BNF Chapter 9: Nutrition and Blood Flashcards
What is the preferred oral treatment for iron deficiency anaemia?
Ferrous fumarate 322mg tablet
Iron-Deficient Anaemia
- Investigate and treat any underlying cause (e.g., Coeliac disease, GI ulcer)
- Choice of preparation is usually decided by the incidence of side- effects and cost.
- Initially treat with one tablet per day taken on an empty stomach. If not tolerated, consider reducing dose to one tablet every other day or consider alternative oral preparations.
- Taking iron with meals can reduce bioavailability by up to 75%.
- Modified release preparations have no therapeutic advantage (they do not enhance iron absorption or reduce side effects) and should not be used.
- Give oral iron and continue until 3 months after deficiency is corrected so that stores are replenished.
- Monitor patient in the first 4 weeks for an Hb response to oral iron. The haemoglobin concentration should rise by about 20 g/L over 3–4 weeks. Once Hb and red cell indices are normal and treatment is stopped, monitor every 3 months for 1 year and then again after a further year.
- Give further oral iron if levels fall below normal.
- Review and stop aspirin/NSAID if appropriate.
Coadministration of vitamin C with oral iron is not recommended. It neither enhances the haematological response or rate of iron loading, nor diminishes side effects.
Iron tablets should be taken with food.
True or false?
False- they should be taken on an empty stomach to enhance bioavailability
What two drugs can be used in megaloblastic anaemias?
Folic acid tablets
Hydroxocobalamin injections
Folic acid tablets can be crushed and mixed with water for administration. True or False?
True- folic acid oral solution is more expensive and unnecessary since you can crush tablets.
Hydroxocobalamin
-B12 deficient patients should be treated with IM hydroxocobalamin. Self-care should be promoted to patients with borderline B12 deficiency without neurological symptoms or anaemia.
-Cyanocobalamin is Do Not Prescribe (DNP) as it is poorly absorbed.
Patients with vitamin B12 deficiency should be treated with IM hydroxocobalamin injections. Patients should be encouraged to self-care in line with local policy. Cyanocobalamin 1mg daily was recommended during COVID-19 by exception for when giving or delaying IM hydroxocobalamin are not viable options- there
will be a transitionary period for existing patients.
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What exactly do hydroxocobalamin injections treat?
Vitamin B12 deficiency
Folic Acid and the Prevention of Neural Tube Defects
-Women at low risk of neural tube defects are advised to take 400microgram of folic acid daily before conception and continue until 12 weeks of pregnancy with the expectation that this is bought OTC by women. Women at high risk of neural tube defects should be prescribed the 5mg dose and once pregnant, to continue this until 12 weeks of pregnancy. In the case of sickle cell anaemia folic acid 5mg daily should continue beyond the 12 weeks and throughout pregnancy.
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What would classify a women as ‘high risk’ for neural tube defects in pregnancy?
- Either partner has an NTD, they have had a previous pregnancy affected by an NTD, or they have a family history of an NTD.
- Woman has coeliac disease (or other malabsorption state)
- Diabetes mellitus
- Sickle cell anaemia or thalassaemia
- Taking anti-epileptic medicines
- Woman is obese (defined as a BMI of 30kg/m² or more)
For a high risk patient for neural tube defects in pregnancy, what is the expectation in regards to taking folic acid?
Should be prescribed the 5mg dose and once pregnant they should continue this dose until 12 weeks.
What are some examples of oral potassium that can be prescribed?
Kay-Cee-L s/f suspension
Sando-K effervescent tablets
What is Phenylketonuria?
Phenylketonuria (PKU) is a common inherited metabolic disorder affecting the metabolism of foods
containing protein. In people with PKU, the enzyme, phenylalanine hydroxylase, required to convert the
amino acid phenylalanine into tyrosine is either absent or deficient.
If left untreated, the build-up of phenylalanine in the blood can result in severe brain damage. PKU can be
successfully treated by a low phenylalanine diet.
How can Phenylketonuria be treated?
By a low phenylalanine diet
What are some examples of powdered products that can be used for supplementing nutrition?
Energie shake
Foodlink complete
Complan shake
Ensure shake
What are some examples of ready-made products that can be used to supplement nutrition?
Altraplen energy
Energie shake complete 1.5kcal
Aymes complete
Fortisip bottle
Thickening Agents
-Polyethylene glycol (PEG) laxatives and starch-based thickeners: potential interactive effect when mixed, leading to an increased risk of aspiration. Avoid directly mixing together PEG laxatives and starch-based thickeners, especially in patients at risk of aspiration e.g., elderly and people with disabilities that affect swallowing.
-Nutilis clear is the preferred thickening agent for patients with dysphagia (xanthan gum based).
Thickeners are provided on prescription and should only be recommended following assessment by a
Speech and Language Therapist or a Dysphagia Trained Nurse.
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Vitamin B
-Deficiency of the B vitamins, other than deficiency of vitamin B12, is rare in the UK, and is usually treated
by preparations containing thiamine (B1), riboflavin (B2), and nicotinamide, which is used in preference to
nicotinic acid, as it does not cause vasodilatation.
-The severe deficiency states Wernicke’s encephalopathy and Korsakoff’s psychosis, especially as seen in chronic alcoholism, are best treated initially by the parenteral administration of B vitamins (Pabrinex®), followed by oral administration of thiamine in the longer term. Anaphylaxis has been reported with
parenteral B vitamins.
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Thiamine 50mg or 100mg
Vitamin B compound strong is RED for specialist use as a short course, post-acute admissions; GREY
after consultant/specialist recommendation for patients with a medically diagnosed deficiency due to
lifelong or chronic condition or following surgery that results in malabsorption. Also, for refeeding
syndrome - short course supplied in hospital or in exceptional circumstances GPs may prescribe
following a community dietician request. Do Not Prescribe (DNP) for all other indications.
Vitamin D Supplements
-Strivit D3 20,000 unit capsules- taken daily (not suitable for vegetarians)
-InVita D3 50,000 unit capsules- taken weekly (not suitable for vegetarians)
-Invita D3 25,000 unit/ml and 50,000 unit/ml oral solution- only use if capsules and tablets aren’t suitable.
-Thorens 10,000 unit/ml oral drops- an option for children
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Supplements with Calcium
-Accrete D3 tablets- taken twice daily
-Evacal D3 tablets- taken twice daily (chewable)
-Calfovit D3 sachet- taken daily
-Adcal D3 caplet- two taken twice daily
-Calci-D- taken once daily (chewable)
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