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GPhC Exam '22 > CH9: BLOOD & NUTRITION > Flashcards

CH9: BLOOD & NUTRITION Flashcards

1
Q

name the 6 types of anaemias, describe each and the potential deficiency it may cause

A
  1. Renal anaemia
  2. Microcytic
  3. Macrocytic = megaoblastic
  4. Haemolytic
  5. Aplastic anaemia
    • rare
      bone marrow is unable to produce enough RBCs
    • less RBCs =
  6. Sickle cell anaemia
    • deformed shaped and less flexible RBCs
    • cause folate deficiency
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2
Q

name the 6 types of anaemias, describe each and the potential deficiency it may cause

A
  1. Renal anaemia
    • when the kidney is damaged and unable to produce EPO (eythropoetins) to make RBCs
    • fewer EPO = fewer RBCs = less O2 is delivered to organs
  2. Microcytic
    • bone marrow produces too SMALL of RBCs= lack of nutrients
    • Iron deficiency
  3. Macrocytic = megaoblastic
    • bone marrow produces too LARGE of RBCs= lack of nutrients
    • cause folate and Vit B12 deficiency
  4. Haemolytic
    • abnormal breakdown of RBCs, and bone marrow inability to produce new RBCs to replace this disorder as fast.
    • caused by use of some medications, G6PD deficiency, infections
  5. Aplastic anaemia
    • rare disorder
    • bone marrow is unable to produce enough RBCs
    • fewer RBCs = less O2 is delivered to organs
  6. Sickle cell anaemia
    • deformed shaped and less flexible RBCs
    • cause folate deficiency
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3
Q

management of sickle cell crisis

A
  • Needs to be hospitalised; fluid replacement, treatment to any concurrent infections and analgesia for pain.
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4
Q

what are the possible complications related to patients with sickle cell anaemia?

A
  • leg ulcers
  • renal failure
  • susceptible to infections
  • anemia
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5
Q

if a patient suffering from sickle cell anaemia and has a form of haemolytic anaemia?

A

results to increase folate requirements, therefore providing folate supplements.

folic acid

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6
Q

state why IM hydroxycarbamide is used in pts with sickle cell anaemia.

A
  • reduces the frequency of sickle cell crisis
  • reduces blood transfusion requirements
  • prevents risk of acute chest syndrome
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7
Q

state the region and gender who are most commonly known to have G6PD deficiency

A
  • most common in males
  • most common in Africa and Asia
  • G6PD deficiency is predisposed to haemolytic anaemia
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8
Q

Name the drugs that are at DEFINITE risk of haemolytic anaemia

A

Nitrofurantoin
Dapsone (sulfones)
Quinolones

acronym: No Driving Quickly in my G6

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9
Q

Name the drugs that are at POSSIBLE risk of causing haemolytic anaemia

A

Aspirin
Menadione
Quinine
Sulfonyureas
Chloroquinine

acronym: Ask Me Quickly Stupid Cunt

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10
Q

treatment management for patients with megaloblastic anaemia

A
  1. Vitamin B12 deficiency
    - symptoms: numbness, tingling of hands/feet, depression, muscle weakness
    - IM Hydroxycobalamin to be given 3 monthly dose
  2. Folate deficiency
    - cx: pregnancy, poor nutrition or AED
    - folic acid supplements for 4 months
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11
Q

emergency treatment for patients with megaloblastic anaemia

A

Give Vitamin B12 with Folic acid

  • Avoid giving folic acid alone = neuropathy of the spinal cord.
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12
Q

state the dose of folic acid in regular pregnancy

A

400mcg OD until 12 weeks of pregnancy

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13
Q

state the dose of folic acid in pregnant women who are at risk of neural tube defect?

A

5mg OD until 12 weeks of pregnancy

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14
Q

what are the risk factors for neural tube defects?

A
  1. Smoking
  2. Sickle cell anaemia during pregnancy
  3. Diabetes
  4. Obesity
  5. Antimalarial drugs
  6. Antiepileptic drugs
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15
Q

what are the signs and symptoms of iron deficiency?

A
  • pale skin
  • fatigue
  • SOB
  • palpitations
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16
Q

name the differential diagnosis that would need to be excluded before tx of iron deficiency.

A
  • GI erosion
  • GI cancer
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17
Q

name the cases in which prophylaxis of iron supplements can be given to?

A
  • menorrhagia
  • pregnant women
  • malabsorption
  • haemodialysis
  • gastroectomy
  • the low birth weight of infants
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18
Q

counselling pointers for patients taking oral iron supplements

A
  • take with or after food = to prevent GI irritation
  • continue taking for 3 months after haematological data is normal
  • can take a glass of orange juice as Vit C helps iron absorption
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19
Q

advice on iron supplements for pregnant women

A
  • PO iron supplement + Folic acid
  • Avoid IV Fe supplement
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20
Q

side effects of PO iron supplements

A
  1. Black tarry stool (rule out GI bleeding)
  2. Constipation/Diarrhoea
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21
Q

Indications for parenteral iron

A

example - iron dextrose

  1. chemo-induced anaemia
  2. chronic renal failure with dialysis
  3. if oral iron is not adequate
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22
Q

mhra alert of parenteral iron

A
  • severe hypersensitivity reactions with IV iron
  1. Caution with every IV dose = trained staff and resuscitation is available
  2. Monitor for 30 mins after each injection
  3. High risk in allergies/inflammation
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23
Q

treatment for neutrophils & its risks

A
  • neutrophils = low neutrophil levels, increased risk of infection/sepsis.
  • treatment= filgrastim
    > stimulates neutrophils production in the bone marrow
    > reduces duration of chemo-induced neutropenia
    > Stop use if pt has developed pulmonary infiltration
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24
Q

what are the hypocalcaemia symptoms?

A

range: <2.2
Muscle cramp
Confusion
Depression
forgetful

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25
Q

what are the hypocalcemia-inducing drugs?

A

BR PP

rifampicin, phenytoin, phenobarbital, bisphosphonate

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26
Q

treatment for mild-moderate hypocalcemia

A

calcium + vitamin D (calcichew, adcal…)

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27
Q

treatment for severe acute hypocalcemia

A
  • Initial slow IV calcium gluconate 10% with plasma calcium and ECG monitoring
  • Too quick = arrhythmia
  • Repeated if needed or follow with continuous IV infusion to prevent recurrence
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28
Q

what are the symptoms of hypercalcemia?

A

range: > 2.6

Nausea
Lethargy
Muscle cramp
Confusion
Arrhythmia

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29
Q

what are the hypercalcemia-inducing drugs?

A
  • Thiazide diuretics
  • lithium
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30
Q

treatment for severe hypercalcaemia

A
  • Correct dehydration with IV NaCl 0.9%
  • Bisphosphonates OR pamidronate disodium (most effective)
  • Takes a few days to work
  • Malignancy: Calcitonin
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31
Q

in what cases would you offer corticosteriods for hypercalcemia?

A

if it is caused by Vitamin D toxicity or sarcoidosis

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32
Q

treatment for hypercalciuria

A

hypercalciuria = excess calcium in urine

  • Bendroflumethiazide + increase fluid intake
33
Q

what are the symptoms of hypomagnesia

A

range <0.6

muscle weakness

  • more common in alcoholics
34
Q

what are the hypomagnesia-inducing drugs?

A

PLTC

PPIs
Loop diuretics (furosemide, bumetinade)
Thiazide diuretics (indapamide)
Ciclosporin

35
Q

treatment of hypomagnesia?

A

mild - PO magnesium supplement
SEVERE: IV/IM magnesium sulphate (IM painful)

36
Q

what are the symptoms of hypermagnesemia?

A

range >1
- muscle weakness
-arrthymias

37
Q

what are the hypermagnesia-inducing drugs?

A

laxatives

38
Q

treatment of hypermagnesemia?

A
  • Treatment: calcium gluconate injection
39
Q

name the cases in which are at risk of hypophosphatemia

A
  • In patients with alcohol dependence/ severe DKA

range <0.87

40
Q

management of hypophosphatemia

A

oral phosphate supplements

41
Q

range of Hyperphosphatemia

A

increases PTH (risk of HYPERPARATHYROIDISM)

range >1.45

42
Q

management of hyperphosphatemia?

A
  • Phosphate binding agents (calcium or non-calcium based)
43
Q

state the treatment options for a patient with stage 4/5 CKD and suffering from hyperphosphatemia.

A
  • Manage diet before starting treatment
  • 1st line: calcium acetate
  • 2nd line: sevelamer
  • 3rd line: CaCO3 (calcium based) or sucroferric oxyhydroxide (non-calcium based)
44
Q

what is hyperparathyroidism

A

Excess PTH resulting in:
* Hypercalcaemia, hyperphosphatemia, hypercalciruria

Women twice as affected as men (age 50-60 common)

45
Q

symptoms of hyperparathyroidism

A
  • Symptoms: thirst, polyuria, constipation, fatigue, memory impairment, CVD, kidney stones, osteoporosis
46
Q

management of hyperparathyroidism (1st line)

A
  • 1st line: Parathyroidectomy surgery
  • Assess CVD and fracture risk (as hyperparathyroidism can cause CVD and osteoporosis)
47
Q

pharmacological options for pt who is CI to surgery, for treatment of hyperparathyroidism

A
  • Cinacalcet
  • Secondary care: measure vitamin D levels – supplement if needed
  • Bisphosphonate to reduce fracture risk
48
Q

what are the symptoms of hyponatremia

A

range <133

Nausea
Headache
Confusion
Fatigue
Irritability
Seizures

49
Q

what are the symptoms of hypernatremia

A

range >146
Thirst
Fatigue
Confusion

50
Q

what are the symptoms of hypokalaemia

A

range <3.5

Muscle cramps
Rhabdomyolysis
Fatigue
Palpitations
Arrhythmias

51
Q

what are the symptoms of hyperkalaemia

A

range >5.3

Fatigue
Numbness
Nausea
SOB
Chest pain
Palpitations

52
Q

name the hypokalemia-inducing drugs

A

ABCDEI

Aminophylline/ theophylline
Beta agonists
Corticosteroids
Diuretics (loop/ thiazide)
Erythromycin/ clarithromycin
Insulin

53
Q

name the hyperkalemia-inducing drugs

A

THANKSB CT

Trimethoprim
Heparins
ACEI/ARBS
NSAIDs
K-sparing diuretics
Betablockers
Ciclosporin
Tacrolimus

54
Q

management for mild to moderate hypokalemia

A
  • Oral replacement therapy:SANDO-K tablets
  • Review medication e.g., potassium sparing diuretic
55
Q

management for severe hypokalemia

A

IV KCl in saline
Rate: max 20mmol/hr

56
Q

management for renal impairment

A

Potassium replacement in caution due to risk of hyperkalaemia from reduced potassium excretion

57
Q

management for mild to moderate hyperkalaemia

A

Ion exchange resins to remove excess potassium – Calcium resonium

58
Q

management for acute severe hyperkalaemia

A
  • urgent treatment
  • IV calcium chloride 10% OR calcium gluconate 10% +/-
  • IV soluble insulin (5-10units) with 50mL glucose 50% given over 5-15 minutes +/-
  • Salbutamol (nebulisation or slow IV injection)
  • Review drugs exacerbating hyperkalaemia
59
Q

name the hyponatraemia-inducing drugs

A

CDDS

Carbamazepine
Diuretics
Desmopression/ vasopression
SSRI

60
Q

Name the hypernatremia-inducing drugs

A

SCEOL

Sodium bicarbonate/ chloride
Corticosteroids
Effervescent formulations
Oestrogens/ androgrens
Lithium

61
Q

management for mild to moderate hyponatremia

A

PO sodium supplements (sodium chloride or sodium bicarbonate)

62
Q

management for severe hyponatremia

A

IV NaCI

63
Q

management for hypernatremia

A

Diabetes insipidus: IV Glucose

64
Q

what is acute porphyrias and its treatment?

A

A genetic defect in haem biosynthesis and if certain drugs are taken in haemolytic anaemia, then acute porphyric crises can occur

Treat moderate-severe crises with haem arginate

65
Q

name the drugs that cause acute porphyrias

A

antibiotics
- trimethoprim
- nitrofurantoin
- clindamycin
- erythromycin
- chloromphenicol

tuberculosis abx
- rifampacin
- isoniazid

cardio-vascular meds
- verapamil
- diltiazem
- amiodarone
- methyldopa
- indapamide
- spironolactone

cns
- phenytoin
- carbamazipine
- topiramate
- valrproate
- risperidone

nsaids
- mefenemic acid

66
Q

in what cases, would you advise using IV vitamins

A
  • Given when inadequate nutrition
  • Supplemental parenteral nutrition: Addition to ordinary feeding
  • Total parenteral nutrition (TPN): Sole source of nutrition
  • Infused through central venous catheter or peripheral vein
67
Q

what are the deficiency symptoms of vitamin A

A
  • Ocular effects
  • Increased risk of infection
68
Q

what are the deficiency symptoms of vitamin D?

A
  • Rickets – poor bone development and bone deformities
69
Q

treatments of vitamin D and where it is found?

A

treatment example ;
Ergocalciferol D2
Cholecalciferol D3
Alfacalcidol
Calcitriol

found in;
* Sunlight
* Oily fish, red meat, liver, egg yolk, fortified foods such as cereal

70
Q

counselling advice for patients with vitamin D deficiency

A
  • Increase sunlight
  • dietary
71
Q

what are the deficiency symptoms of vitamin E

A
  • Neuromuscular abnormalities
72
Q

Treatment of vitamin E deficiency

A

drug - tocopherol

management
- plant oils
- nuts
- seeds
- wheat

73
Q

what are the deficiency symptoms of vit K

A
  • Blood clotting factors
  • Deficiency = bleeding
74
Q

Treatment and management of vitamin K deficiency

A
  • Menadiol (water-soluble derivative) given orally in malabsorption syndrome
  • Green leafy veg, veg oil, cereal grains
75
Q

what are the deficiency symptoms of vitamin C

A
  • Scurvy
  • Lack of wound healing
  • Unhealthy skin, blood vessels and bone/ cartilage
76
Q

treatment and management of Vitamin C deficiency

A
  • treatment: ascorbic acid
  • Orange, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
  • Citrus fruits
77
Q

what are the types of vitamin B and the deficiency symptoms of vitamin B?

A

B1 (THIAMINE)
* Wernicke’s encephalopathy
B2 (RIBOFLAVIN)
* Keeps skin, eyes, CNS healthy
B6 (PYRIDOXINE)
* Treats peripheral neuropathy associated with isoniazid
B12 (HYDROXOCOBALAMIN)
* Used for megoblastic anaemia

78
Q

treatment and management of Vitamin B deficiency

A
  • Meats, cereals, vegetables

GPhC Exam '22 (16 decks)

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