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GPhC BNF > BLOOD & NUTRITION (in progress) > Flashcards

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
Q

MAGNESIUM NOTES- essential in enzyme systems, generation- stored in skeleton
Excreted by kidneys, so retained in renal failure, thus-> hypermagnesamia

A
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26
Q

HYPERPARATHYROIDISM

DRUG TREATMENT? (Surgery unsuccessful/declined)
SECONDARY CARE?
REDUCING FRACTURE RISK?

A

DRUG TREATMENT? (Surgery unsuccessful/declined) CINACALCET
SECONDARY CARE? MEASURE VITAMIN D LEVELS
REDUCING FRACTURE RISK? BISPHOSPHONATE

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27
Q

PRIMARY HYPERPARATHYROIDISM TREATMENT

1st line?

A

SURGERY

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28
Q

HYPERPARATHYROIDISM FACTS
Leading cause of hypercalciuria
Affects twice as many women than men women 50-60 most common

A
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29
Q

SIDE-EFFECTS OF HYPERPARATHYROIDISM?

A 
THIRST
POLYUREA
CONSTIPATION
FATIGUE
MEMORY IMPAIRMENT
CVD
KIDNEY STONES
OSTEOPOROSIS
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30
Q

HYPERPARATHYROIDISM

EXCESS parathyroid hormone leads to?

A

Hypercalcaemia
Hypercalciuria
Hypophosphataemia

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31
Q

HYPERCALCIURIA TREATMENT?

A

INCREASE FLUID INTAKE
GIVE BENDROFLUMETHIAZIDE
REDUCE DIETARY CALCIUM INTAKE BUT NOT SEVERE RESTRICTION (harmful)

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32
Q

HYPERCALCAEMIA TREATMENT

SEVERE HYPERCALCAEMIA?

Hypercalcaemia due to sarcoidosis/vitamin D deficiency?

Hypercalcaemia w/ malignancy?

A

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

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33
Q

HYPOCALCAEMIA TREATMENT

SEVERE ACUTE HYPOCALCAEMIA/HYPOCALCAEMIC TETANY?

A

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

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34
Q

HYPOCALCAEMIA NOTES

Poor diet?
Osteoporosis?
Oral supplements given w/?

A

Poor diet? Calcium supplements
Osteoporosis? Double recommended amount reduces rate of bone loss
Oral supplements given w/? Vitamin D

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35
Q

HYPONATRAEMIA TREATMENT

Mild-moderate?

Severe?

A

FLUID RESTRICTION IDEAL THOUGH
Mild-moderate? Oral supplements (NaCl Na2CO3)

Severe? IV NaCl

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36
Q

DRUGS THAT CAUSE HYPERNATRAEMIA?

A 
SALTY CEO
Sodium Bicarbonate/Chloride
Corticosteroids
Phenytoin
Lithium side-effect, hypernatraemia in OD
Effervescent Formulations
Oestrogens/Androgens
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37
Q

DRUGS THAT CAUSE HYPONATRAEMIA?

A 
CERTAIN DRUGS DITCH SALT
Carbamazepine
Diuretics
Desmopressin/Vasporessin
SSRIs
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38
Q

HYPERKALAEMIA TREATMENT

MILD-MODERATE HYPERKALAEMIA?

A

Ion-exchange resins- (Calcium Resonium)

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39
Q

HYPERKALAEMIA IMPORTANT NOTE- SODIUM BICARBONATE AND CALCIUM SALTS?

A

DO NOT ADMINISTER IN SAME LINE- RISK OF PRECIPITATION

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40
Q

HYPERKALAEMIA TREATMENT

ACUTE SEVERE HYPERKALAEMIA? >/= 6.5mmol/L, URGENT

A 
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
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41
Q

HYPOKALAEMIA TREATMENT

MILD-MODERATE?

SEVERE?

K+ replaced cautiously in patients w/ renal impairment?

A

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

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42
Q

POTASSIUM IMBALANCE RISK?

HYPOKALAEMIA AND DIGOXIN?

A

POTASSIUM IMBALANCE RISK? Cardiac side-effects- arrhythmias

HYPOKALAEMIA AND DIGOXIN? Toxicity risk

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43
Q

DRUGS THAT CAUSE HYPERKALAEMIA?

A 
THANKS, B
Trimethoprim
Heparins
ACE-inhibitors/ARBs
NSAIDs
K-sparing Diuretics
Beta-blockers
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44
Q

DRUGS THAT CAUSE HYPOKALAEMIA?

A 
ABCDE I
Aminophylline/Theophylline
Beta-agonists
Corticosteroids
Diuretics (Loop/Thiazides)
Erythromycin/Clarithromycin
Insulin
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45
Q

HYPOCALCAEMIA vs HYPERCALCAEMIA?

A

HYPOCALCAEMIA- depressed, forgetful
HYPERCALCAEMIA- nausea, lethargy, arrhythmias

both muscle cramp/confusion

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46
Q

HYPONATRAEMIA vs HYPERNATRAEMIA?

A

HYPONATRAEMIA- nausea, headache, irritability, seizures

HYPERNATRAEMIA- thirst, fatigue, confusion

47
Q

HYPOKALAEMIA vs HYPERKALAEMIA?

A

HYPOKALAEMIA- muscle cramps, arrhythmias
HYPERKALAEMIA- numbness, nausea, SOB, chest pain

both palpitations- heart rate

48
Q

FLUID AND ELECTROLYTE IMBALANCE RANGES

Ca2+?
Mg2+?
Po4-?
K+?
Na+?
A 
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
Q

NEUTROPENIA-

TREATMENT?

HOW DOES IT WORK?

A

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
Q

NEUTROPENIA

WHAT IS IT?

RISK FACTOR FOR?

A

WHAT IS IT? Low neutrophil count (<1.5*10^9L)

RISK FACTOR FOR? Infection/sepsis, esp. chemotherapy

51
Q

RISK FACTORS OF NEURAL TUBE DEFECTS?

A 
Smoking
Sickle-cell anaemia (throughout)
Diabetes
Obesity
Anti-epileptic drugs
Anti-malarial drugs
52
Q

FOLIC ACID DOSES

RISK OF NEURAL TUBE-DEFECT?

A

5mg before conception+till week 12 of pregnancy

53
Q

FOLIC ACID DOSES

REGULAR PREGNANCY?

A

400mcg OD before conception+till week 12 of pregnancy

54
Q

MEGALOBLASTIC ANAEMIA- Folate Deficiency TREATMENT?

A

5mg Daily supplement for 4 months

Probs cos of poor nutrition/pregnancy/epilepsy drugs

55
Q

MEGALOBLASTIC ANAEMIA- Malabsorption of Vitamin B12 TREATMENT?

A 
Give hydroxocobalamin (vitamin B12) at intervals of up to 3 months
Frequent IM injections to replenish stores- then maintenance
56
Q

PARENTERAL IRON EXAMPLES?

A

IRON DEXTRAN
IRON SUCROSE
FERRIC CARBOXYMALTOSE
FERRIC DERISOMALTOSE

57
Q

C.dif, stop iron because?

A

Diarrhoea!

58
Q

iron toxicity treatment?

A

Desferrioxamine

59
Q

iron use once Hb is in normal range?

A

Continue for 3 more months

60
Q

Side-effects of Iron?

A

constipation
diarrhoea
black tarry stools

61
Q

DAILY ELEMENTAL IRON DOSE?

A

100 to 200mg

62
Q

What is sickle-cell anaemia?

A

Deformed, less flexible red blood cells

63
Q

MEGALOBLASTIC ANAEMIA EMERGENCY?

A

GIVE FOLIC ACID+VITAMIN B12, BOTH

Not just folic acid alone, can cause neuropathy

64
Q

Causes->Treatment of VITAMIN B12 DEFICIENCY?

A

Dietary-> Give oral hydroxocobalamin

Malabsorption (gastrectomy, Crohn’s)-> Give IM hydroxocobalamin

65
Q

SYMPTOMS OF MEGALOBLASTIC ANAEMIA? NTMD

A

Numbness
Tingling hands/feet
Muscle weakness
Depression

66
Q

MEGALOBLASTIC ANAEMIA- vitamin B12/folic acid deficiency

A
67
Q

PARENTERAL IRON- MHRA HYPERSENSITIVITY WARNING

Take caution w/..?
Monitor for..?
High risk of sensitivity in..?
AVOID in.. but..?

A

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
Q

PARENTERAL IRON IS USED IN?

A

Chronic renal failure w/ haemodialysis
Malabsorption syndromes
Chemotherapy-induced anaemia

69
Q

Compound preparations containing FOLIC ACID AND IRON are ONLY given to pregnant women who are..?

A

AT HIGH RISK OF FOLIC ACID AND AND IRON DEFICIENCY.

Make distinction for prevention of neural tube defects in women planning a pregnancy

70
Q

IRON COUNSELLING?

A

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
Q

WHEN IS IRON DEFICIENCY PROPHYLAXIS REQUIRED?

A 
Malabsorption, e.g. Crohn's disease
Gastrectomy
Menorrhagia
Chronic renal failure; haemodialysis
Pregnancy
Low birth weight infants
72
Q

SYMPTOMS OF IRON DEFICIENCY? FSPP

A

Fatigue
SOB
Pale Skin
Palpitations

73
Q

SICKLE CELL DISEASE- folate supplementation helps make new red blood cells

SICKLE CELL CRISES- hydroxycarbamide reduces frequency of crises

A
74
Q

ECULIZUMAB- MONITORING
WHAT IS THIS BRUH
How many hours after infusion?
Paroxysmal nocturnal haemoglobinuria, monitor for?
Atypical haemolytic uraemic syndrome, monitor for?

A

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
Q

ECULIZUMAB CONTRACEPTION?

A

DURING+5 MONTHS AFTER TREATMENT

76
Q

What about patients receiving Eculizumab less than 2 weeks after vaccine?

A

Must be given prophylactic antibiotics until 2 weeks after vaccination

77
Q

ECULIZUMAB CAUTION?

A

MENINGOCOCCAL INFECTION
Vaccinate against Neisseria meningitidis at least 2 weeks before treatment, revac if need be

CONTRACEPTION DURING+5 MONTHS AFTER

78
Q 
TREATMENT OF
Paroxysmal nocturnal haemoglobinuria
Atypical haemolytic uraemic syndrome
Myasthenia gravis
Neuromyelitis optica spectrum disorder
(under expert supervision)
?
A

ECULIZUMAB

79
Q

METHOXY IS GIVEN TO CKD DIALYSIS PATIENTS WHEN NOT TAKING…?

A

ERYTHROPOETINS

80
Q

EPOETIN ZETA TREATMENT?

A

SYMPTOMATIC ANAEMIA W/ CHRONIC RENAL FAILURE+HAEMODIALYSIS

81
Q

EPOETIN BETA TREATMENT?

A

SYMPTOMATIC ANAEMIA W/ CHRONIC RENAL FAILURE

82
Q

Treatment of symptomatic anaemia w/ chronic renal failure+haemodialysis?

A

EPOETIN ALFA

83
Q

Treatment of symptomatic anaemia w/ chronic renal failure+dialysis?

A

DARBEPOETIN ALFA

84
Q

ERYTHROPOETIN MONITORING?

A 
BP
RETICULOCYTE COUNTS?
HB
ELECTROLYTES
IRON/FOLATE DEFICIENCY KEY
85
Q

ERYTHROPOETIN KEY KEY SIDE-EFFECTS?

A

HYERPTENSIVE CRISIS
PURE RED CELL APLASIA
?

86
Q

SIDE-EFFECTS OF ERYTHROPOETINS? H^2S^2J

A 
HEADACHE
HYPERTENSION
SKIN REACTIONS
STROKE
JOINT pain
87
Q

EPOETINS

CAUTIONED IN?

A 
ALUMINIUM TOXICITY
INFECTION
DIALYSIS
EPILEPSY
POOR BP CONTROL
IVD
MD
CVD
88
Q

EPOETINS

CONTRAINDICATED IN?

A

Unable to receive thromboprophylaxis
Pure red cell aplasia following erythropoetin therapy
Uncontrolled hypertension

89
Q

Treatment of aplastic anaemia?

A

OXYMETHOLONE (anabolic steroid)

90
Q

ERYTHROPOETINS MHRA WARNING- CANCER, DON’T USE OUTSIDE OF LICENSE MAN!

Treatment of symptomatic anaemia associated with cancer?

A

Only for those receiving chemotherapy

Can consider blood transfusion, risks VS benefits (good cancer prognosis ideal)

91
Q

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?

A
  • 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
Q

EPOETINS MHRA WARNING SKIN?

A

Severe cutaneous ADRs/Stevens-Johnson syndrome/toxic epidermal necrolysis

LOOK OUT FOR: RASHES/BLISTERING->FEVER/FLU SYMPTOMS

STOP ASAP N SEEK HELP

93
Q

What drug (a continuous erythropoietin receptor activator) is licensed for the treatment of symptomatic anaemia associated with chronic kidney disease?

A

Methoxy polyethylene glycol-epoetin beta- longer duration of action than epoetin

94
Q

Name and features of hyperglycosylated derivative of epoetin- DARBEPOETIN ALFA?

A

DARBEPOETIN ALFA
Longer half-life
Can be administered less frequently than epoetin

95
Q

Drug licensed for the prevention of anaemia in preterm neonates of low birth-weight?

A

Epoetin beta (takes few weeks for effect)

96
Q

Treatment of idiopathic sideroblastic anaemia?

A

Pyridoxine (high dose)

97
Q

Early adverse effects associated with antithymocyte globulin treatment?

A 
fever
rash
fluid retention
rigors
acute respiratory distress syndrome
anaphylaxis

Serum sickness? Occurs 7-14 days later

98
Q

Corticosteroid used to prevent adverse effects with antithymocyte globulin treatment?

A

Prednisolone

99
Q

NAME SOME DRUGS WITH POSSIBLE RISK OF HAEMOLYSIS (what is this) IN G6PD-DEFICIENT INDIVIDUALS?

A 
ASPIRIN
CHLOROQUINE
MENADIONE
QUININE
SULFONYLUREAS
100
Q

NAME SOME DRUGS WITH DEFINITE RISK OF HAEMOLYSIS (what is this) IN G6PD-DEFICIENT INDIVIDUALS?

A 
DAPSONE
FLUOROQUINONES
NITROFURANTOIN
QUINOLONES
SULFONAMIDES (+co-trimoxazole)
101
Q

Prescribing for patients with G6PD deficiency, 3 KEY POINTS?

A

G6PD deficiency is genetically heterogeneous- safety varies between people
Manufacturers- NO routine drug tests
Risk/severity of haemolysis-> almost always dose-related

102
Q

Individuals with G6PD deficiency are susceptible to developing acute haemolytic anaemia when they eat…?

A

FAVA BEANS? Mad

103
Q

G6DPD deficiency, 4 common regions?

A

AFRICA
ASIA
MEDITERRANEAN
MIDDLE EAST

104
Q

SICKLE CELL DISEASE

What drug is used to prevent acute chest syndrome/reduce painful crises/transfusion requirements?

Recurrent sickle cell disease?

A

What drug is used to prevent acute chest syndrome/reduce painful crises?
Hydroxycarbamide, benefits take months

Recurrent sickle cell disease?
Crizanlizumab

105
Q

IRON TABLETS+TEA/MILK?

A

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
Q

HYPERCALCAEMIA?

A

ARRHYTHMIA

107
Q

Patient presents with
CONFUSION, DROWSINESS

TREATMENT?

A

zoledronic acid- tumour-induced hypercalcaemia

108
Q

olanzapine, hyponatraemia?

A
109
Q

hypokalaemia- muscle weakness, palpitations, corti beta agonist

A
110
Q

phenytoin deficiency?

A

hypocalcaemia

111
Q

AMOX+OMEP H PYLORI?

A

USE 500MG TDS, otherwise 1000MG BD AS PER

112
Q

NEVER GIVE FOLIC ACID ALONE IN…

A

undiagnosed megaloblastic anaemia unless vitamin B12 is administered concurrently otherwise neuropathy may be precipitated

113
Q

orlistat avoid?

A

LACWAA

LEVOTHYROXINE 
AMIODARONE
WARFARIN 
AED
ARCOBSE
114
Q

HYDROXOCOBALAMIN DOSING?

A

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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