Blood/nutrition Flashcards
What common drugs have risk of haemolysis in G6PD deficient patients?
Nitrofurantoin, quinolones, rasburicase, sulfonamides
Possible - aspirin (usually not under 1g), chloroquine, quinine, sulfonylureas.
What type of anaemia are corticosteroids used?
Hypoplastic or hemolytic
What is used in aplastic anaemia?
Antilymphocyte immunoglobulin
What anaemias is pyridoxine indicated?
Hypoplastic, hemolytic and sideroblastic
What monitoring is needed with epoetins?
Hypertensive crisis and pure red cell aplasia have occurred - consider testing ethropoetin antibodies with latter.
Monitor blood pressure, retuculocyte counts, haemoglobin and electrolytes. Monitor for deficiencies.
What advice should be given with oral Iron preparations?
Better absorbed on an empty stomach but taking after food can reduce gastro side effects. May discolour stools.
What are megaloblastic anaemias usually a result of?
Lack of vitamin b12 or folate.
What can occur if folic acid is given alone in undiagnosed megaloblastic anaemia?
Neuropathy precipitation. Administer with b12 concurrently
Is hydroxocobalamin or cyanocobalamin more suitable for prescribing?
Hydroxocobalamin
What should be given in iron overload?
Dexferrioxamine. Can add ascorbic acid if no cardiac dysfunction 1 month after.
What treatment options are there for idiopathic thrombocytopenic purpura?
Usually self limiting in children
Corticosteroids
Immunoglobulins to raise platelet counts rapidly
Antineoplastic drugs
Tranexamic acid to reduce severity of haemorrhage
Splenectomy
Who is at risk of essential thrombocytopenia?
Over 60yo. Platelets greater than 1000 x 10^9/L. History of thrombohaemorrhagic events
When is compensation for potassium loss especially necessary?
Digoxin or antiarrhythmics
Secondary hyperaldosterism (cirrhosis, Nephrotic syndrome, severe heart failure)
Losses in faeces due to diarrhoea or laxatives
When are smaller doses of potassium given?
Renal insufficiency which is common in elderly
What else can be given instead of potassium salts with losses, and why might other options be preferred?
Often poor compliance due to nausea and vomiting so potassium sparing diuretics preferred.
What is given if potassium levels are above 6.5mmol/l?
Calcium gluconate 10%
Soluble insulin or salbutamol
When should rehydration occur slower than the usual aim of 3-4hours?
If hypernatreamic
When should sodium products be cautioned?
Salt restricted diet - C/I with bicarbonate
Dilutional Hyponatreamia
Oedema
Hypertension
What calcium intake should be recommended in osteoporosis?
Double normal recommendations
When is calcium deficiency common?
Childhood, pregnancy, lactation, elderly (increased demands or poor absorption)
Which drugs promote Hypercalcaemia?
Thiazides, vitamin D compounds
What drugs can be given in Hypercalcaemia?
Bisphosphonate, corticosteroids, calcitonin
What condition may be causing Hypercalcaemia?
Hyperparathyroidism
What is given in idiopathic hypercalciuria
Increased fluid and bendroflumethiazide
What conditions may worsen upon hypocalcaemia?
QT interval prolongation, seizures, congestive heart failure.
What are the symptoms of hypermagneseamia?
Nausea, vomiting, flushing, thirst, hypotension, drowsiness, loss of tendon reflex, slurred speach, arrhythmia.
What drug groups are unsafe with acute porphyria?
Anabolic steroids, antidepressants, barbiturates, hormonal contraceptives, HRT, triazole&imidazole antifungals, non nucleoside reverse transcriptase inhibitors, progestogens, protease inhibitors, sulfonamides, sulfonylureas, taxanes.
What common drugs are unsafe in acute porphyria?
Alcohol, amiodarone, carbemazepine, clindamycin, diltiazem, erythromycin, hydralazine, Indapamide, nitrazepam, nitrofurantoin, phenytoin, pivmecillinam, pizotifen, rifampicin, rispeidone, Spironlolactone, tamoxifen, trimethoprim, valproate and Verapamil.
What should be determined before treatment with Eliglustat?
CYP2D6 metabolised status
Enzymes are used in different blood disorders. What can occur with these preparations?
Infusion related reactions
A patient experiences gastric irritation when taking zinc acetate. How can this be reduced?
Take first dose mid morning or with protein.
Most vitamins are given daily in TPN, which aren’t and when are they given?
Hydroxocobalamin IM single dose unless nutrition continues for many months.
Folic acid 15mg once or twice weekly.
What should be done if high glucose amounts are given by TPN?
If over 180g in a day, monitor blood glucose. Insulin may be required.
What sweetener effects the control of phenylketonuria?
Aspartame.
What results from a deficiency in vitamin a?
Ocular defects and increase susceptibility to infections
When is vitamin a deficiency most common?
Preterm neonates, liver disease (as less absorption of fat soluble), biliary obstruction
When may vitamin b6 deficiency occur?
Isoniazid or penicillamine treatment
What vitamin may be given in chronic alcoholism?
B. Pabrinex and thiamine.
What extra conditions in children can be treated with vitamin B preparations?
Mitochondrial disorders, maple syrup urine disease (thiamine), congenital lactic acidosis.
What are vitamin c supplements used for?
Scurrvy
Increase excretion of iron
Metabolic/mitochondrial disorders
Not proven for colds or wound healing.
What are the symptoms of vitamin D overdose?
Anorexia, nausea, vomiting, diarrhoea, constipation, sweating, headache, thirst, raised calcium and phosphate in urine.
What are the risk factors for neural tube defects?
Maternal folate/b12 deficiency, history of infant with defects, smoking, diabetes, obesity, antiepileptics. Also sickle cell.
