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BLOOD & NUTRITION (in progress) Flashcards

1
Q

HYPERKALAEMIA?

MURC

iiMerkIt, throwback

A

Muscle cramps
Urine abnormalities
Respiratory distress
Cardiac L

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2
Q

HYPOKALAEMIA?

SIC WALT!

A

Shallow resp
Irritability
Confused/drowsy

Weak/fatigue
Arrhythmias
Lethargy
‘Thready pulse

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3
Q

HYPONATRAEMIA?

SALT LOSS!

A

Stupor
Anorexia (N&V)
Lethargy
Tendon L

Limp muscle L
Orthostatic hypotension
Seizures/headache
Stomach cramping

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4
Q

HYPERNATRAEMIA?

FRIED SALT!

A 
Flushed skin, fever
Restless, irritable, anxious, confused
Increased bp, fluid retention
Edema 
Decreased urine/dry mouth

Skin flush
Agitation
Low-grade Fever
Thirst

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5
Q

HYPOCALCAEMIA?

CATS!

A

CONVULSION
ARRHYTHMIAS
Tetany (muscle L)
Stridor (can’t breathe)

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6
Q

HYPERCALCAEMIA?

BACK ME!

A 
Bone pain
Arrhythmias
Cardiac arrest
Kidney stones
Muscle weakness
Excessive urination
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7
Q

VITAMINS (WATER-SOLUBLE)

VITAMIN B- TREATMENTS
B1 (thiamine)?
B2 (riboflavin)?
B6 (pyridoxine)?
B12 (hydroxocobalamin)?
found in?
A

VITAMIN B- TREATMENTS
B1 (thiamine)? Wernicke’s encephalopathy
B2 (riboflavin)? keeps skin/eyes/nervous system healthy
B6 (pyridoxine)? peripheral neuropathy caused by isoniazid (TB)
B12 (hydroxocobalamin)? Megaloblastic anaemia
found in? meat/cereals/vegetables, so vegans lack it!

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8
Q

VITAMINS (WATER-SOLUBLE)

VITAMIN C (ascorbic acid)
deficiency leads to?
helps w/?
found in?

A 
VITAMIN C (ascorbic acid)
deficiency leads to? scurvy
helps w/? wound healing+maintains healthy skin/blood vessels/bone & cartilage
found in? oranges/peppers/strawberries/blackcurrants/broccoli/sprouts/potatoes
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9
Q

VITAMINS (FAT SOLUBLE)

VITAMIN K (phytomenadione)
blood clotting factor?
menadiol (water-souble derivate) given orally in?
found in?

MENADIOL BONUS?

A

VITAMIN K (phytomenadione)
blood clotting factor? warfarin reversal agent
menadiol (water-souble derivate) given orally in? malabsorption syndromes
found in? green leafy vegetables/vegetable oils/cereal grains

For menadiol sodium phosphate
G6PD deficiency (risk of haemolysis); vitamin E deficiency (risk of haemolysis)
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10
Q

VITAMINS (FAT SOLUBLE)

VITAMIN E (tocopherol)
deficiency leads to?
found in?
A 
VITAMIN E (tocopherol)
deficiency leads to? neuromuscular abnormalities
found in? plant oils/nuts/seeds/wheatgerm
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11
Q

VITAMINS (FAT-SOLUBLE)

VITAMIN D (ergocalciferol [D2], colecalcifero l[D3], alfacalcidol, calcitriol)
deficiency leads to?
deficiency occurs in?
normal dose?
found in?
A 
VITAMIN D (ergocalciferol [D2], colecalcifero l[D3], alfacalcidol, calcitriol)
deficiency leads to? rickets
deficiency occurs in? reduced sunlight+diet intake
normal dose? 10mcg (400UI)
found in? oily fish, red meat, liver, egg yolk, cereal
So vegans are deficient in vitamin D  b12 i guess?
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12
Q

VITAMINS (FAT-SOLUBLE)

VITAMINA A (retinol)
deficiency?
avoid in?
found in?
A 
VITAMINA A (retinol)
deficiency? ocular defects+infections
avoid in? pregnancy, teratogenicity
found in? cod liver/cheese/eggs/oily fish/milk/yoghurt/
DO NOT TAKE COD LIVER PREGNANT
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13
Q

Orlistat impairs absorption of fat-solube vitamins so…?

A

GIVE VITMAIN D SUPPLEMENTS

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14
Q

INTRAVENOUS NUTRITION- contains and purpose? PGPF^2

A

PROTEINS- synthetic L-amino acids- source of energy

GLUCOSE- carb, infused through central venous catheter to avoid thrombosis (WHAT ACTUALLY IS THIS MATE?)

PHOSPHATE- phosphorylates glucose+prevents hypophosphataemia

FRUCTOSE+SORBITOL- prevents hyperosmolar hyperglycaemia non-ketotic acidosis

FAT EMULSIONS- high energy to fluid volume ratio (X additives)

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15
Q

INTRAVENOUS NUTRITION

2 METHODS?

Infused through?

A

SUPPLEMENTAL PARENTERAL NUTRITION- additional
TOTAL PARENTERAL NUTRITION- sole source

Infused through? Central venous catheter/peripheral vein

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16
Q

DRUGS UNSAFE IN ACUTE PORPHYRIAS?

A 
ANTIDEPRESSANTS
HORMONAL CONTRACEPTIVES, HRT
BARBITUATES
PROGESTOGEN
SULFONYLUREAS
TAXANES
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17
Q

MODERATE-SEVERE-ACUTE PORPHYRIA CRISES TREATMENT?

A

IV Haem Arginate

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18
Q

What is ACUTE PORPHYRIAS?

A

Hereditary disorder of haem biosynthesis (1 in 75000)

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19
Q

UREA CYCLE DISORDERS TREATMENT?

A 
SODIUM BENZOATE (unlicensed)
SODIUM PHENYLBUTYRATE
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20
Q

HYPERPHOSPHATAEMIA TREATMENT

1st LINE?
2nd LINE?
3rd LINE?

A

1st LINE? Calcium acetate
2nd LINE? Sevelamer
3rd LINE? CaCO3 (calcium-based) OR Sucroferric Oxyhydroxide (non-calcium based)

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21
Q

HYPERPHOSPHATAEMIA- patients w/ stake 4/5 CKD prerequisite?

A

MANAGE DIET
+
DIALYSIS BEFORE STARTING AGENTS

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22
Q

HYPOHPOSPHATAEMIA TREATMENT? (Common in alcohol dependence/severe DKA)

A

Oral phosphate supplements

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23
Q

HYPOMAGNESAEMIA TREATMENT

SYMPTOMATIC?
MILD?

A

SYMPTOMATIC? IV/IM magnesium sulfate (IM= painful)

MILD? Oral magnesium

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24
Q

HYPERMAGNESAEMIA TREATMENT? (Causes muscle weakness & arrhythmias)

A

Calcium gluconate injection- magnesium toxicity

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25
MAGNESIUM NOTES- essential in enzyme systems, generation- stored in skeleton Excreted by kidneys, so retained in renal failure, thus-> hypermagnesamia
26
HYPERPARATHYROIDISM DRUG TREATMENT? (Surgery unsuccessful/declined) SECONDARY CARE? REDUCING FRACTURE RISK?
DRUG TREATMENT? (Surgery unsuccessful/declined) CINACALCET SECONDARY CARE? MEASURE VITAMIN D LEVELS REDUCING FRACTURE RISK? BISPHOSPHONATE
27
PRIMARY HYPERPARATHYROIDISM TREATMENT 1st line?
SURGERY
28
HYPERPARATHYROIDISM FACTS Leading cause of hypercalciuria Affects twice as many women than men women 50-60 most common
29
SIDE-EFFECTS OF HYPERPARATHYROIDISM?
``` THIRST POLYUREA CONSTIPATION FATIGUE MEMORY IMPAIRMENT CVD KIDNEY STONES OSTEOPOROSIS ```
30
HYPERPARATHYROIDISM EXCESS parathyroid hormone leads to?
Hypercalcaemia Hypercalciuria Hypophosphataemia
31
HYPERCALCIURIA TREATMENT?
INCREASE FLUID INTAKE GIVE BENDROFLUMETHIAZIDE REDUCE DIETARY CALCIUM INTAKE BUT NOT SEVERE RESTRICTION (harmful)
32
HYPERCALCAEMIA TREATMENT SEVERE HYPERCALCAEMIA? Hypercalcaemia due to sarcoidosis/vitamin D deficiency? Hypercalcaemia w/ malignancy?
SEVERE HYPERCALCAEMIA? Correct dehydration first w/ IV NaCl 0.9%+discontinue the bad drugs Bisphosphonates n pamidronate sodium used Hypercalcaemia due to sarcoidosis/vitamin D deficiency? Corticosteroids Hypercalcaemia w/ malignancy? Calcitonin
33
HYPOCALCAEMIA TREATMENT SEVERE ACUTE HYPOCALCAEMIA/HYPOCALCAEMIC TETANY?
SEVERE ACUTE HYPOCALCAEMIA/HYPOCALCAEMIC TETANY? SLOW IV Calcium Gluconate 10% w/ plasma-calcium & ECG monitoring (arrhythmias L if rapid Repeat if need be/continuous IV to prevent recurrence
34
HYPOCALCAEMIA NOTES Poor diet? Osteoporosis? Oral supplements given w/?
Poor diet? Calcium supplements Osteoporosis? Double recommended amount reduces rate of bone loss Oral supplements given w/? Vitamin D
35
HYPONATRAEMIA TREATMENT Mild-moderate? Severe?
FLUID RESTRICTION IDEAL THOUGH Mild-moderate? Oral supplements (NaCl Na2CO3) Severe? IV NaCl
36
DRUGS THAT CAUSE HYPERNATRAEMIA?
``` SALTY CEO Sodium Bicarbonate/Chloride Corticosteroids Phenytoin Lithium side-effect, hypernatraemia in OD Effervescent Formulations Oestrogens/Androgens ```
37
DRUGS THAT CAUSE HYPONATRAEMIA?
``` CERTAIN DRUGS DITCH SALT Carbamazepine Diuretics Desmopressin/Vasporessin SSRIs ```
38
HYPERKALAEMIA TREATMENT MILD-MODERATE HYPERKALAEMIA?
Ion-exchange resins- (Calcium Resonium)
39
HYPERKALAEMIA IMPORTANT NOTE- SODIUM BICARBONATE AND CALCIUM SALTS?
DO NOT ADMINISTER IN SAME LINE- RISK OF PRECIPITATION
40
HYPERKALAEMIA TREATMENT ACUTE SEVERE HYPERKALAEMIA? >/= 6.5mmol/L, URGENT
``` ACUTE SEVERE HYPERKALAEMIA? IV CaCl 10% OR IV CaGlu 10% IV soluble insulin (5-10units) w/ 50mL glucose 50% over 5-15 mins Salbutamol (nebs/slow IV) caution in CVD + review drugs worsening the hyper ```
41
HYPOKALAEMIA TREATMENT MILD-MODERATE? SEVERE? K+ replaced cautiously in patients w/ renal impairment?
MILD-MODERATE? Oral replacement (Sando-K) SEVERE? IV KCL in NaCl K+ replaced cautiously in patients w/ renal impairment? Risk of hyperkalaemia secondary to impaired K+ excretion
42
POTASSIUM IMBALANCE RISK? HYPOKALAEMIA AND DIGOXIN?
POTASSIUM IMBALANCE RISK? Cardiac side-effects- arrhythmias | HYPOKALAEMIA AND DIGOXIN? Toxicity risk
43
DRUGS THAT CAUSE HYPERKALAEMIA?
``` THANKS, B Trimethoprim Heparins ACE-inhibitors/ARBs NSAIDs K-sparing Diuretics Beta-blockers ```
44
DRUGS THAT CAUSE HYPOKALAEMIA?
``` ABCDE I Aminophylline/Theophylline Beta-agonists Corticosteroids Diuretics (Loop/Thiazides) Erythromycin/Clarithromycin Insulin ```
45
HYPOCALCAEMIA vs HYPERCALCAEMIA?
HYPOCALCAEMIA- depressed, forgetful HYPERCALCAEMIA- nausea, lethargy, arrhythmias both muscle cramp/confusion
46
HYPONATRAEMIA vs HYPERNATRAEMIA?
HYPONATRAEMIA- nausea, headache, irritability, seizures | HYPERNATRAEMIA- thirst, fatigue, confusion
47
HYPOKALAEMIA vs HYPERKALAEMIA?
HYPOKALAEMIA- muscle cramps, arrhythmias HYPERKALAEMIA- numbness, nausea, SOB, chest pain both palpitations- heart rate
48
FLUID AND ELECTROLYTE IMBALANCE RANGES ``` Ca2+? Mg2+? Po4-? K+? Na+? ```
``` Ca2+? 2.2-2.6 mmol/L Mg2+? 0.6-1 mmol/L Po4-? 0.87-1.45 mmol/L K+? 3.5-5.3 mmol/L Na+? 133-146 mmol/L ```
49
NEUTROPENIA- TREATMENT? HOW DOES IT WORK?
TREATMENT? Recombinant human granulocyte-colony stimulating factor (rhG-CSF) HOW DOES IT WORK? Stimulates neutrophil production-> reduces duration of chemotherapy-induced neutropenia-> reduces incidence of febrile neutropenia
50
NEUTROPENIA WHAT IS IT? RISK FACTOR FOR?
WHAT IS IT? Low neutrophil count (<1.5*10^9L) RISK FACTOR FOR? Infection/sepsis, esp. chemotherapy
51
RISK FACTORS OF NEURAL TUBE DEFECTS?
``` Smoking Sickle-cell anaemia (throughout) Diabetes Obesity Anti-epileptic drugs Anti-malarial drugs ```
52
FOLIC ACID DOSES RISK OF NEURAL TUBE-DEFECT?
5mg before conception+till week 12 of pregnancy
53
FOLIC ACID DOSES REGULAR PREGNANCY?
400mcg OD before conception+till week 12 of pregnancy
54
MEGALOBLASTIC ANAEMIA- Folate Deficiency TREATMENT?
5mg Daily supplement for 4 months Probs cos of poor nutrition/pregnancy/epilepsy drugs
55
MEGALOBLASTIC ANAEMIA- Malabsorption of Vitamin B12 TREATMENT?
``` Give hydroxocobalamin (vitamin B12) at intervals of up to 3 months Frequent IM injections to replenish stores- then maintenance ```
56
PARENTERAL IRON EXAMPLES?
IRON DEXTRAN IRON SUCROSE FERRIC CARBOXYMALTOSE FERRIC DERISOMALTOSE
57
C.dif, stop iron because?
Diarrhoea!
58
iron toxicity treatment?
Desferrioxamine
59
iron use once Hb is in normal range?
Continue for 3 more months
60
Side-effects of Iron?
constipation diarrhoea black tarry stools
61
DAILY ELEMENTAL IRON DOSE?
100 to 200mg
62
What is sickle-cell anaemia?
Deformed, less flexible red blood cells
63
MEGALOBLASTIC ANAEMIA EMERGENCY?
GIVE FOLIC ACID+VITAMIN B12, BOTH | Not just folic acid alone, can cause neuropathy
64
Causes->Treatment of VITAMIN B12 DEFICIENCY?
Dietary-> Give oral hydroxocobalamin | Malabsorption (gastrectomy, Crohn's)-> Give IM hydroxocobalamin
65
SYMPTOMS OF MEGALOBLASTIC ANAEMIA? NTMD
Numbness Tingling hands/feet Muscle weakness Depression
66
MEGALOBLASTIC ANAEMIA- vitamin B12/folic acid deficiency
67
PARENTERAL IRON- MHRA HYPERSENSITIVITY WARNING Take caution w/..? Monitor for..? High risk of sensitivity in..? AVOID in.. but..?
Fatal anaphylactic :( Take caution w/..? Every IV dose Monitor for..? 30mins after each injection High risk of sensitivity in..? allergies/immune conditions/asthma/eczema AVOID in.. but..? AVOID in FIRST trimester but use in SECOND OR THIRD TRIMESTER if benefits>risks
68
PARENTERAL IRON IS USED IN?
Chronic renal failure w/ haemodialysis Malabsorption syndromes Chemotherapy-induced anaemia
69
Compound preparations containing FOLIC ACID AND IRON are ONLY given to pregnant women who are..?
AT HIGH RISK OF FOLIC ACID AND AND IRON DEFICIENCY. Make distinction for prevention of neural tube defects in women planning a pregnancy
70
IRON COUNSELLING?
Take with/after food (reduces GI side-effects/constipation/diarrhoea) Take with a glass of orange juice (vitamin C aids absorption) Continue for 3months after blood levels return to normal after food reduces side-effects before food, best absorption
71
WHEN IS IRON DEFICIENCY PROPHYLAXIS REQUIRED?
``` Malabsorption, e.g. Crohn's disease Gastrectomy Menorrhagia Chronic renal failure; haemodialysis Pregnancy Low birth weight infants ```
72
SYMPTOMS OF IRON DEFICIENCY? FSPP
Fatigue SOB Pale Skin Palpitations
73
SICKLE CELL DISEASE- folate supplementation helps make new red blood cells SICKLE CELL CRISES- hydroxycarbamide reduces frequency of crises
74
ECULIZUMAB- MONITORING WHAT IS THIS BRUH How many hours after infusion? Paroxysmal nocturnal haemoglobinuria, monitor for? Atypical haemolytic uraemic syndrome, monitor for?
How many hours after infusion? 1hr Paroxysmal nocturnal haemoglobinuria, monitor for? Intravascular haemolysis during treatment+for at least 8 weeks after discontinutation Atypical haemolytic uraemic syndrome, monitor for? Thrombotic microangiopathy during treatment+for at least 12 weeks after discontinuation
75
ECULIZUMAB CONTRACEPTION?
DURING+5 MONTHS AFTER TREATMENT
76
What about patients receiving Eculizumab less than 2 weeks after vaccine?
Must be given prophylactic antibiotics until 2 weeks after vaccination
77
ECULIZUMAB CAUTION?
MENINGOCOCCAL INFECTION Vaccinate against Neisseria meningitidis at least 2 weeks before treatment, revac if need be CONTRACEPTION DURING+5 MONTHS AFTER
78
``` TREATMENT OF Paroxysmal nocturnal haemoglobinuria Atypical haemolytic uraemic syndrome Myasthenia gravis Neuromyelitis optica spectrum disorder (under expert supervision) ? ```
ECULIZUMAB
79
METHOXY IS GIVEN TO CKD DIALYSIS PATIENTS WHEN NOT TAKING...?
ERYTHROPOETINS
80
EPOETIN ZETA TREATMENT?
SYMPTOMATIC ANAEMIA W/ CHRONIC RENAL FAILURE+HAEMODIALYSIS
81
EPOETIN BETA TREATMENT?
SYMPTOMATIC ANAEMIA W/ CHRONIC RENAL FAILURE
82
Treatment of symptomatic anaemia w/ chronic renal failure+haemodialysis?
EPOETIN ALFA
83
Treatment of symptomatic anaemia w/ chronic renal failure+dialysis?
DARBEPOETIN ALFA
84
ERYTHROPOETIN MONITORING?
``` BP RETICULOCYTE COUNTS? HB ELECTROLYTES IRON/FOLATE DEFICIENCY KEY ```
85
ERYTHROPOETIN KEY KEY SIDE-EFFECTS?
HYERPTENSIVE CRISIS PURE RED CELL APLASIA ?
86
SIDE-EFFECTS OF ERYTHROPOETINS? H^2S^2J
``` HEADACHE HYPERTENSION SKIN REACTIONS STROKE JOINT pain ```
87
EPOETINS | CAUTIONED IN?
``` ALUMINIUM TOXICITY INFECTION DIALYSIS EPILEPSY POOR BP CONTROL IVD MD CVD ```
88
EPOETINS CONTRAINDICATED IN?
Unable to receive thromboprophylaxis Pure red cell aplasia following erythropoetin therapy Uncontrolled hypertension
89
Treatment of aplastic anaemia?
OXYMETHOLONE (anabolic steroid)
90
ERYTHROPOETINS MHRA WARNING- CANCER, DON'T USE OUTSIDE OF LICENSE MAN! Treatment of symptomatic anaemia associated with cancer?
Only for those receiving chemotherapy Can consider blood transfusion, risks VS benefits (good cancer prognosis ideal)
91
EPOETINS MHRA WARNING HAEMOGLOBIN CONC. Overcorrection of haemoglobin concentration in patients with CKD/cancer can increase risk of death/thrombosis 4 KEY POINTS TO CONSIDER?
- Only treat these patients if symptoms of anaemia are present - Haemoglobin maintenance range 10–12 g/100 mL - AVOID haemoglobin concentrations> than 12 g/100 mL - Haemoglobin concentration should not be increased beyond that which provides adequate control of symptoms of anaemia (in some patients, this may be achieved at concentrations lower than the recommended range) avoiding need for blood transfusion
92
EPOETINS MHRA WARNING SKIN?
Severe cutaneous ADRs/Stevens-Johnson syndrome/toxic epidermal necrolysis LOOK OUT FOR: RASHES/BLISTERING->FEVER/FLU SYMPTOMS STOP ASAP N SEEK HELP
93
What drug (a continuous erythropoietin receptor activator) is licensed for the treatment of symptomatic anaemia associated with chronic kidney disease?
Methoxy polyethylene glycol-epoetin beta- longer duration of action than epoetin
94
Name and features of hyperglycosylated derivative of epoetin- DARBEPOETIN ALFA?
DARBEPOETIN ALFA Longer half-life Can be administered less frequently than epoetin
95
Drug licensed for the prevention of anaemia in preterm neonates of low birth-weight?
Epoetin beta (takes few weeks for effect)
96
Treatment of idiopathic sideroblastic anaemia?
Pyridoxine (high dose)
97
Early adverse effects associated with antithymocyte globulin treatment?
``` fever rash fluid retention rigors acute respiratory distress syndrome anaphylaxis ``` Serum sickness? Occurs 7-14 days later
98
Corticosteroid used to prevent adverse effects with antithymocyte globulin treatment?
Prednisolone
99
NAME SOME DRUGS WITH POSSIBLE RISK OF HAEMOLYSIS (what is this) IN G6PD-DEFICIENT INDIVIDUALS?
``` ASPIRIN CHLOROQUINE MENADIONE QUININE SULFONYLUREAS ```
100
NAME SOME DRUGS WITH DEFINITE RISK OF HAEMOLYSIS (what is this) IN G6PD-DEFICIENT INDIVIDUALS?
``` DAPSONE FLUOROQUINONES NITROFURANTOIN QUINOLONES SULFONAMIDES (+co-trimoxazole) ```
101
Prescribing for patients with G6PD deficiency, 3 KEY POINTS?
G6PD deficiency is genetically heterogeneous- safety varies between people Manufacturers- NO routine drug tests Risk/severity of haemolysis-> almost always dose-related
102
Individuals with G6PD deficiency are susceptible to developing acute haemolytic anaemia when they eat...?
FAVA BEANS? Mad
103
G6DPD deficiency, 4 common regions?
AFRICA ASIA MEDITERRANEAN MIDDLE EAST
104
SICKLE CELL DISEASE What drug is used to prevent acute chest syndrome/reduce painful crises/transfusion requirements? Recurrent sickle cell disease?
What drug is used to prevent acute chest syndrome/reduce painful crises? Hydroxycarbamide, benefits take months Recurrent sickle cell disease? Crizanlizumab
105
IRON TABLETS+TEA/MILK?
AVOID, ABSORPTION L Although iron preparations are best absorbed on an empty stomach they can be taken after food to reduce gastro-intestinal side-effects.
106
HYPERCALCAEMIA?
ARRHYTHMIA
107
Patient presents with CONFUSION, DROWSINESS TREATMENT?
zoledronic acid- tumour-induced hypercalcaemia
108
olanzapine, hyponatraemia?
109
hypokalaemia- muscle weakness, palpitations, corti beta agonist
110
phenytoin deficiency?
hypocalcaemia
111
AMOX+OMEP H PYLORI?
USE 500MG TDS, otherwise 1000MG BD AS PER
112
NEVER GIVE FOLIC ACID ALONE IN...
undiagnosed megaloblastic anaemia unless vitamin B12 is administered concurrently otherwise neuropathy may be precipitated
113
orlistat avoid?
LACWAA ``` LEVOTHYROXINE AMIODARONE WARFARIN AED ARCOBSE ```
114
HYDROXOCOBALAMIN DOSING?
Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months

GPhC BNF (48 decks)

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