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Inori Pre Reg > Blood And Nutrition > Flashcards

Blood And Nutrition Flashcards

1
Q

What’s a sickle cell crisis?

A

An acute complication where infarction of the micro vascular and blood supply to organs result in severe pain

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2
Q

What does sicle cell crisis require?

A

Hospitalisation
IV fluids
Analgesia
Treatment of any concurrent infection

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3
Q

What’s a chronic complication of sickle cell anaemia?

A

Skin ulceration
Renal impairment
Increased susceptibility to infection

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4
Q

What can reduce the risk of infection for sickle cell pt?

A 
Pneumococcal vaccine
Haemophilus influenza b vaccine
Annual influenza vaccine
Prophylactic penicillin
Hepatitis B vaccine if not immune
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5
Q

What is erythropoiesis?

A

Production of RBCs

Development from erythropoietic stem cell to mature red cells

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6
Q

What can help sicle cell anemia pts?

A

Foliate supplementation = to support erythropoiesis

Hydroxycarbamide = reduces frequency of crisis and the need for blood transfusions
The benefit may not become evident for several months

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7
Q

What is G6PD deficiency

A

Glucose 6 phosphate dehydrogenase deficiency is an inborn error of carbohydrate metabolism which predisposes you to

  • developing acute hemolytic anaemia when taken common drugs
  • develop acute hemolytic anaemia when eaten fava beans /broad beans = called favism can be severe in children
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8
Q

What drugs has definitive risk of haemolysis in G6PD deficient pts?

A

Quinolones
Nitrofurantoin
Sulfonamides (co-trimoxazole)
Rasburicase

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9
Q

Drugs that have possible risk of haemolysis in G6PD deficient pts?

A

Aspirin (acceptable up to a dose of 1g daily)
Chloroquine, quinidine, quinine (acceptable in acute malaria)
Sulfonylureas

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10
Q

What is used to treat hypoplastic and hemolytic anaemia?

A 
Anabolic steroids
Pyridoxine HCL
Rituximab
Antilyphocyte immuniglobulin
Various corticosteroids
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11
Q

What is used to treta anaemia associated with erythropoietic deficiency in chronic renal failure?

A

Epoetins (recombinant human erythropoietins)
Epoetins beta used for prevention of anaemia in preterm neonates
Darbepoetin
Methoxy polyethylene glycol epoetin beta

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12
Q

Safety info on epoetins?

A

Very rare risk of severe cutaneous adverse reaction including Steven johnsons and toxic epidermal necrolusis
(more severe cases recorded with longer acting agents like Darbepoetin, Methoxy polyethylene)

Over correction using epoetins in pts with chronic kidney disease may increase the risk of death and serious CV events and in pts with cancer, may increase the risk of thrombosis
- try to maintain the haemoglobin conc. 10-12g/100ml (Hb higher than 12 should be avoided)

Increase risk of tumour progression in pts with anaemia associated with cancer

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13
Q

Who need prophylaxis with an iron preparation?

A 
Malabsorption e.g. Crohns disease
Menorrhagia
Preganancy
Gastrectomy
Haemodialysis pts = chronic renal failure
Low birth weight infants
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14
Q

Important safety info on injectable iron?

A

Serious hypersensitivity reactions including life threatening fatal anaphylaxis

  • closely monitor for at least 30mins after every administration
  • risk of hypersensitivity reaction is increased in pts with known allergy, immune, Inflammatory conditions, asthma, eczema
  • IV iron should be avoided in the 1st trimester of Preganancy and only used after if b wins r
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15
Q

Side effects of iron oral?

A

Constipation and occasionally lead to faecal imoaction

MR prep can exacerbate diarrhoea in pts with Inflammatory bowel disease, also care in intestinal stricture and diverticular diaease

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16
Q

How should Hb concn increase?

A

100-200mg/100ml (1-2g/L) per day or 2g/100ml over 3-4wks

When the Hb is within range, treatment should continue for a further 3wks to replenish the iron stores

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17
Q

Pt advice on iron oral?

A

Best to take on an empty stomach for best absorption but can be take with food to reduce GI side effect

May discolour stools

Take with a glass of orange juice as vit C aids absorption of iron

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18
Q

When are IV iron used?

A

Chronic renal failure with haemodilalysis
Malabsorption syndrome
Chemotherapy induce anaemia

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19
Q

What causes megaloblastic anaemia?

A

Vitamin B12 Or folic acid deficiency

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20
Q

Symptoms of megaloblastic anaemia?

A

Numbness, tingling hands/feet, muscle weakness, depression

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21
Q

Lack of what leads to B12 deficiency?

A

Hydroxycobalamin

Caused from dietary deficiency or malabsorption

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22
Q

Maintainance therapy of hydroxycobalamin I’m can be given at an interval of?

A

Up to 3months

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23
Q

Normally before treatment, megaloblastic anaemia, the deficiency leading to the cause needs to be differentiated
What to do in an emergency though?

A

Give both, folic acid and vitamin B12

-if folic acid is given alone, neuropathy can occur

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24
Q

What can cause foliate deficient megaloblastic anaemia?

A 
Poor nutrition
Pregnancy
Anti epileptic drugs
Methotrexate
Malabsorption
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25
Q

How to treat foliate deficient megaloblastic anaemia?

A

Folic acid 5mg daily for 4months

For pregs, until term

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26
Q

Why should folic acid never be given alone for undiagnosed megaloblastic anaemia?

A

Neuropathy of the spinal cord

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27
Q

Take caution to avoid iron overload, esp in children as it can be fatal

How do you treat iron overload?

A

1st line= repeated venesectn

2nd line =desferrioxamine (iron chelating compound)

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28
Q

How can desferrioxamine be enhanced?

A

By administration of ascorbic acid (vit C) 1 month after starting desferrioxamine but give separately from food

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29
Q

Who can not take ascorbic acid?

A

Cardiac dysfunction pts

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30
Q

Can you sell folic acid

A

Yes provided daily doses do not exceed 500mcg

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31
Q

How to treat low neutrophil count?

A

Filgrastim
It’s a recombinant granulocyte colony stimulating factor
Can reduce the duration of Chemotherapy induced neutropenia

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32
Q

Normal range of sodium?

A

133-146

33
Q

Symptoms of hypernatraemia?

A 
Convulsions
Hypokalaemia
Thirst
Dehydration
Oliguria (low output of urine)
Postural hypotention
Tachycardia
34
Q

Drugs that cause Hypernatraemia?

A 
Oral contraceptives
Corticosterouds
Sodium bicarbonate
Sodium contents in IV antibiotics
Lithium
35
Q

How to treat hypernatraemia caused by volume depletion?

A

Diabetes insipidum

IV glucose

36
Q

Symptoms of Hyponatraemia?

A 
Drowsiness
Confusion
Convulsions
N&V
Headache
Cramps
37
Q

Drugs that cause Hyponatraemia?

A

Antidepressants
Loop and thiazidr diuretics
Carbamazepine desmopressin

38
Q

Treatment of mild to moderate Hyponatraemia?

A

Oral sodium chloride/sodium bicarbonate

add glucose if there is water depletion

39
Q

Treatment of severe Hyponatraemia?

A 
IV Saline (isotonic via peripheral vein or concentrated via Central vein)
Give slowly as risk of osmotic demyelination syndrome
40
Q

How to manage electrolyte imbalance?

A

Oral rehydration therapy
(potassium, sodium, glucose)
Given over 3-4hrs in diarrhoea
Over 12hrs in hypernatraemia dehydration like diabetes insipidus

41
Q

How to manage water deficit?

A

IV glucose

Should not be given alone unless there is no significant loss of electrolytes

42
Q

What’s the normal range of chlorine? And what happens in hyperchloraemia?

A

Normal value is 103mmol/L

Metabolic acidosis happens

43
Q

How to treat metabolic acidosis?

A

Sodium bicarbonate
If caused by low potassium
Potassium bicarbonate

44
Q

Normal range of calcium?

A

2.10-2.58 mmol./L

45
Q

Treatment of hypercalcaemia?

A

Bisphosphonates it corticosteroids

46
Q

Hypercalcaemia of malignancy?

A

Calcitonin

47
Q

Treatment of hypercalcaemia caused by hyperparathytoidism?

A

Cinalcet reduces parathyroid hormone therefore calcium

Paracalcitol for chronic renal failure

48
Q

Management of hypercalciuria?

A

Bendroflumethiazide

Increase fluid intake and reduce dietary calcium

49
Q

What can Hypocalcaemia lead to?

A

Causes osteoporosis

50
Q

Management of mild to moderate Hypocalcaemia?

A

Vit D and calcium supplements

51
Q

Management of acute Hypocalcaemia or Hypocalcaemic tetany?

A

Slow IV calcium gluconatr

But if given too rapidly, can lead to arrhythmia

52
Q

Normal range of magnesium?

A

0.7-1.05mmol/L

53
Q

What condition is it common to have Hypomagnesium?

A

Alcoholics

54
Q

What can Hypomagnesium lead to?

A

Hypocalcaemia
Hypokalaemia
Hyponatraemia

55
Q

Management of Hypomagnesium?

A

IV/IM magnesium sulphate

56
Q

Normal range of phosphate?

A

0.85-1.45mmol/L

57
Q

Management of Hyperphosphataemia?

A 
Calcium containing preparations, phosphate binding agent
Like sevelamer
Calcium carbonate
Lanthanum
Sucroferric
58
Q

Management of hypophosphataemia?

A

Phosphate, Give IV if moderate to severe

59
Q

Normal range of potassium?

A

3.5-5.3mmol/L

60
Q

Symptoms of Hyperkalaemia?

A

Ventricular fibrillation

Cardiac arrest

61
Q

Drugs that cause Hyperkalaemia?

A 
HADBEANS
H=heparin
A=ACEi /ARB
D=digoxin (when overdose)
B=bbs
E=eplerenone
A=amiloride
N=NSAIDs
S=spironolactone
Ciclosporin, tacrolimus
62
Q

Management of mild to moderate Hyperkalaemia with no ECG change?

A

Calcium resonium

63
Q

Acute severe hyperkalaemia and its range?

A

Over 6.5mmol/L

Slow IV calcium gluconatr first to temporarily protect against myocardial Excitability
Then IV insulin, glucose and salbutamol
Add sodium bicarbonate to correct compounding acidosis
Do not give via the same line as can precipitate thrombosis

64
Q

Symptoms of Hypokalaemia?

A

Muscle hypotonia

Arrhythmia

65
Q

Drug that causes Hypokalaemia?

A 
Diuretics
Insulin
B2 agonists
Theophylline
Corticosteroids
66
Q

How to manage mild Hypokalaemia?

A

Oral slow potassium chloride
N&V cause poor compliance
Smaller doses required in renal imapirement

67
Q

Management of mild Hypokalaemia caused by diuretics?

A

K sparing diuretics

68
Q

Management of severe Hypokalaemia?

A

IV potassium chloride
Do not add glucose for initial potassium replacement as glucose cause hypokalaemia
KCL injection overdose is fatal so use ready mixed solution or throughly mix concentrate

69
Q

What is acute porphyria?

A

A genetic defect in haem biosynthesis

Some drugs can cause it as well as cause hemolytic anaemia

70
Q

Treatment of acute porphyria crises?

A

Haem arginate

71
Q

What does parenteral nutrition contain?

A 
Amino acids
Glucose
Electrolytes
Trace elements
Vitamins
72
Q

How are parenteral nutrition administered?

A

Via Central or peripheral vein

73
Q

How are SPN (Supplementary parenteral nutrition) given?

A

In addition to oral/enteral feeds

74
Q

When are total parenteral nutrition given (TPN)?

A

When it’s the sole source of nutrition

75
Q

How is TPN given?

A

Glucose is given via a central vein to avoid thrombosis
Give enough phosphates to allow the phosphorylation of glucose
Fructose and Sorbitol are added to avoid hgperosomolar hyperglycaemia nonketotic acidosis
Do not add additives to fat emulsions unless compatibility is known

76
Q

Fat soluble vitamins?

A

A D E K

77
Q

Water soluble vits?

A

B and C

78
Q

Symptoms of vit A deficiency
Benefits?
Disadvantage?
Source?

A

Occylar effects like dry eyes and risk of infection

Good night vision, good immune system and healthy skin

Teratogenic bc retinol

Liver pates, fish liver oil, raw eggs

79
Q

Other name of vit C?
Symptoms of vit C deficiency
Benefits?
Sources?

A

Ascorbic acid

Deficiency leads to scurvy, Gingival bleeding and petechiae (tiny purple red brown spot)

Aids absorption of iron
Claimed to help improve common cold
Protects cells, collagen formation

Oranges
Peppers
Tomatoes
Blackcurrant

Inori Pre Reg (22 decks)

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