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2021 Pre-registration > Chapter 9: Blood and nutrition > Flashcards

Chapter 9: Blood and nutrition Flashcards

1
Q

Before starting treatment for anaemia what is imperative?

A

To find out what type of anaemia it is due to risks associated with iron overload.

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2
Q

What is sickle cell disease?

A

Impaired haemoglobin structure (moon-like) of red blood cells. Can lead to blockage/infracts = lack of bloody supply to vital organs and leads to severe pain. Can cause severe hospitalisation.

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3
Q

Increased folate levels helps to __________

A

make new red blood cells

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4
Q

What type of anaemia is associated with sickle cell disease?

A

Haemolytic anaemia

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5
Q

What drug is used to reduce the frequency of crises and blood transfusions in sickle cell?

A

hydroxycarbamide

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6
Q

What does sickle cell disease increase the risk of (in terms of vasculature)?

A

Stroke

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7
Q

What is G6PD deficiency?

A

Inborn error with the metabolism of carbohydrates. Common in those from africa, asia, oceania

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8
Q

Risks of G6PD deficiency?

A
  • haemolytic anemia (spontaneous destruction of RBC)
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9
Q

What is haemolysis?

A

Spontaneous destruction of RBC

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10
Q

Which drugs have a definite risk of haemolysis in those that are G6PD-deficient?

A

Nitrofurantoin
Sulfonamides: co-trimoxazole
Quinolones
Rasburicase

Possible risk - gliclazide (sulfonylureas) = haemolytic anaemia

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11
Q

MHRA warnings associated with epoetins?

A

1) Risk of SCARs

2) Tumour progression in those with cancer related anaemia

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12
Q

Key side-effect of epoetins?

A

Hypertensive crisis

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13
Q

What is the role of iron?

A

Helps to make healthy RBC that carry oxygen around the body

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14
Q

Symptoms of iron deficiency?

A 
Fatigue
Pale skin
SOB
Palpitations
Hair loss
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15
Q

what conditions would require iron prophylaxis and why? hint: you can give it parenterally for these reasons

A

Chrons - nutrients and vits poorly absorbed from the gut
Gastrectomy - stomach removal so insufficient absorption
Menorrhagia - blood loss and haemodialysis
Renal failure - dialysis
Pregnancy - extra iron required for baby
Pre-term neonates with low birth weight - nutritional deficiencies

Due to malabsorption

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16
Q

Which iron preparation has the highest amount of ferrous iron?

A

Ferrous fumarate 210mg (65mg) + ferrous sulphate 200mg (65mg)

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17
Q

Patient counselling with oral iron preparations?

A

Take with or after food (reduce GI SE e.g. constipation)
- though best absorbed on empty stomach

Can take with vitamin c e.g. orange juice - better absorbed

Black, tarry stools as a side-effect

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18
Q

name an iron-containing compound preparation and which category of patients would this be suitable in?

A

iron + folic acid: for pregnant women - only if deficient in both

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19
Q

A patient asks you how long they need to continue their iron therapy for. What do you say?

A

Continue till 3 months after levels return to normal

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20
Q

What is the normal iron level range? (NICE)

A

In men aged over 15 years — Hb below 130 g/L.

In non-pregnant women aged over 15 years — Hb below 120 g/L.

In children aged 12–14 years — Hb below 120 g/L.

In pregnant women — Hb below 110 g/L throughout pregnancy. An Hb level of 110 g/L or more appears adequate in the first trimester, and a level of 105 g/L appears adequate in the second and third trimesters.

Postpartum — below 100 g/L.

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21
Q

Iron has a ceiling effect with dose. Above what dose does iron demonstrate no further evidence of absorption?

A

200mg

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22
Q

If iron is used in iBD what can it exacerbate?

A

diarrhoea

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23
Q

Why is parenteral iron not routinely recommended?

A

No evidence of benefit compared to oral.

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24
Q

Give an example of iron infusion used in practice.

A

Monofer max 20mg/kg in one sitting and then repeat after a week if needs more (not licensed for >20mg/kg in one seating)

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25
Q

In what disease/condition states would you require parenteral iron?

A

Chemo-induced anaemia

Chronic renal failure with haemodialysis

Malabsorption syndrome

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26
Q

What is an MHRA warning with IV iron?

A

serious hypersensitivity reactions therefore, monitor for signs during and 30mins after

  • can happen even if tolerated previously
  • ensure resus equipement and facilities available and the dose is given by trained staff
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27
Q

What category of patients are at higher risk of hypersensitivity rx with parenteral iron?

A
  • asthma
  • allergies
  • eczema
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28
Q

Recommendations on parenteral iron in pregnancy.

A

Avoid 1st trimester but can give in 2nd or 3rd if there is no other choice

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29
Q

Two causes of megaloblastic anaemia?

A

vit b12 deficiency or folic acid deficiency

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30
Q

Symptoms of megaloblastic anaemia?

A

Muscle weakness
Tingling of hands and feet
Numbness
Depression

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31
Q

Drug treatment for dietary vitamin b12 deficiency?

A

Oral cyanacobalamin (B12)

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32
Q

Drug treaåtment for malabsorption vitamin b12 deficiency e.g. chrons?

A

IM Hydroxocobalamin every 3 months

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33
Q

Emergency treatment for vitamin b12 deficiency?

A

folic acid + b12 but not folic acid alone due to risk of neuropathy

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34
Q

Which vitamin b12 therapy is the therapy of choice? cyanocobalamin or hydroxocobalamin?

A

Hydroxocobalamin as retained in the body for longer hence 3 monthly injections

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35
Q

Causes of folate deficiency?

A

pregnancy
malabsorption e.g. chrons
anti-epileptics
methotrexate (not licensed as adjunct therapy)

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36
Q

Treatment for folate deficiency?

A

Folic acid daily for 3 months

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37
Q

Why would you NEVER give folic acid alone for megaloblastic anemia and with unknown folate levels?

A

Risk of neuropathy of spinal cord (if emergency - give with b12)

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38
Q

Max OTC dose for folic acid?

A

500micrograms

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39
Q

What is the dose of folic acid used to prevent neural tube defects in pregnant women?

A

folic acid 5mg daily to take before conception and upto week 12 of pregnancy

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40
Q

risk of iron overdose?

A

Can damage organs e.g. liver, heart, pancreas and can be fatal especially in children

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41
Q

Antidote for iron overdose?

A

Desferrioxamine

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42
Q

Role of neutrophils?

A

Form of WBC and help to fight infection.

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43
Q

What drug can be used to increase neutrophil count and how does it work?

A

Filgrastim: has a recombinant growth stimulating factor which boosts formation of neutrophils

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44
Q

What indication is filgrastim commonly used in?

A

chemotherapy induced neutopaenia (as chemo kills healthy, rapidly dividing cells too)

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45
Q

Filgrastim main side-effect?

A

osteoporosis: monitor bone mass density

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46
Q

Consequence of potassium depletion?

A

Arrhythmias, ventricular fibrillation, cardiac arrest

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47
Q

Drugs that cause hypokalaemia?

A

Corticosteroids
Laxative abuse
Loop diuretics: furosemide/bumetanide
Thiazide like diuretics: Bendroflumethiazide/indapamide

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48
Q

How do potassium sparing diuretics affect potassium?

A

Cause hyperkalaemia e.g. spironolactone, eplerenone, amiloride

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49
Q

Potassium range (normal)?

A

3.5-5.3mmol/L

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50
Q

Treatment options for hyperkalaemia?

A

Insulin (soluble) with 50ml glucose 50%

Salbutamol

Calcium gluconate 10% - slow iv inj

calcium resonium

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51
Q

Why shouldnt you give sodium bicarbonate and calcium salts in the same line?

A

Risk of precipitation + Thrombosis

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52
Q

What potassium level is classified as acute, severe hyperkalaemia?

A

> 6.5mmol/L

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53
Q

Drug treatment of acute, severe hyperkalaemia +/- eCG changes to protect against myocardium excitability?

A

Calcium gluconate - slow iv injection

then give soluble insulin IV if needed or as continuous infusion (5-15mins)

salbutamol if needed

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54
Q

Drug treatment of mild-mod hyperkalaemia + no ECG changes?

A

Calcium resonium

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55
Q

Hyperkalaemia causing drugs?

A

HAD-c-BEANS
Heparin - UFH
ACEi/ARB
Digoxin (overdose = hyperkal but hypokal induces toxicity)

Ciclosporin

B-blockers
Eplerenone (pot sparing)
Antibiotic - trimethoprim
NSAIDS
Spironolactone/amiloride
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56
Q

Which antibiotic used for UTI causes hyperkalaemia?

A

Trimethoprim

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57
Q

Symptoms of hypokalaemia?

A

Muscle hypotonia (stiff and tense), arrhythmias

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58
Q

Drugs causing hypokalaemia?

A

Diuretics: Loops, thiazides

Insulin

B2 agonist e.g. salbutamol

Corticosteroids

Theophylline

Rarely - PPIs

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59
Q

Treatment for mild hypokalaemia?

A

Oral potassium supplements based on levels e.g. Sando K

if due to diuretic –> switch to potassium sparing diuretic

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60
Q

Treatment for severe hypokalaemia?

A

IV potassium chloride (dont add glucose as that reduces potassium levels)

KCL in overdose = fatal so use pre-mixed solutions

61
Q

Which drug exhibits a risk of toxicity with hypokalaemia?

A

digoxin

62
Q

Why give smaller doses of potassium in renal impairment?

A

Reduce risk of hyperkalaemia

63
Q

indication for Nacl IV

A

Sodium depletion

64
Q

Chronic sodium depletion conditions e.g. renal disease/salt-losing bowel can be treated with

A

Oral sodium bicarbonate/sodium chloride

65
Q

What temporary condition required the usage of oral rehydration therapy - ORT?

A

Diarrhoea: to replenish fluid and electrolytes

66
Q

What is metabolic acidosis?

A

ph <7.1 (high level of chloride in blood) - counteract with bicarbonate, if hyponatraemia present give sodium bicarb, if hypokal present give potassium bicarb

67
Q

Normal sodium range?

A

136-145mmol/L

68
Q

Signs and symptoms of hypernatraemia?

A 
Dehydration
Thirst
Oliguria (sml amounts of urine)
Hypovolaemia (reduced blood volume)
Tachycardia
Postural hypotension
69
Q

Drug causes of hypernatraemia?

A 
Contraceptive
Corticosteroids
Sodium bicarbonate
Sodium in IV antibiotics
Lithium
70
Q

What happens in diabetes insipidus?

A

Reduced excretion of water so hypernatraemia due to vol depletion: give IV glucose

71
Q

Treatment for hypernatraemia due to volume depletion?

A

IV Glucose

72
Q

Symptoms of hyponatraemia?

A 
Drowsy
Confused
Cramps
N/V
Headache
Convulsions
73
Q

Drugs causing hyponatraemia?

A 
Loop/thiazide diuretics
SSRIs
PPI
Carbamazepine
Desmopressin
NSAIDs
Trimethoprim
74
Q

How to treat mild/mod hyponatraemia?

A

Fluids: NaCl/Na bicarbonate.

If PH is acidic - give sodium bicarbonate to help neutralise

75
Q

How to treat severe hyponatraemia?

A

IV saline

76
Q

Drug options for persistent hyponatraemia despite fluid restriction and oral na? e.g. due to SIADH

A

Tolvaptan - risk of demyelination so monitor for neural side effects

Demeclocycline

77
Q

What electrolytes are in ORT

A

Sodium, Potassium, Chloride

78
Q

How would you adivse ORT to be given for diarrhoea

A

Over 3-4 hours

79
Q

How would you adivse ORT to be given for hypernatraemic dehydration?

A

> 12hrs

80
Q

How to treat severe dehydration?

A

IV glucose (but rarely given alone): only alone in states where only fluid is lost and no electrolytes are lost e.g. diabetes inspidus and hypercalcaemia

81
Q

When would a patient require calcium supplements?

A 
If dietary intake is too low and therefore there is an increased risk of osteoporosis/bone loss. 
e.g.
- pregnancy
- elderly
- childhood
(due to malabsorption)
82
Q

Treatment for severe acute hypocalcaemia?

A

Calcium gluconate 10%: Slow IV (due to risk of arrhythmias), calcium chloride inj is more irritant and there is an increased risk of extravasation

(mild-mod: vitd and ca supplements)

83
Q

How would you correct hypomagnesaemia?

A

magnesium sulfate

84
Q

Risks of hypercalcaemia?

A 
Impaired bone health - fractures/osteoporosis
Arrhythmias
Kidney impairment
N/V
Heart issues
85
Q

How would you treat hypercalcemia?

A

Limit dietary Ca intake
Bisphosphonates: pamidronate is most effective
Corticosteroids - only if cause is due to sarcoidosis/vitamin D as takes several days to work

86
Q

What medication/vitamins can cause hypercalcaemia?

A

Vitamin D, thiazides (bendroflumethiazide, indapamide)

87
Q

What drug used for gastro purposes can cause hypomagnesemia?

A

PPIs

88
Q

How would you manage hypercalciuria?

A

Bendroflumethiazide

Increase fluid intake

89
Q

Risk of hypercalciuria?

A

Increased calcium in the urine so can lead to impaired renal function and CKD

90
Q

Range of adjusted calcium?

A

2.15-2.5mmol/l

91
Q

Normal range for hypomagnaesemia?

A

0.7-1.05mmol/l

92
Q

What kind of patients commonly suffer from hypomagnesemia and why?

A

Those with diarrhoea/alcoholics due to most mg in GI fluid. (hypomag can lead to hypocalc,hypokal and hyponat)

93
Q

Some indications for IV mg sulphate are:

A

pre-eclampsia in pregnancy (to treat and prev seizures - if longer than 5/7 days can cause skeletal imp in neonate MHRA)
TDP (torsade de pointes)

94
Q

What causes hyperparathyroidism?

A

Disorder of parathyroid glands where non cancerous tumour is in one of the glands. The excess parathyroid causes hypercalcaemia, hypophosphataemia and hypercalciuria.

95
Q

Main symptoms of hypercalcaemia:

A

thirst
fatigue
memory impairment

long term: CVD, kidney stones, osteoporosis and fractures

96
Q

Treatment for hyperparathyroidism?

A

1) Surgery
2) Cinacelet - can prolong QT
(paracalcitol in renal failure)
3) Vit d supplements
4) bisphosphonates

97
Q

MHRA warning with calcium gluconate?

A

Repeated/prolonged administration in 10ml glass bottles is contraindicated in <18yrs and those with renal impairment due to risk of aluminium accumulation.

Use packaged plastic containers for these patients.

98
Q

What to use in magnesium toxicity?

A

Calcium gluconate

99
Q

How to treat hyperphosphataemia?

A

Calcium-containing preparations (phosphate binding agents)

100
Q

How to treat hypophosphataemia?

A

Give PO phosphate (give IV if mod-sev)

101
Q

What would you use for wilson’s disease?

A

Zinc acetate

102
Q

What is the role of selenium?

A

Helps metabolism/thyroid function, boosts immune system, slows mental decline, CVS benefits

103
Q

Give some foods that contain selenium?

A

Brazilian nuts, eggs, fish, poultry, soya

104
Q

For patients who are unable to eat, what is available?

A

TPN - Total parenteral nutrition

eg.

1) major surgery
2) cancer e.g. mouth/oral
3) prolonged disorders

105
Q

What should glucose be infused through to prevent thrombosis?

A

central venous catheter

+ give enough phosphate to allow glucose phosphorylation

106
Q

Give examples of sugars in medicine.

A

Glucose
Fructose
Sucrose

107
Q

Give examples of sweeteners

A

Sorbitol

108
Q

What is contained in TPN?

A

Amino acids, glucose, electrolytes, trace elements, vitamins via central/peripheral vein

109
Q

what is SPN?

A

Supplementary parenteral nutrition given in addition to oral/enteral feeds

110
Q

Can you give liquid feeds prepared for adults to children?

A

No - different dietary requirements - seek guidance from paeds dietician

111
Q

What should be avoided in coeliac disease

A

Gluten
Bodys immune system attacks body when gluten in bod. This damages small intestine in gut and results in malabsorption of nutrients

112
Q

Which vitamins are fat-soluble?

A

ADEK

113
Q

Which vitamins are water soluble?

A

B and C

114
Q

Vitamin A deficiency causes what?

A

it is rare.

Can cause ocular defects and increased susceptibility to infections.

115
Q

Another name for Vitamin A

A

Retinol

116
Q

What vitamin needs to be avoided in pregnancy and why?

A

Vitamin A - teratogenic

117
Q

Benefits of vitamin A?

A

healthy skin
good vision especially night
immune system

118
Q

Sources of vitamin A?

A

Fish oil, Liver, Raw eggs

119
Q

overdose of vitamin a can cause?

A

Rough skin
liver enlargement
dry lips
dry hair

120
Q

What vitamin B deficiency is the most common in UK?

A

B12

121
Q

Name the different vitamin B’s and their medical drug names.

A

B1 - Thiamine
B2 - Riboflavin
B6 - Pyridoxine (give with isoniazide to prevent ocular toxicity)
B12 - hydroxocobalamin: meat, salmon, cereal

122
Q

Indications for using Vitamin B?

A

1) Chronic alcoholism - to prevent wernicke’s encephalopathy and korsakoffs: give iV pabrinex and then maintenance with thiamine
2) megaloblastic anaemia: vit b12 +/- folic acid

123
Q

Risk of IV pabrinex?

A

Hypersensitivity reactions

124
Q

Role of vitamin B?

A

Responsible to make new RBC, convert food into energy, maintain healthy skin and brain cells and body tissues

125
Q

What is the medical drug name for vitamin C?

A

Abscorbic acid

126
Q

Deficiency of vitamin C can cause?

A

scurvy
gingival bleeding/swelling
petechiae - small, red, flat spots on skin - rare and sign of leukaemia

127
Q

Vitamin c goes hand in hand with what other mineral?

A

Iron, vitamin c increases its absorption

128
Q

Benefits of vitamin C?

A

protects cell
wound healing
collagen formation

129
Q

Source of vitamin C?

A

Oranges
Peppers
Tomatoes
Blackcurrants

130
Q

Vitamin D is responsible for?

A

Healthy bones and teeth and required for calcium absorption

131
Q

Medical drug names for vitamin D

A

Vitamin D - calciferol
D2 - ergocalciferol
D3 - cholecalciferol (inactive and needs to be metabolised)

Hydroxylated (Active): alfacalcidol/calcitriol

132
Q

What vitamin D should be given in those with renal impairment?

A

Alfacalcidol/calcitriol - active forms of vitamin D

133
Q

Thiamine (vitamin b1) MHRA?

A

Serious allergic adverse reactions

134
Q

Vitamin E medical drug name?

A

Tocopherol

135
Q

Vitamin E role?

A

Inhibits platelet aggregation and increased risk of bleeding especially with warfarin

136
Q

Benefits of vitamin E?

A

Powerful antioxidant that protects from free radicals so: healthy skin and eyes

137
Q

Sources of vitamin E?

A

Plant oils - olive oils, nuts/seeds, wheat germ

138
Q

What is the medical drug name for vitamin K?

A

Phytomenadione - lipid soluble

139
Q

Role of vitamin K?

A

Production of clotting factors and proteins necessary for blood clotting

140
Q

What can be given to prevent vitamin K deficiency in malabsorption?

A

Menadiol - water soluble used in liver impairment

141
Q

Indication of vitamin K?

A

new born babies: to prevent neonatal haemmorhage

142
Q

Should not give vitamin K with what….

A

Warfarin - antagonising effect

143
Q

Source of vitamin K

A

Green, leafy vegetables

144
Q

Pyridoxine (vit b6) is given alongside which TB drug to reduce the risk of peripheral neuropathy?

A

Isoniazide

145
Q

Prolonged use with pyridoxine is safe but long-term use is associated with what?

A

Neuropathy (safety info)

146
Q

What are the risk factors for neural tube defects in pregnancy?

A

Previous hx of them

antiepileptic drugs

folate/b12 deficiency

smoking

diabetes

obesity

147
Q

How to prevent neural tube defects in pregnancy?

A

1) antiepilepstics: levetiracetam and lamotrigine are the safest
2) folic acid 5mg before conception and up to week 12.

(smaller doses in those without risk factors e.g. pregnacare)

148
Q

ow to prevent neural tube defects in pregnancy in someone with sickle cell disease?

A

Give folic acid 5mg throughout the WHOLE pregnancy

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