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GPhC BNF > BLOOD & NUTRITION (key aspects) > Flashcards

BLOOD & NUTRITION (key aspects) Flashcards

1
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
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2
Q

HYPOKALAEMIA vs HYPERKALAEMIA?

A

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

both palpitations- heart rate

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3
Q

HYPONATRAEMIA vs HYPERNATRAEMIA?

A

HYPONATRAEMIA- nausea, headache, irritability, seizures

HYPERNATRAEMIA- thirst, fatigue, confusion

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4
Q

HYPOCALCAEMIA vs HYPERCALCAEMIA?

A

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

both muscle cramp/confusion

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5
Q

DRUGS THAT CAUSE HYPOKALAEMIA?

A 
ABCDE I
Aminophylline/Theophylline
Beta-agonists
Corticosteroids
Diuretics (Loop/Thiazides)
Erythromycin/Clarithromycin
Insulin
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6
Q

DRUGS THAT CAUSE HYPERKALAEMIA?

A 
THANKS, B
Trimethoprim
Heparins
ACE-inhibitors/ARBs
NSAIDs
K-sparing Diuretics
Beta-blockers
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7
Q

POTASSIUM IMBALANCE RISK?

HYPOKALAEMIA AND DIGOXIN?

A

POTASSIUM IMBALANCE RISK? Cardiac side-effects- arrhythmias

HYPOKALAEMIA AND DIGOXIN? Toxicity risk

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8
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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9
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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10
Q

HYPERKALAEMIA IMPORTANT NOTE- SODIUM BICARBONATE AND CALCIUM SALTS?

A

DO NOT ADMINISTER IN SAME LINE- RISK OF PRECIPITATION

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11
Q

HYPERKALAEMIA TREATMENT

MILD-MODERATE HYPERKALAEMIA?

A

Ion-exchange resins- (Calcium Resonium)

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12
Q

DRUGS THAT CAUSE HYPONATRAEMIA?

A 
CERTAIN DRUGS DITCH SALT
Carbamazepine
Diuretics
Desmopressin/Vasporessin
SSRIs
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13
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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14
Q

HYPONATRAEMIA TREATMENT

Mild-moderate?

Severe?

A

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

Severe? IV NaCl

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15
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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16
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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17
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
Use BISPHOSPHONATES+PAMIDRONATE SODIUM

Hypercalcaemia due to sarcoidosis/vitamin D deficiency? Corticosteroids

Hypercalcaemia w/ malignancy? Calcitonin

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18
Q

HYPERCALCIURIA TREATMENT?

A

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

19
Q

HYPERPARATHYROIDISM

EXCESS parathyroid hormone leads to?

A

Hypercalcaemia
Hypercalciuria
Hypophosphataemia

20
Q

SIDE-EFFECTS OF HYPERPARATHYROIDISM?

A 
THIRST
POLYUREA
CONSTIPATION
FATIGUE
MEMORY IMPAIRMENT
CVD
KIDNEY STONES
OSTEOPOROSIS
21
Q

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

A
22
Q

PRIMARY HYPERPARATHYROIDISM TREATMENT

1st line?

A

SURGERY

23
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

24
Q

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

A
25
Q

HYPERMAGNESAEMIA TREATMENT? (Causes muscle weakness & arrhythmias)

A

Calcium gluconate injection- magnesium toxicity

26
Q

HYPOMAGNESAEMIA TREATMENT

SYMPTOMATIC?
MILD?

A

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

MILD? Oral magnesium

27
Q

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

A

Oral phosphate supplements

28
Q

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

A

MANAGE DIET
+
DIALYSIS BEFORE STARTING AGENTS

29
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)

30
Q

UREA CYCLE DISORDERS TREATMENT?

A 
SODIUM BENZOATE (unlicensed)
SODIUM PHENYLBUTYRATE
31
Q

What is ACUTE PORPHYRIAS?

A

Hereditary disorder of haem biosynthesis (1 in 75000)

32
Q

MODERATE-SEVERE-ACUTE PORPHYRIA CRISES TREATMENT?

A

IV Haem Arginate

33
Q

DRUGS UNSAFE IN ACUTE PORPHYRIAS?

A 
ANTIDEPRESSANTS
HORMONAL CONTRACEPTIVES, HRT
BARBITUATES
PROGESTOGEN
SULFONYLUREAS
TAXANES
34
Q

Orlistat impairs absorption of fat-solube vitamins so…?

A

GIVE VITMAIN D SUPPLEMENTS

35
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
36
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, children, soft and deformed bones
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?
37
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
38
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)
39
Q

VITAMINS (WATER-SOLUBLE)

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

A 
VITAMIN C (ascorbic acid)
deficiency leads to? scurvy- bleeding gums
helps w/? wound healing+maintains healthy skin/blood vessels/bone & cartilage
found in? oranges/peppers/strawberries/blackcurrants/broccoli/sprouts/potatoes
40
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)
B9 (folic acid)? +with methotrexate separate day, 5mg weekly
B12 (hydroxocobalamin)? Megaloblastic anaemia
found in? meat/cereals/vegetables, so vegans lack it!

41
Q

Pamidronate sodium?

A

Hypercalcaemia of malignancy

42
Q
  1. A 58-year-old female has atypical signs of hyperthyroidism. You are the practice pharmacist conducting a structured medication review and recognise the patient is taking a nutritional supplement that can result in a false diagnosis of thyrotoxicosis. Below is a list of her regular medication:
    • Propylthiouracil 50mg twice a day
    • Ramipril 2.5mg daily
    • Atorvastatin 20mg daily
A

VITAMIN B1?

There may be false assay results due to the ingestion of the over-the-counter supplement biotin - this may cause spuriously low TSH levels and elevate T4 and T3 levels.
Additional information: B vitamins and their medical names
-	Thiamin (Bl)
-	Riboflavin (B2)
-	Niacin {B3)
-	Pantothenic acid (BS)
-	Pyridoxine (B6)
-	Biotin (B7)
-	Folic acid (B9)
-	Cyanocobalamin {B12)
43
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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