CH9: BLOOD & NUTRITION Flashcards
1
Q
name the 6 types of anaemias, describe each and the potential deficiency it may cause
A
- Renal anaemia
- Microcytic
- Macrocytic = megaoblastic
- Haemolytic
- Aplastic anaemia
- rare
bone marrow is unable to produce enough RBCs - less RBCs =
- rare
- Sickle cell anaemia
- deformed shaped and less flexible RBCs
- cause folate deficiency
2
Q
name the 6 types of anaemias, describe each and the potential deficiency it may cause
A
- 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
- Microcytic
- bone marrow produces too SMALL of RBCs= lack of nutrients
- Iron deficiency
- Macrocytic = megaoblastic
- bone marrow produces too LARGE of RBCs= lack of nutrients
- cause folate and Vit B12 deficiency
- 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
- Aplastic anaemia
- rare disorder
- bone marrow is unable to produce enough RBCs
- fewer RBCs = less O2 is delivered to organs
- Sickle cell anaemia
- deformed shaped and less flexible RBCs
- cause folate deficiency
3
Q
management of sickle cell crisis
A
- Needs to be hospitalised; fluid replacement, treatment to any concurrent infections and analgesia for pain.
4
Q
what are the possible complications related to patients with sickle cell anaemia?
A
- leg ulcers
- renal failure
- susceptible to infections
- anemia
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
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
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
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
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
10
Q
treatment management for patients with megaloblastic anaemia
A
- Vitamin B12 deficiency
- symptoms: numbness, tingling of hands/feet, depression, muscle weakness
- IM Hydroxycobalamin to be given 3 monthly dose - Folate deficiency
- cx: pregnancy, poor nutrition or AED
- folic acid supplements for 4 months
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.
12
Q
state the dose of folic acid in regular pregnancy
A
400mcg OD until 12 weeks of pregnancy
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
14
Q
what are the risk factors for neural tube defects?
A
- Smoking
- Sickle cell anaemia during pregnancy
- Diabetes
- Obesity
- Antimalarial drugs
- Antiepileptic drugs
15
Q
what are the signs and symptoms of iron deficiency?
A
- pale skin
- fatigue
- SOB
- palpitations
16
Q
name the differential diagnosis that would need to be excluded before tx of iron deficiency.
A
- GI erosion
- GI cancer
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
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
19
Q
advice on iron supplements for pregnant women
A
- PO iron supplement + Folic acid
- Avoid IV Fe supplement
20
Q
side effects of PO iron supplements
A
- Black tarry stool (rule out GI bleeding)
- Constipation/Diarrhoea
21
Q
Indications for parenteral iron
A
example - iron dextrose
- chemo-induced anaemia
- chronic renal failure with dialysis
- if oral iron is not adequate
22
Q
mhra alert of parenteral iron
A
- severe hypersensitivity reactions with IV iron
- Caution with every IV dose = trained staff and resuscitation is available
- Monitor for 30 mins after each injection
- High risk in allergies/inflammation
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
24
Q
what are the hypocalcaemia symptoms?
A
range: <2.2
Muscle cramp
Confusion
Depression
forgetful
25
what are the hypocalcemia-inducing drugs?
BR PP
rifampicin, phenytoin, phenobarbital, bisphosphonate
26
treatment for mild-moderate hypocalcemia
calcium + vitamin D (calcichew, adcal…)
27
treatment for severe acute hypocalcemia
- 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
28
what are the symptoms of hypercalcemia?
range: > 2.6
Nausea
Lethargy
Muscle cramp
Confusion
Arrhythmia
29
what are the hypercalcemia-inducing drugs?
- Thiazide diuretics
- lithium
30
treatment for severe hypercalcaemia
* Correct dehydration with IV NaCl 0.9%
* Bisphosphonates OR pamidronate disodium (most effective)
- Takes a few days to work
* Malignancy: Calcitonin
31
in what cases would you offer corticosteriods for hypercalcemia?
if it is caused by Vitamin D toxicity or sarcoidosis
32
treatment for hypercalciuria
hypercalciuria = excess calcium in urine
- Bendroflumethiazide + increase fluid intake
33
what are the symptoms of hypomagnesia
range <0.6
muscle weakness
- more common in alcoholics
34
what are the hypomagnesia-inducing drugs?
PLTC
PPIs
Loop diuretics (furosemide, bumetinade)
Thiazide diuretics (indapamide)
Ciclosporin
35
treatment of hypomagnesia?
mild - PO magnesium supplement
SEVERE: IV/IM magnesium sulphate (IM painful)
36
what are the symptoms of hypermagnesemia?
range >1
- muscle weakness
-arrthymias
37
what are the hypermagnesia-inducing drugs?
laxatives
38
treatment of hypermagnesemia?
* Treatment: calcium gluconate injection
39
name the cases in which are at risk of hypophosphatemia
* In patients with alcohol dependence/ severe DKA
range <0.87
40
management of hypophosphatemia
oral phosphate supplements
41
range of Hyperphosphatemia
increases PTH (risk of HYPERPARATHYROIDISM)
range >1.45
42
management of hyperphosphatemia?
* Phosphate binding agents (calcium or non-calcium based)
43
state the treatment options for a patient with stage 4/5 CKD and suffering from hyperphosphatemia.
- Manage diet before starting treatment
* 1st line: calcium acetate
* 2nd line: sevelamer
* 3rd line: CaCO3 (calcium based) or sucroferric oxyhydroxide (non-calcium based)
44
what is hyperparathyroidism
Excess PTH resulting in:
* Hypercalcaemia, hyperphosphatemia, hypercalciruria
Women twice as affected as men (age 50-60 common)
45
symptoms of hyperparathyroidism
* Symptoms: thirst, polyuria, constipation, fatigue, memory impairment, CVD, kidney stones, osteoporosis
46
management of hyperparathyroidism (1st line)
* 1st line: Parathyroidectomy surgery
* Assess CVD and fracture risk (as hyperparathyroidism can cause CVD and osteoporosis)
47
pharmacological options for pt who is CI to surgery, for treatment of hyperparathyroidism
* Cinacalcet
* Secondary care: measure vitamin D levels – supplement if needed
* Bisphosphonate to reduce fracture risk
48
what are the symptoms of hyponatremia
range <133
Nausea
Headache
Confusion
Fatigue
Irritability
Seizures
49
what are the symptoms of hypernatremia
range >146
Thirst
Fatigue
Confusion
50
what are the symptoms of hypokalaemia
range <3.5
Muscle cramps
Rhabdomyolysis
Fatigue
Palpitations
Arrhythmias
51
what are the symptoms of hyperkalaemia
range >5.3
Fatigue
Numbness
Nausea
SOB
Chest pain
Palpitations
52
name the hypokalemia-inducing drugs
ABCDEI
Aminophylline/ theophylline
Beta agonists
Corticosteroids
Diuretics (loop/ thiazide)
Erythromycin/ clarithromycin
Insulin
53
name the hyperkalemia-inducing drugs
THANKSB CT
Trimethoprim
Heparins
ACEI/ARBS
NSAIDs
K-sparing diuretics
Betablockers
Ciclosporin
Tacrolimus
54
management for mild to moderate hypokalemia
- Oral replacement therapy:SANDO-K tablets
- Review medication e.g., potassium sparing diuretic
55
management for severe hypokalemia
IV KCl in saline
Rate: max 20mmol/hr
56
management for renal impairment
Potassium replacement in caution due to risk of hyperkalaemia from reduced potassium excretion
57
management for mild to moderate hyperkalaemia
Ion exchange resins to remove excess potassium – Calcium resonium
58
management for acute severe hyperkalaemia
* 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
name the hyponatraemia-inducing drugs
CDDS
Carbamazepine
Diuretics
Desmopression/ vasopression
SSRI
60
Name the hypernatremia-inducing drugs
SCEOL
Sodium bicarbonate/ chloride
Corticosteroids
Effervescent formulations
Oestrogens/ androgrens
Lithium
61
management for mild to moderate hyponatremia
PO sodium supplements (sodium chloride or sodium bicarbonate)
62
management for severe hyponatremia
IV NaCI
63
management for hypernatremia
Diabetes insipidus: IV Glucose
64
what is acute porphyrias and its treatment?
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
name the drugs that cause acute porphyrias
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
in what cases, would you advise using IV vitamins
* 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
what are the deficiency symptoms of vitamin A
* Ocular effects
* Increased risk of infection
68
what are the deficiency symptoms of vitamin D?
* Rickets – poor bone development and bone deformities
69
treatments of vitamin D and where it is found?
treatment example ;
Ergocalciferol D2
Cholecalciferol D3
Alfacalcidol
Calcitriol
found in;
* Sunlight
* Oily fish, red meat, liver, egg yolk, fortified foods such as cereal
70
counselling advice for patients with vitamin D deficiency
* Increase sunlight
* dietary
71
what are the deficiency symptoms of vitamin E
* Neuromuscular abnormalities
72
Treatment of vitamin E deficiency
drug - tocopherol
management
- plant oils
- nuts
- seeds
- wheat
73
what are the deficiency symptoms of vit K
* Blood clotting factors
* Deficiency = bleeding
74
Treatment and management of vitamin K deficiency
* Menadiol (water-soluble derivative) given orally in malabsorption syndrome
* Green leafy veg, veg oil, cereal grains
75
what are the deficiency symptoms of vitamin C
* Scurvy
* Lack of wound healing
* Unhealthy skin, blood vessels and bone/ cartilage
76
treatment and management of Vitamin C deficiency
- treatment: ascorbic acid
* Orange, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
* Citrus fruits
77
what are the types of vitamin B and the deficiency symptoms of vitamin B?
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
treatment and management of Vitamin B deficiency
* Meats, cereals, vegetables
