemic?

A

precipitation of renal damage and cardiac arrest (>3.5mmol/L)

46
Q

What are common causes of hypercalaemic?

A

malignancy (bone metastases), thyrotoxicosis, hyperparathyroidism (elderly)

47
Q

What is the tx of hypercalcaemia?

A

required phopshate salts, cinacalcet or calcitonin

48
Q

What drugs cause hypercalaemia?

A

thiazides, Li, tamoxifen

effects of digoxin are enhanced with hypercalcaemia

49
Q

What causes hypocalcemia?

A

chronic renal failure and hpoparathyroidsm

Levels of >2.5mmol/L may result in loss of muscle tone, cardiac arrhythmias and tetany

50
Q

What is adjusted/corrected Ca2+?

A

40% of plasma Ca2+ is bound to albumin hence corrected Ca2+ levels are used which take this into account

51
Q

What is the tx of hypocalemia?

A

calcium and Vit D

52
Q

Which drugs cause hypocalemia?

A

biphosphonates, loop diuretics, phenytion

53
Q

What is given to pts with low blood volume?

A

albumin, dextran, gelatin, tetrastarch

54
Q

what are the most common cause of hypomagnesia?

A

severe diarrhoea or malnutrition

55
Q

What can hypomagnesia cause?

A

tetany, arrhythmias, tachycardia, respiratory depression

may occur alongside hypocalaemia/kalaemia

56
Q

What is the range of magnesium?

A

0.7- 1.05 mmol/L

57
Q

What treatment is required for hypomagnesium?

A

rarely necessary. Mg2+ salts can be administered

58
Q

What can cause hypomagnesia?

A

thiazide/loop diuretics, ciclosporin, biphosphonates

59
Q

What can IV Mg2+ be used for?

A

For emergency treatment of serious arrhythmias, treatment and prevention of recurrent seizures in women with ECLAMPSIA.

60
Q

What is the phosphate range?

A

0.85-1.45mmol/L

61
Q

which pts required phosphate supplements in addition to vitamin D supplements?

A

pts with hypophosphateamic vitaminD-resistant rickets

62
Q

What preparations are used as phosphate binding agents?

A

Calcium-containing preparations are used as phosphate-binding agents in the management of hyperphosphataemia complicating renal failure. Calcium acetate (Phosex/renacet) SHOULD be taken with meals.

63
Q

What level is considered as hypophosphatemia? How does this occur?

A

<0.5mmol/L - develops after prolonged periods (4 or more days) of starvation and responsible for refeeding symptoms.

64
Q

What are symptoms of hypophosphataemia? How to treat?

A

arrhythmias, rhabdomyolosis, seizures, confusion

Tx includes phosphate supplementation (oral for mild and IV for mod-severe) - regular monitoring

65
Q

What causes hyperphosphataemia?

A

CKD, high diet intake, hypoparathyroidism , drugs like amphotericin (liposomal form)

66
Q

What are symptoms of hyperphosphataemia?

A

muscle cramps, tetany, perioral numbness, tingling

67
Q

What is the tx for hyperphosphataeia ?

A

Sevelamer/Lanthanum is licensed for hyperphosphataemia in patients on dialysis or patients with CKD no t on dialysis but have serum-phosphate concentration >1.78mmol/L.

68
Q

What are the side effects for the following?

1) Aluminium based products
2) Calcium based products
3) Lanthanum/Sevelamer

A

1) Constipation
2) Hypercalcaemia
3) GI disturbances (taking with food will reduce these SEs)

69
Q

What is some advise you would give pts for phosphate supplements?

A

Always take WITH/AFTER FOOD to bind any phosphate present in food.

70
Q

What is the correct range for sodium?

A

133-146 mmol/L

71
Q

What are symptoms of hypernatramia?

A

water depletion - possible result of renal failure

confusion and coma can occur above 155mmol/L

72
Q

What is tx for hypernatraemia?

A

dextrose infusion or dialysis

73
Q

What drugs cause hypernatraemia?

A

corticosteriods, phenytoin, Li

74
Q

What are symptoms of hyponatraemia?

A

indication of Na+ depletion or water retnetion in excess of sodium which can occur due to cardiac failure
SIADH
muscle weakness, confusion and cardiac failure appear when levels fall below 1001-120mmol/L

75
Q

What is hyponatraemia tx with ?

A

mannitol, demeclocycline or limiting fluid intake (depending on cause)

76
Q

Which drugs cause hyponatramiea?

A

carbamazepine, thiazine diuretics

Chapter 9 (2 decks)

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