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Pre Reg > Blood Disorders > Flashcards

Blood Disorders Flashcards

1
Q

What is the dose for iron for anaemia?

A

One daily or on alternate days and continue for three months after reach normal levels

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2
Q

What is the MHRA warning for IV iron?

A

Hypersensitivity

At higher risk: those with severe atopic reactions e.g. asthma and eczema, immune or inflammatory conditions

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3
Q

Can iron supplements be given to pregnant women?

A

Avoid during 1st trimester

Can be given in 2nd-3rd trimester if benefit outweighs risks

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4
Q

What are the side effects of iron and how should a patient take it?

A

SE: constipation or diarrhoea
- counsel to take with or after food if GI effects otherwise take on empty stomach to allow better absorption
- can take with glass of orange juice as vitamin C enhances absorption of iron

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5
Q

What drugs interact with iron?

A

Antacids - leave 2 hr gap
Bisphosphonates - leave 2 hr gap
Levothyroxine - leave 4 hr gap
Quinolones - leave 2 hr gap
Tetracyclines - leave 2 hr gap

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6
Q

What is megaloblastic anaemia?

A

Enlarged RBC caused by low B12 or folate

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7
Q

What are the symptoms of megaloblastic anaemia?

A

Fatigue
Dyspnoea
Tingling hands and feet
Muscle weakness

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8
Q

Who are at higher risk of megaloblastic anaemia?

A

Pregnant women
Patients taking antifolate drugs e.g. methotrexate
Patients taking antiepileptic drugs

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9
Q

How do you treat patients with megaloblastic anaemia with a B12 deficiency?

A

IM Hydroxocobalamin

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10
Q

What is the MHRA warning for hydroxocobalamin?

A

Those with cobalt allergy - look out for hypersensitivity reaction

Counsel patients to report any skin reactions and seek medical help:
- extensive ir blistering rash
- wheeze
- difficulty breathing
- feeling faint

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11
Q

How do you treat patients with megaloblastic anaemia with a folate deficiency?

A

Folic acid daily for 4 months
- never give alone unless B12 also tested

If both low - treat B12 first as otherwise it can cause spinal cord neuropathy

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12
Q

What are the symptoms of neutropenia?

A

Fever
Sore throat
Mouth ulcers
Influenza

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13
Q

How do you treat neutropenia?

A

Recombinant human granulocyte colony-stimulating factor
- filgratism

stimulate more bone marrow to make more granulocytes including neutrophils

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14
Q

How do you treat sickle cell anaemia?

A

Folic acid

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15
Q

How do you treat sickle cell crises?

A

Hydroxycarbamide

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16
Q

Which increases the risk of haemolytic anaemia from G6PD anaemia?

A

Fava beans (broad-beans) = favism
Infections

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17
Q

Who are more at risk of G6PD deficiency?

A

Those from Africa, Asia and Mediterranean region and the Middle east
Males

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18
Q

Which drugs have a definite risk of haemolysis in most G6PD-deficient individuals?

A

Nitrofurantoin
Fluoroquinolones
Quinolones
Sulfonamides

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19
Q

Which drugs have a possible risk of haemolysis in most G6PD-deficient individuals?

A

Aspirin
Chloroquine
Quinine
Sulfonylureas

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20
Q

What is used as immunosuppressive treatment for aplastic anaemia?

A

IV horse antitymocyte globulin in combination with ciclosporin

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21
Q

What is used to prevent adverse effects associated with antithymocyte globulin treatment?

A

Prednisolone

Early reactions include:
- fever
- rash
- fluid retention
- rigors
- acute respiratory distress syndrome
- anaphylaxis
- serum sickness may occur 7-14 days later

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22
Q

How is idiopathic sideroblastic anaemia treated?

A

Pyridoxine

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23
Q

What is used to treat erythropoietins deficiency in chronic renal failure?

A

Epoetins (recombinant human erythropoietins

  • also used to shorten period of symptomatic anaemia in patients receiving cytotoxic chemotherapy
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24
Q

Which eythropoietin is licensed for preventing anaemia in pre-term neonates of low birth-weight

A

Epoetin beta

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25
Q

What are the MHRA warnings associated with epoetins?

A

Recombinant human erythropoietins - very rare risk of severe cutaneous adverse reactions

Erythropoietins - overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase risk of death and serious cardiovascular events
- haemoglobin concentrations between 10-12g/ 100ml should be maintained

Erythropoietins - tumour progression and survival in patients with cancer

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26
Q

What are the side effects of epoetins?

A

Arthralgia
Embolism and thrombosis
Headache
Hypertension
Influenza like illness
Skin reactions
Stroke

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27
Q

What colour does hydroxocobalamin turn urine?

A

Reddish

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28
Q

How is immune thrombocytopenic purpura treated?

A

Corticosteroids - prednisolone

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29
Q

What are the symptoms of dehydration?

A

Thirst and reduced urine output
Light-headed and fatigue
Sunken eyes
Dry skin
Rapid breathing
Low BP

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30
Q

How is severe dehydration treated?

A

IV sodium chloride, potassium and glucose

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31
Q

What enhances absorption of oral rehydration therapy?

A

Glucose and rice starch

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32
Q

How do you rehydrate in diabetes insipidus?

A

Slowly over 12 hours because you lose water without losing sodium which causes hypernatremic dehydration

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33
Q

What are the symptoms of hyponatraemia?

A

Drowsiness
Muscle cramps
Headache
Confusion
N/V
Severe cases: coma/ seizure

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34
Q

What drugs can cause hyponatraemia?

A

Carbamazepine
Antidepressants
Desmopressin
Diuretics

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35
Q

How do you treat mild to moderate hyponatraemia?

A

Oral sodium salts

Chloride - if blood pH too alkaline
Bicarbonate - if blood pH too acidic

36
Q

How do you treat severe hyponatraemia?

A

IV saline

If injection in peripheral vein - it has to be isotonic and have the same salt concentration as blood

If higher saline concentration is required - use central vein

Use glucose and sodium when theres a combined water and sodium depletion

37
Q

What happens if you try to correct sodium imbalance too quickly?

A

risk of osmotic demyelination syndrome

38
Q

When is Hartmann’s solution used for hyponatraemia?

A

During or after surgery or in the initial management of the injured or wounded - reduces risk of hyperchloraemic acidosis

39
Q

What are the symptoms of hypernatraemia?

A

Low urine output
Thirst
Muscle spasms
Lethargy
N/V
Confusion
Seizure and coma in severe cases

40
Q

How is severe hypernatraemia treated?

A

IV glucose

41
Q

Which drugs are known to cause hypernatraemia?

A

Oral contraceptives
IV antibiotics
Corticosteroids
Lithium

42
Q

What two electrolytes go hand in hand?

A

Potassium and sodium

When sodium goes up, potassium goes down

43
Q

What are the signs and symptoms of hyperkalaemia?

A

Muscle cramps
Constipation
Fatigue
Arrhythmias
Polyuria
Polydipsia

44
Q

What drugs are associated with hypokalaemia?

A

Loop and thiazide diuretics
Insulin
Theophylline
Laxatives (overuse)
B2 agonists
Corticosteroids

45
Q

What is the treatment for mild-moderate hypokalaemia?

A

Oral potassium salts
- smaller doses required in renal insufficiency to reduce risk of hyperkalaemia

46
Q

What is the treatment for severe hypokalaemia?

A

IV potassium chlroide
- CAREFUL in overdose can be fatal

47
Q

What is potassium depletion commonly associated with?

A

Chloride depletion and metabolic acidosis

48
Q

What are the signs and symptoms of hyperkalaemia?

A

Muscle weakness
Numbness
Tingling
Arrhythmias
Cardiac arrest

49
Q

Which drugs are associated with hyperkalaemia?

A

ACE/ARB
BB
Digoxin
Potassium-sparing diuretics
Heparins
NSAIDs

Drug causes- HAD BEANS:
➢ Heparin
➢ ACE-inhibitors/ARBs
➢ Digoxin
➢ Beta blockers
➢ Eplerenone
➢ Amiloride
➢ NSAIDs
➢ Spironolactone

50
Q

How is acute severe hyperkalaemia treated in presence of ECG changes?

A

Potassium 6.5mmol/L or > or in the presence of ECG changes
- IV calcium chloride OR
- Calcium gluconate 10%
These temporarily protect against myocardial excitability

IV soluble insulin with 50ml of glucose 50% given over 5-10 minutes reduces serum-potassium concentration: can be repeated or infusion set-up

Salbutamol by nebulisation or slow IV may be given to reduce plasma-potassium concentration –> caution in patients with CVD

51
Q

How do you treat mild-moderate hyperkalaemia when there is no ECG changes?

A

Calcium resonium

52
Q

How do you treat hypomagnesiaemia?

A

IV/IM magnesium sulfate

53
Q

How do you treat hyperchloremia?

A

hyperchloremia can result in metabolic acidosis

Treat using IV sodium bicarbonate

If potassium levels low too - potassium bicarbonate

54
Q

How do you treat hypercalcaemia?

A

Bisphosphonates or corticosteroids

55
Q

How is hypercalciuria treated?

A

Increasing fluid and
Bendroflumethiazide

56
Q

What does Hyperparathyroidism result in?

A

Hypercalcaemia, hypophosphataemia and hypercalcuria

57
Q

What are the symptoms of hypercalcaemia?

A

Thirst
Increased urine output
Constipation
Fatigue
Memory impairment

Long-term effects
- CVD
- kidney stones
- osteoporosis
- fractures

58
Q

What is the treatment for hyperparathyroidism?

A

1st line surgery
2nd line: cinacalcet

increased risk of fractures - consider bisphosphonate BUT do not offer for chronic hypercalcaemia of primary hyperparathyroidism

59
Q

What is used to treat magnesium toxicity?

A

Calcium gluconate injection

60
Q

What is the MHRA warning for magnesium sulfate?

A

Risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy (administered for longer than 5-7 days)

61
Q

Which vitamin is teratogenic?

A

Vitamin A

62
Q

What is a sign of severe vitamin C deficiency?

A

Gingival bleeding

63
Q

What is the contraindication or vitamin E?

A

Warfarin

64
Q

What are the signs of vitamin A deficiency?

A

Ocular effects e.g. dry eyes, poor night vision, risk of infection

65
Q

What are good sources of vitamin A?

A

Lives pates
Fish liver oil
Raw eggs
Soft cheese

66
Q

What are the signs of vitamin C deficiency?

A

Scurvy
Gingival bleeding
petechiae

67
Q

When would you give an hydroxylated (activated) version of vitamin D?

A

In severe renal and hepatic impairment e.g. alfacalcidol, calcitriol

68
Q

What are the signs of iron poisoning?

A

N/V
Abdominal pain
Diarrhoea
Haematemesis
Rectal bleeding

Hypotension and hepatocellular necrosis can occur later

69
Q

What is used to treat iron poisoning?

A

IV desferrioxamine mesilate

70
Q

How do you treat hypercalcaemia of malignancy?

A

Calcitonin

71
Q

What vitamins does orlistat impair?

A

Vitamins (fat-soluble vitamins);
- A
- D
- K
- E

72
Q

What is used in Wernicke’s encephalopathy?

A

Vitamin B1 (thiamine)

73
Q

Which vein should glucose be given via?

A

Central vein to avoid thrombosis

74
Q

Why are Fructose and sorbitol given in parenteral nutrition?

A

avoid hyperosmolar hyperglycaemic acidosis

75
Q

Why is phosphate given in parenteral nutrition?

A

allow phosphorylation of glucose

76
Q

What ferritin level usually confirms a diagnosis of anaemia?

A

30 micrograms per litre

77
Q

What levels of haemoglobin in men, women, children and pregnant women would be considered as anaemia?

A

In men aged over 15 years - Hb below 130 g/L

In non-pregnant women aged over 15 years - Hb below 120 g/L

In children aged 12–14 years of age - Hb below 120 g/L.

Pregnant women:
1st trimester: 110g/L
2-3 trimester: 105g/L

78
Q

What liver function test is raised when there is a liver blockage (blocked bile dutcs)?

A

ALP

79
Q

What binds to acidic drugs?

A

Albumin

80
Q

What electrolyte is found in dark chocolate, seeds and avocado?

A

Magnesium

81
Q

What is the by-product of muscle breakdown?

A

Creatinine

82
Q

Which vitamin, if given long-term, can cause peripheral neuropathy?

A

B6

83
Q

What is a low neutrophil count?

A

Less than 1.5x10^9/L

84
Q

How is severe acute hypocalcaemia treated?

A

IV calcium gluconate injection 10%
- ECG monitoring (risk of arrythmias if given too rapidly)

Calcium chloride injection is also available but it is more irritant - care should be taken to avoid extravasion

Concurrent hypomagnesaemia should be corrected with magnesium sulfate

85
Q

How is severe hypercalcaemia treated?

A

Rehydration using sodium chloride

If persists - bisphosphonates and pamidronate disodium

Corticosteroids sometimes given

Calcitonin (Salmon) if associated with malignancy

86
Q

How should hyperphosphataemia be treated?

A

Calcium acetate - phosphate binder

2nd line: sevelamer

3rd line: calcium carbonate

87
Q

What vitamin is used to treat Wilson’s disease?

A

Vitamin B6 - Pyridoxine

Pre Reg (14 decks)

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