blood and nutrition (medium) Flashcards by Thamanna Miah

What are the 4 different types of anaemia

sickle cell anaemia
iron deficient anaemia
G6PD
mesoblastic

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what is the management for sick cell anaemia crisis

fluid replacement
analgesia
antibiotics for any infections

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what are the complications for sickle cell anaemia

leg ulcers
anaemia
renal failure
infections

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management of haemolytic anaemia

folic acid supplements

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

hydroxycarbamide

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

dapsone/ sulfones
fluoroquinolones/ quinolones
nitrofurantoin

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

aspirin
chloroquine
menadione
quinine
sulfonylureas

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

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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side effects of oral iron and how can these be reduced

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

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reversal for iron toxicity

desferrioxamine

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counselling for iron preparations

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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what are the indications for parenteral iron and who should avoid

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

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MHRA warning parenteral iron and who are susceptible

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

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what is mesoblastic anaemia

vitamin b12 deficiency/ malabsorption or folate deficiency

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what is the management for mesoblastic anaemia

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

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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treatment for neutropenia

recombinant human granulocyte colony stimulating factor

filgrastin
lenograstim
pegfilgrastim
lipefilgrastim

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what is the normal range for calcium

2.2 - 2.6 mmol/l

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what is the normal level for magnesium

0.6 - 1mmol/l

what is the normal level for phosphate

0.87 - 1.45 mmol/l

what is the normal level for potassium

3.5 - 5.3 mmol/l

what is the normal level of sodium

133 - 146 mmol/l

what drugs can cause hypokalaemia

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

what drugs can cause hyperkalaemia

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

management of mild and severe hypokalaemia how would treatment in renal impairment differ

mild: sando-K and review medication severe: IV KCl in saline renal impairment: reduced renal excretion of potassium so replace potassium cautiously

what is the management of mild and severe hyperkalaemia

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

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

carbamazapine SSRI diuretics desmopressin/ vasopressin treatment: MILD - oral sodium chloride or sodium bicarbonate SEVERE: IV NaCl

drugs that cause hypernatraemia and treatment for hypernatraemia

``` sodium compound drugs corticosteroids effervescent formulations oestrogen and androgens lithium ``` treatment: IV glucose

what drugs can cause hypocalcaemia

rifampicin, phenobarbital, phenytoin, bisphosphonate

how do you treat mild hypocalcaemia and severe acute hypocalcaemia

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

management of hypercalcaemia

- 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

what electrolyte imbalance does hyperparathyroidism cause and what are the symptoms

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

1st and 2nd line management of hyperparathyroidism

1st line: parathyroidectomy + assess CVD and fracture risk 2nd line: cinnacalcet bisphosphonates to reduce fracture risk

what are the symptoms and mild/ severe treatment of hypermagnesemia how does renal failure affect magnesium

symptoms: muscle weakness, arrhythmia treatment: calcium gluconate magnesium is really excreted so renal impairment will cause hypermagnesemia

symptoms and treatment of mild/ severe hypomagnesemia

symptoms: muscle weakness treatment mild: oral magnesium severe: IV/IM magnesium sulphate (IM painful)

management of hypophosphotaemia

in patients with alcohol dependence/ severe DKA: | oral phosphate supplements

treatment of hyperphosphataemia

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)

management of acute porphyria

IV haem arginate

what are the fat soluble vitamins

ADEK

what are the water soluble vitamins

B, C

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

symptoms: ocular effects, increased risk of infection teratogenic - avoid in pregnancy

what are the symptoms of vitamin D deficiency

rickets

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

neuromuscular abnormalities food: plant oils, nuts, wheat

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

blood clotting issues = bleed risk supplement: menadiol given in malabsorption syndrome found in green leafy veg

what are the symptoms of vitamin C deficiency

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

what are the symptoms of the different vitamin B deficiencies

B1: thiamine = wernickes encephalopathy b2: riboflavin - skin, eyes, CNS b6: pyridoxine - treats peripheral neuropathy associated with isoniazid b12: hydroxocobalamin - used for megoblastic anaemia