Blood + Nutrition Flashcards
You are a clinical pharmacist covering a gastroenterology ward round, and you are currently with the dietetics team. There is a patient who has malabsorption issues, so is being prescribed supplementary vitamins to make up for the deficit. Which of the following vitamins are not fat soluble?
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin E
E) Vitamin K
B
Patients who are being treated for mycobacterium tuberculosis are often put on a multitude of different antibiotics, each with different side effects. One of the antibiotics, isoniazid, is often associated with peripheral neuropathy, so pyridoxine is co-prescribed to mitigate the development of peripheral neuropathy. The active ingredient in Pyridoxine is:
A) Vitamin A
B) Vitamin B1
C) Vitamin B6
D) Vitamin B12
E) Vitamin C
C
RATIONALE: ISONIAZID CAN CAUSE PERIPHERAL
NEUROPATHY. THE ACTIVE INGREDIENT IN PYRIDOXINE IS
VITAMIN B6.
You are the ward pharmacist on a care of the elderly ward. Many of your patients are found with an incidentally low vitamin D level, and it is often decided to treat their Vitamin D deficiency. At the same time, many of these patients have mild to severe renal impairment. What would be the most appropriate choice of therapy for an 82-year-old man with severe chronic kidney disease?
A) Alfacalcidol
B) Calcium Carbonate
C) Calcium Carbonate with Colecalciferol
D) Colecalciferol
E) Ergocalciferol
A
RATIONALE: COLECALCIFEROL REQUIRES HYDROXYLATION BY
THE KIDNEYS TO BECOME ITS ACTIVE FORM. PATIENTS
WITH SEVERE CHRONIC KIDNEY DISEASE, OR HAVE END
STAGE RENAL FAILURE (ESRF), SHOULD BE PRESCRIBED
ALFACALCIDOL. IT IS WORTH NOTING CALCIUM AIDS THE
ABSORPTION OF COLECALCIFEROL, HOWEVER IS NOT ALWAYS
REQUIRED IN THE ABSENCE OF HYPOCALCAEMIA.
Which of the following conditions is characterised by an excessive intake of iron leading to organ damage?
A) Anaemia of chronic disease
B) Haemochromatosis
C) Megaloblastic anaemia
D) Sideroblastic anaemia
E) Thalassemia
B
RATIONALE: HAEMOCHROMATOSIS IS A GENETIC OR ACQUIRED
DISORDER IN WHICH IRON-BINDING PROTEIN ACCUMULATES IN
VARIOUS TISSUES, TYPICALLY LEADING TO LIVER DAMAGE,
DIABETES MELLITUS, AND BRONZE DISCOLORATION OF THE
SKIN
A patient with iron-deficiency anaemia is prescribed ferrous sulphate. What is the optimal way to enhance iron absorption from the gastrointestinal tract?
A) Administer it with a proton pump inhibitor
B) Combine it with a high fibre meal
C) Consume it with vitamin C-rich food
D) Take it with a calcium supplement
E) Take it with a cup of coffee
C
RATIONALE: VITAMIN C IS OFTEN ADVISED TO BE TAKEN
CONCOMITTANTLY WITH IRON TO AID ABSORPTION. A HIGH
FIBRE MEAL MAY PRECIPITATE CONSTIPATION, WHICH WOULD
NOT AID ABSORPTION. IT IS ADVISED NOT TO TAKE IRON
WITH OTHER SALTS, WHICH RULES OUT CALCIUM.
What is the primary function of folic acid in the body?
A) Bone metabolism
B) Electrolyte balance
C) Red blood cell production
D) Synthesis of clotting factors
E) Wound healing
C
RATIONALE: FOLIC ACID IS USED IN THE TREATMENT OF
MEGALOBLASTIC ANAEMIA, WHICH HAS RED BLOOD CELL
INVOLVEMENT. THE LIVER IS RESPONSIBLE FOR CLOTTING
FACTOR SYNTHESIS. ELECTROLYTE BALANCE IS MANAGED BY
THE KIDNEYS, BONE METABOLISM IS MAINLY CALCIUM AND
PHOSPHATE.
A patient with a history of gastrointestinal bleeding is prescribed a vitamin K antagonist. What is the mechanism of action of vitamin K antagonists in the body?
A) Enhancement of red blood cell production
B) Inhibition of vitamin K activation
C) Inhibition of vitamin K synthesis
D) Promotion of vitamin D absorption
E) Prevention of platelet aggregation
B
RATIONALE: VITAMIN K ANTAGONISTS, SUCH AS WARFARIN,
INHIBIT VITAMIN K ACTIVATION. WARFARIN COMPETITIVELY
INHIBITS THE VITAMIN K EPOXIDE REDUCTASE WHICH
OTHERWISE ACTIVATES AVAILABLE VITAMIN K IN-VIVO.
WARFARIN WOULD NOT ENHANCED RED BLOOD CELL
PRODUCTION AS IT INCREASES BLEEDING RISK, NOR WOULD IT
PREVENT PLATELET AGGREGATION AS IT IS NOT
ANTITHROMBOTIC.
In the context of vitamin D deficiency, which condition is characterised by softening of the bones and skeletal deformities?
A) Beriberi
B) Osteoporosis
C) Pellagra
D) Rickets
E) Scurvy
D
RATIONALE: RICKETS IS DEFINED AS SOFTENING AND
DEFORMATION OF THE BONES DUE TO A LACK OF VITAMIN D,
CALCIUM AND PHOSPHATE. OSTEOPOROSIS ON THE OTHER
HAND IS A LACK OF BONE MINERAL DENSITY. ALL OTHER
OPTIONS ARE NOT RELEVANT.
In the context of vitamin B1 deficiency, which condition is characterised by neurological symptoms such as peripheral neuropathy and Wernicke-Korsakoff syndrome?
A) Beriberi
B) Megaloblastic anaemia
C) Pellagra
D) Rickets
E) Scurvy
A
RATIONALE: BERIBERI IS DEFINED AS A DISEASE CAUSING
INFLAMMATION OF THE NERVES AND HEART FAILURE,
ASCRIBED TO A DEFICIENCY OF VITAMIN B1.
A patient with a history of malabsorption is prescribed vitamin B12 supplementation. What is the preferred route of administration for vitamin B12 in this case?
A) Intramuscular injection
B) Intravenous infusion
C) Oral tablets
D) Subcutaneous injection
E) Topical cream
A
RATIONALE: INTRAMUSCULAR INJECTION IS THE PREFERRED
ROUTE OF ADMINISTRATION AS IT OFFERS THE MOST
ABSORPTION. INTRAVENOUS B12 IS NOT INDICATED. ORAL B12
HAS VERY LITTLE ABSORPTION. SUBCUTANOUE INJECTION
AND TOPICAL ARE NOT INDICATED.
Which of the following is a common side effect associated with iron supplementation?
A) Constipation
B) Hypercalcaemia
C) Hyponatraemia
D) Photosensitivity
E) Polyuria
A
RATIONALE: CONSTIPATION IS OFTEN ASSOCIATED WITH IRON
SUPPLEMENTATION. ALL OTHER OPTIONS ARE NOT RELEVANT.
Which vitamin is essential for the synthesis of clotting factors in the liver?
A) Vitamin A
B) Vitamin B12
C) Vitamin C
D) Vitamin D
E) Vitamin K
E
RATIONALE: PROTHROMBIN IS A VITAMIN K-DEPENDENT
PROTEIN DIRECTLY INVOLVED WITH BLOOD CLOTTING.
OSTEOCALCIN IS ANOTHER PROTEIN THAT REQUIRES VITAMIN
K TO PRODUCE HEALTHY BONE TISSUE.
In the context of anticoagulant therapy, which factor is not directly inhibited by warfarin?
A) Factor I (Fibrinogen)
B) Factor II (Prothrombin)
C) Factor VII (Stable factor)
D) Factor IX (Christmas factor)
E) Factor X (Stuart–Prower factor)
D
RATIONALE: WARFARIN INHIBITS FACTORS II, VII, IX AND X.
You are a pharmacist working on a renal ward. Many patients who come for dialysis are often on different electrolyte binders. A patient with renal impairment is prescribed a phosphate binder. What is the primary purpose of phosphate binders in the management of renal bone disease?
A) Enhancement of magnesium excretion
B) Inhibition of phosphate absorption
C) Promotion of calcium absorption
D) Promotion of calcium excretion
E) Promotion of magnesium absorption
B
RATIONALE: PHOSPHATE BINDERS WORK BY BINDING
(ATTACHING) TO SOME OF THE PHOSPHATE IN FOOD. THIS
WILL REDUCE THE AMOUNT OF PHOSPHATE BEING ABSORBED
INTO YOUR BLOOD STREAM.
A patient has been newly started on warfarin for treatment of a portal vein thrombus. They were previously on rivaroxaban, but previous anticoagulation therapy has failed, hence why haematology has recommended warfarin. The patient explains that he enjoys leafy vegetables and has always eaten three portions of leafy greens a day. What is the most appropriate advice to give this patient?
A) Cut down the amount of leafy green vegetables you have, they’re still important to your diet but Vitamin K still affects warfarin levels.
B) Do not make any sudden changes to your diet, continue eating leafy greens three times a day.
C) No advice to give.
D) Stop eating leafy green vegetables, as they contain Vitamin K which counteracts the action of warfarin.
E) The patient can’t have warfarin due to his diet; we may have to switch the anticoagulation to another DOAC or a low molecular weight heparin.
D??
RATIONALE: WHILST LEAFY GREENS SUCH AS KALE CONTAIN
VITAMIN K WHICH ANTAGONISES WARFARIN, THE GUIDANCE
STIPULATES THAT NO SUDDEN CHANGES ARE MADE.
CUTTING DOWN THE AMOUNT OF LEAFY GREEN VEGETABLES
WHILST TAKING THE SAME DOSE OF WARFARIN COULD MEAN
THE PATIENT’S INR IS OUT OF RANGE. OPTING FOR A DOAC
WOULD BE INAPPROPRIATE AS THE PATIENT HAS ALREADY
HAD TREATMENT FAILURE ON RIVAROXABAN.
Which of the following is a water-soluble vitamin that plays a role in the formation of coenzymes involved in energy metabolism?
A) Vitamin A
B) Vitamin B1 (Thiamine)
C) Vitamin C
D) Vitamin D
E) Vitamin E
C
Whilst working on the gastroenterology ward as a clinical pharmacist, you’ve noticed that you often come across many patients who present with alcohol excess. Many of these patients are initially started on Pabrinex, before being stepped down to high dose oral thiamine. Which complication does the use of thiamine prevent?
A) Alcohol withdrawal
B) Hepatic failure
C) Jaundice
D) Peripheral neuropathy
E) Wernicke’s Encephalopathy
E
RATIONALE: THIAMINE DEPLETION IS RELATED TO
WERNICKE’S ENCEPHALOPATHY. JAUNDICE AND HEPATIC
FAILURE ARE RELATED TO ALCOHOL EXCESS, BUT HIGH DOSE
THIAMINE IS NOT USED PRIMARILY TO PREVENT THIS.
ALCOHOL WITHDRAWAL IS MANAGED ACUTELY WITH
CHLORDIAZEPOXIDE, OR IN SEVERE HEPATIC IMPAIRMENT,
OXAZEPAM.
In the management of hyperlipidaemia, which medication/medication(s) primarily works by inhibiting cholesterol absorption in the small intestine?
A) Bile acid sequestrants
B) Ezetimibe
C) Fibrates
D) Omega-3 fatty acids
E) Statins
A
RATIONALE: STATINS WORK BY COMPETITIVELY INHIBITING
ENZYME COA REDUCTASE WHICH REDUCES THE PRODUCTION
OF CHOLESTEROL. FIBRATES WORK BY DECREASING THE
LIVER’S RELEASE OF TRIGLYCERIDES AND BY INCREASING THE
PRODUCTION OF LIPOPROTEIN LIPASE, WHICH BREAKS DOWN
TRIGLYCERIDES. BILE ACID SEQUESTRANTS BLOCK BILE ACID
ABSORPTION WHICH THEN RESULTS IN AN INCREASE IN THE
UTILISATION OF CHOLESTEROL TO MAKE MORE BILE ACID.
A patient with hyperkalaemia is advised to avoid certain dietary choices. Which of the following food items is high in potassium and should be limited?
A) Bananas
B) Cheese
C) Eggs
D) Red meat
E) White bread
A
RATIONALE: BANANAS ARE HIGH IN POTASSIUM. CHEESE IS
HIGH IN TYRAMINE, AND EGGS ARE HIGH IN PROTEIN. WHITE
BREAD HAS 50% OF VITAMIN B1 (THIAMINE), THE SAME
LEVEL OF VITAMIN B2 (RIBOFLAVIN) AND 30% OF THE LEVEL
OF VITAMIN B3 (NIACIN) THAT IS PRESENT IN WHOLEMEAL
BREAD. RED MEAT IS RICH IN IRON.
A patient with heart failure is prescribed a loop diuretic. What electrolyte imbalance is commonly associated with loop diuretic use?
A) Hypokalaemia
B) Hypernatremia
C) Hypercalcemia
D) Hyperkalaemia
E) Hypernatremia
A
In the context of nutritional deficiencies, which vitamin is essential for maintaining vision and plays a role in the immune system?
A) Vitamin A
B) Vitamin B12
C) Vitamin C
D) Vitamin D
E) Vitamin E
A
RATIONALE: VITAMIN A, OR RETINOL, IS A FAT-SOLUBLE VITAMIN IN
THE VITAMIN A FAMILY THAT IS FOUND IN FOOD AND USED AS A
DIETARY SUPPLEMENT. RETINOL OR OTHER FORMS OF VITAMIN A ARE
NEEDED FOR VISION, CELLULAR DEVELOPMENT, MAINTENANCE OF SKIN
AND MUCOUS MEMBRANES, IMMUNE FUNCTION AND REPRODUCTIVE
DEVELOPMENT.
Which of the following symptoms is not a recognised side effect of iron poisoning in children?
A) Abdominal pain
B) Coma
C) Constipation
D) Diarrhoea
E) Rectal bleeding
C
RATIONALE: IRON POISONING IN CHILDHOOD IS USUALLY
ACCIDENTAL. THE SYMPTOMS ARE NAUSEA, VOMITING,
ABDOMINAL PAIN, DIARRHOEA, HAEMATEMESIS, AND RECTAL
BLEEDING. HYPOTENSION AND HEPATOCELLULAR NECROSIS
CAN OCCUR LATER. COMA, SHOCK, AND METABOLIC ACIDOSIS
INDICATE SEVERE POISONING.
A patient, with history of stroke, has been admitted from his care home with increased confusion, dysuria, and an elevated respiratory rate. It is determined that the patient has a lower urinary tract infection. The patient normally takes amlodipine 5mg OD, atorvastatin 20mg OD, and carmellose eye drops when required for dry eye. He has no allergies. The patient has a G6PD deficiency. Which antibiotic would be the most appropriate choice to treat this patient’s urinary tract infection?
A) Ciprofloxacin
B) Co-trimoxazole
C) Co-amoxiclav
D) Nitrofurantoin
E) Trimethoprim
E
RATIONALE: CIPROFLOXACIN AND NITROFURANTOIN ARE BOTH
EXAMPLES OF DRUGS THAT CAN INDUCE HAEMOLYSIS IN G6PD
DEFICIENCY. CO-AMOXICLAV IS TOO BROAD OF AN ANTIBIOTIC.
CO-TRIMOXAZOLE IS RESERVED FOR PCP INFECTIONS OR IN
PROPHYLAXIS. THE MOST APPROPRIATE CHOICE WOULD BE
TRIMETHOPRIM.
Pregnant women or women who wish to become pregnant are advised to take supplementation with folic acid before conception and until week 12 of pregnancy. Higher doses are recommended for women who are at a higher risk of conceiving children with neural tube defects. Out of the following five groups, which of the following is not a risk factor for neural tube defects?
A) Antiepileptic medication
B) Antiparkinsonian medication
C) Diabetes
D) Previous births with neural tube defects
E) Sickle Cell Disease
B
RATIONALE: ALL OTHER OPTIONS LISTED ARE ASSOCIATED
WITH AN INCREASED RISK OF NEURAL TUBE DEFECTS.
OFTEN, DOSES OF 5MG FOLIC ACID ARE USED IN THESE
CASES.
