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pre reg Thammis cards > blood and nutrition (medium) > Flashcards

blood and nutrition (medium) Flashcards

1
Q

What are the 4 different types of anaemia

A

sickle cell anaemia
iron deficient anaemia
G6PD
mesoblastic

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2
Q

what is the management for sick cell anaemia crisis

A

fluid replacement
analgesia
antibiotics for any infections

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3
Q

what are the complications for sickle cell anaemia

A

leg ulcers
anaemia
renal failure
infections

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4
Q

management of haemolytic anaemia

A

folic acid supplements

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5
Q

what drug reduces the frequency of haemolytic anaemia and sickle cell crisis

A

hydroxycarbamide

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6
Q

what drugs are likely to cause haemolytic anaemia in those with G6PD deficiency

A

dapsone/ sulfones
fluoroquinolones/ quinolones
nitrofurantoin

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7
Q

what drugs have a possible risk of causing haemolysis in patients with G6PD deficiency

A 
aspirin
chloroquine
menadione
quinine
sulfonylureas
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8
Q

what are the 4 different types of oral iron tablets and their equivalent elemental iron dose

A

ferrous fumerate 200mg = 65mg iron
ferrous gluconate 300mg = 35mg iron
ferrous sulphate 300mg = 60mg iron
ferrous sulphate dried 300mg = 65mg iron

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9
Q

side effects of oral iron and how can these be reduced

A

constipation or diarrhoea
black tarry stools
take after food to reduce SE
although better absorption if taken before food

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10
Q

reversal for iron toxicity

A

desferrioxamine

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11
Q

counselling for iron preparations

A

stop in C.diff - may worsen due to diarrhoea
continue iron for 3 months after normal levels
take with vitamin C to increase absorption

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12
Q

what are the indications for parenteral iron and who should avoid

A

oral therapy not tolerated/ not working
chemotherapy induces anaemia
CKD receiving dialysis
AVOID IN PREGNANCY

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13
Q

MHRA warning parenteral iron and who are susceptible

A

serious hypersensitivity reaction
monitor for 30 minutes after each administration
high risk in allergy patients

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14
Q

what is mesoblastic anaemia

A

vitamin b12 deficiency/ malabsorption or folate deficiency

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15
Q

what is the management for mesoblastic anaemia

A

if vitamin B12 deficiency:
- give hydroxycobalamin (vitamin B12) in intervals up to 3 months (usually given for a period of time then 3 monthly)

if folate deficiency:
- give folic acid 5mg for 4 months

if emergency and deficiency unknown
- give both until results known

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16
Q

what are the doses of folic acid in pregnancy and risk of neural tube defects and what are the risk factors

A

regular pregnancy: 400mcg daily until 12 weeks of pregnancy

risk of NTD: 5mg daily until 12 weeks

risk factors:

  • AED
  • smoking
  • sickle cell anaemia
  • diabetes
  • obesity
  • antimalarial drugs
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17
Q

treatment for neutropenia

A

recombinant human granulocyte colony stimulating factor

filgrastin
lenograstim
pegfilgrastim
lipefilgrastim

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18
Q

what is the normal range for calcium

A

2.2 - 2.6 mmol/l

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19
Q

what is the normal level for magnesium

A

0.6 - 1mmol/l

20
Q

what is the normal level for phosphate

A

0.87 - 1.45 mmol/l

21
Q

what is the normal level for potassium

A

3.5 - 5.3 mmol/l

22
Q

what is the normal level of sodium

A

133 - 146 mmol/l

23
Q

what drugs can cause hypokalaemia

A 
aminophylline/ theophylline
beta agonists
corticosteroids
diuretics (loop/ thiazide)
erythro/ clarithromycin
insulin
24
Q

what drugs can cause hyperkalaemia

A 
trimethoprim
heparins
ACEI/ARBS
NSAIDs
k-sparing diuretics
beta blockers
25
Q

management of mild and severe hypokalaemia

how would treatment in renal impairment differ

A

mild: sando-K and review medication
severe: IV KCl in saline

renal impairment: reduced renal excretion of potassium so replace potassium cautiously

26
Q

what is the management of mild and severe hyperkalaemia

A

mild: calcium resonium - ion exchange resin

severe: 
IV calcium gluconate or chloride 10% 
IV soluble insulin with glucose 
salbutamol nebules/ slow IV 
review drugs

sodium bicarbonate may also be given to correct acidosis but not given in the same line as it will cause precipitation = thrombosis

27
Q

what drugs cause hyponatraemia and how is mild and severe hyponatraemia treated

A

carbamazapine
SSRI
diuretics
desmopressin/ vasopressin

treatment:
MILD - oral sodium chloride or sodium bicarbonate

SEVERE: IV NaCl

28
Q

drugs that cause hypernatraemia and treatment for hypernatraemia

A 
sodium compound drugs 
corticosteroids 
effervescent formulations
oestrogen and androgens 
lithium

treatment: IV glucose

29
Q

what drugs can cause hypocalcaemia

A

rifampicin, phenobarbital, phenytoin, bisphosphonate

30
Q

how do you treat mild hypocalcaemia and severe acute hypocalcaemia

A

in osteoporosis patients - doublerse the dose of calcium to reduce rate of bone loss

mild:
- oral supplements of vitamin d + calcium

severe:
- IV calcium gluconate 10 % with plasma calcium
- ECG monitoring as too quick = arrhythmia
- repeat if needed

31
Q

management of hypercalcaemia

A
  • correct dehydration with IV saline
  • discontinue drugs causing hypercalcaemia (thiazides, lithium)
  • bisphosphonates or pamidronate
  • corticosteroids if hypercalcaemia due to sarcoidoisis or vitamin d toxicity
  • calcitonin if malignancy
  • bendroflumethiazide and increasing fluid intake if hypercalciuria
32
Q

what electrolyte imbalance does hyperparathyroidism cause and what are the symptoms

A

hypercalcaemia, hyperphosphotaemia, hypercalciuria

symptoms: thirst, polyuria, constipation, fatigue, memory impairment, CVD, kidney stones, osteoporosis

33
Q

1st and 2nd line management of hyperparathyroidism

A

1st line: parathyroidectomy + assess CVD and fracture risk

2nd line:
cinnacalcet
bisphosphonates to reduce fracture risk

34
Q

what are the symptoms and mild/ severe treatment of hypermagnesemia

how does renal failure affect magnesium

A

symptoms: muscle weakness, arrhythmia

treatment:
calcium gluconate

magnesium is really excreted so renal impairment will cause hypermagnesemia

35
Q

symptoms and treatment of mild/ severe hypomagnesemia

A

symptoms: muscle weakness

treatment
mild: oral magnesium

severe: IV/IM magnesium sulphate (IM painful)

36
Q

management of hypophosphotaemia

A

in patients with alcohol dependence/ severe DKA:

oral phosphate supplements

37
Q

treatment of hyperphosphataemia

A

patients with stage 4/5 CKD
- manage diet
then start drug treatment

1st line: calcium acetate
2nd line: sevelamer
3rd line: calcium carbonate or sucroferric oxhydroxide (non- calcium based)

38
Q

management of acute porphyria

A

IV haem arginate

39
Q

what are the fat soluble vitamins

A

ADEK

40
Q

what are the water soluble vitamins

A

B, C

41
Q

what are are the symptoms of vitamin A deficiency and who should vitamin A be avoided in

A

symptoms: ocular effects, increased risk of infection

teratogenic - avoid in pregnancy

42
Q

what are the symptoms of vitamin D deficiency

A

rickets

43
Q

what are the symptoms of vitamin E deficiency and what foods are they found in

A

neuromuscular abnormalities

food: plant oils, nuts, wheat

44
Q

what are the symptoms of vitamin K deficiency and how is this treated and what are the counselling points

A

blood clotting issues = bleed risk

supplement: menadiol given in malabsorption syndrome

found in green leafy veg

45
Q

what are the symptoms of vitamin C deficiency

A

scurvy
lack of wound healing
unhealthy skin/ bone/ blood vessels

46
Q

what are the symptoms of the different vitamin B deficiencies

A

B1: thiamine = wernickes encephalopathy

b2: riboflavin - skin, eyes, CNS
b6: pyridoxine - treats peripheral neuropathy associated with isoniazid
b12: hydroxocobalamin - used for megoblastic anaemia

pre reg Thammis cards (8 decks)

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