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Pre-reg > Chapter 9- Blood And Nutrition > Flashcards

Chapter 9- Blood And Nutrition Flashcards

1
Q

How long does it take for a rise in haemoglobin concentration when taking oral iron

And how long is it carried in for

A

3-4 weeks

Carried on for 3 months to replenish body stores

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2
Q

First line route for iron replacement

A

Oral

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3
Q

MHRA alert for parenteral iron

A

Severe hypersensitivity reaction and Incidence of anaphylaxis

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4
Q

Side effects of oral iron

A

GI irritation: nausea, epigastric pain and diarrhoea or constipation
Can discolour the stool

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5
Q

How should oral iron be taken

A

Best taken before food but if GI effects are bad can take after food

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6
Q

What are some foods naturally rich in iron?

A

Pork
Beans
Red meat

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7
Q

What’s the choice of iron salt treatment dependent on

A

Side effects

Cost

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8
Q

What can be given in sickle cell disease to reduce the frequency of crisis

A

Hydroxycarbamide

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9
Q

Who is G6PD Deficiency more common in

A

People from Africa, Asia, Oceania and Southern Europe

Also more common in men

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10
Q

What are individuals with G6PD deficiency at risk of developing

A

Haemolytic anaemia

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11
Q

Drugs that may be harmful to patients with D6PD deficiency

A

Definite: nitrofurantoin, ciprofloxacin, co-trimoxazole

Potential: aspirin, quinine, gliclazide

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12
Q

When is prophylaxis with iron prep indicated

A 
Malabsorption 
Menorrhagia
Pregnancy 
Post gastrectomy
Haemodialysis
Low birth weight infants
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13
Q

What can be given to aid iron absorption

A

Ascorbic acid (Vit C)

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14
Q

What is megaloblastic anaemia usually due to

A

Lack of either vitamin B12 or folate

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15
Q

When should vitamin b12 be given prophylactically?

A

After total gastrectomy or ileal resection

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16
Q

What’s the drug treatment of choice for vitamin B12 deficiency and why’s it preferred

A

Hydroxycobalamin

It is preferred over cyanacobalamin as it is retained in the body longer and thus requires fewer dosing intervals (upto 3 months)

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17
Q

What can cause vitamin b12 deficiency?

A

Being Vegeterian

People who’ve had total or partial gastrectomy

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18
Q

What can cause folate deficiency

A

Poor diet
Pregnancy
Anti epileptic drugs

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19
Q

What’s a good dietary source of folic acid

A

Broccoli

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20
Q

What is iron overload usually as a result of

A

Repeated blood transfusion

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21
Q

How can you treat iron overload

A

Iron cheating compound (desferrioxamine)

Enhanced by administration of ascorbic acid

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22
Q

What can be used in neutropenia follow bone marrow transplant or chemo

What should be monitored

A

Lenograstim or Filgrastim

FBC and WBC and platelets should be monitored

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23
Q

What’s more likely to occur with agranulocytosis and neutropenia

A

Acquiring an infection

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24
Q

Warning signs for agaranulocytosis and neutropenia

A 
Fever
Headache 
Sore throat 
Mouth ulcer 
Fatigue 
Flu like symptoms
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25
Q

Drugs that may cause bone marrow suppression

A 
Carbimazole
Clozapine 
Co-trimoxazole
Mesalazine
Sulfalazine 
Methotrexate 
Mirtazapine
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26
Q

What’s the normal plasma level for sodium, potassium, bicarbonate, chloride and calcium. (mmol/L)

A 
Sodium= 133-146
Potassium= 3.5- 5.3
Bicarbonate= 26
Chloride= 103
Calcium= 2.1-2.58
Magnesium = 0.7-1.05
Phosphate= 0.85-1.45
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27
Q

How is acute sever hyperkalaemia treated

A

Calcium Gluconate to protect the heart

Insulin to reduce serum potassium levels

Salbutamol used to reduce potassium levels

Sodium bicarbonate given in acidotic state, useful for increasing the pH of the urine and in dyspepsia - not in the same line as can cause thrombosis

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28
Q

What is considered hyperkalaemia and what is acute severe hyperkalaemia

A

Serum potassium >5 mmol/L

Acute severe >6.5mmol/L

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29
Q

Symptoms of hyperkalaemia

A 
Fatigue 
Numbness 
Tingling 
Nausea and vomiting 
Trouble breathing 
Chest pain 
Irregular heart beat
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30
Q

Drugs that can cause hyperkalaemia (HADBEANS)

A 
Heparin 
ACEi/arbs 
Digoxin 
BB
Eplerenone
Amoloride 
NSAIDs 
Spironolactone
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31
Q

Treatment for hypokalaemia

A

Ready mixed infusion containing potassium (potassium chloride)

Given via slow infusion at a rate not exceeding 20mmol potassium per hour

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32
Q

Symptoms of hypokalaemia

A 
Constipation 
Irregular heartbeat
Fatigue
Muscle damage 
Muscle spasm 
Tingling 
Dumbness
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33
Q

What can rapid infusion of potassium chloride cause

A

Arrhythmia as it can be cardiotoxic

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34
Q

Drugs that can cause hypokalaemia

A 
Diuretics 
Beta 2 agonist 
Insulin 
Corticosteroids 
Laxative 
Theophylline
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35
Q

Symptoms of hypernatremia

A 
Dehydration 
Thirst 
Osmotic damage to cells 
Confusion 
Muscle twitching or spasms 
Seizures
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36
Q

Drugs that can cause hypernatremia

A

Corticosteroids
IV abx with sodium
Oral contraceptive
Sodium bicarbonate

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37
Q

Treatment for hypernatremia

A

Dextrose or saline infusion

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38
Q

Symptoms of hyponatremia

A 
Nausea and vomiting 
Headache 
Confusion 
Fatigue 
Loss of appetite 
Irritable 
Osmotic damage to cells
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39
Q

Drugs that can cause hyponatremia

A 
Anti-depressants 
Desmopressin 
Carbamazepine 
Diuretics 
Lithium 
Gliclazide 
Amphotericin 
Quetiapine
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40
Q

Treatment of hyponatremia

A

Hypovolemia= IV saline

Hypervolemia= address underlying HF or liver failure

Euvolemic= fluid restriction and remove stimuli for ADH

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41
Q

When is replacement of potassium loss especially necessary

A

Patients taking digoxin or anti arrhythmic drugs when K depletion can induce arrhythmias

Patients where secondary aldosteronism occurs

Patients with excessive K loss in faeces

Elderly

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42
Q

Symptoms of hypercalaemia

A

Bone pain
Kidney Stones
Psychiatric issues
Constipation

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43
Q

Drug Treatment for hypercalaemia

A

Cincalcet

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44
Q

Symptoms of hypocalcaemia

A

Convulsion
Arrhythmia
Numbness
Diarrhoea

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45
Q

Treatment for hypocalcaemia and hypercalcaemia

A

Hypo:
Calcium salts

Hyper: 
bisphosphonates/ steroids 
Calcitonin 
Cinalcet 
Paracalcotil
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46
Q

Why is magnesium retained in renal failure

A

Is excreted by the kidneys

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47
Q

Symptoms of hypomagnesaemia

A

Arrhythmia
Hypokalaemia
Hypocalcaemia

(Common in alcoholism)

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48
Q

Drug treatment for hypomagnesium imbalance

A

Magnesium salts

Iv mangesium sulphate

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49
Q

Symptoms of hyperphosphataemia

A

Ectopic calcification

Hyperparathyroidism

50
Q

Drug treatment for hyperphosphate imbalance

A

Aluminium hydroxide
Phosex
Sevlamer

Or calcium containing preps

51
Q

Symptoms of hypophosphate

A

Weak muscles
Mental issues
Blood disorder

52
Q

Treatment for hypophosphate

A

Phosphate salts

53
Q

Where is magnesium not absorbed

A

GI tract

54
Q

What should oral rehydration therapy do

A

Enhance the absorption of water and electrolytes
Replace the electrolyte deficit adequately and safely
Be slightly hyper-osmolar to prevent induction of osmotic diarrhoea
Be simple to use in hospital and homes
Be palatable and acceptable
Be readily available

55
Q

How is intestinal absorption of sodium and water enhanced

A

By glucose and other carbohydrates (eg: rice starch)

56
Q

If calcium is high would phosphate be low or high?

A

Low

They work in opposites

57
Q

What’s supplemental parenteral nutrition

A

Nutrition given by IV infusion in addition to ordinary oral or tube feeding

58
Q

What’s total parenteral nutrition

A

Nutrients given by IV infusion as the sole source of nutrition

59
Q

What does parenteral nutrition contain

What route is it given via

A 
Amino acids 
Glucose 
Fat 
Electrolytes 
Trace elements 
Vitamins

Via central or peripheral vein

60
Q

What is vitamin A and what is deficiency associated with

A

Retinol

Associated with ocular defects, dry eyes and in increased susceptibility to infections

61
Q

What are the vitamin B’s

A 
B1- thiamine
B2- riboflavin
B3- Nicotinamide/ nicotininic acid
B6- pyridoxine
B7- Biotin
B12- cyan/ hydroxycobalamin
62
Q

What’s vitamin C and what’s it essential in

A

Ascorbic acid

Essential in scurvy, gingivial bleeding and helps wound healing, common colds and aids iron absorption

63
Q

What’s vitamin D and what’s it essential in

A

Colecalicerol/ alfacalcidol

Preventing or curing rickets
Needed for dietary absorption of calcium

64
Q

What’s vitamin E and what’s the benefits

A

Tocopherol

Inhibits platelet aggregation and a powerful antitoxidant which protects free radical

65
Q

What’s vitamin K and what’s the benefits

A

Phytomenadione

Necessary for the production of blood clotting factors and proteins necessary for the normal calcification of bones

66
Q

Sources for vitamin A, C, D, E, K

A 
A- fish liver oil, raw eggs 
C- orange, pepper, tomato, blackcurrent 
D- natural sunlight 
E- plant oils 
K- green leafy vegetable
67
Q

Which are fat soluble vitamins and which are water soluble?

A

Fat soluble- ADEK

Water soluble- BC

68
Q

Benefits of vitamin A

A

Night vision
Immune system
Healthy skin

69
Q

Benefits of vitamin c

A

Protects cells
Wound healing
Collagen formation

70
Q

Benefits of vitamin D

A

Maintains calcium and phosphate levels

Healthy bones and teeth

71
Q

Benefits of vitamin E

A

Powerful antioxidant which protects free radicals
Healthy skin
Eyes

72
Q

What is straight forward vitamin D deficiency treated with

A

D2- ergocalciferol

D3- cholecalciferol

73
Q

What is complicated vitamin D deficiency caused by malabsorption or chronic renal disease treated with?

A

The hydroxylated version (active form)= alfacalcidol or calcitriol

74
Q

What’s the benefit and source of vitamin B1

A

Benefit: releases energy from food, healthy CNS

source: whole grain, cereal

75
Q

What’s the benefit and source of vitamin B2

A

Benefits: healthy skin, nerves and eyes

Source: milk, eggs, cereal, rice

76
Q

What’s the benefit and source of vitamin B3

A

Benefits: healthy skin and eyes

Sources: meat, fish. Wheat flour, eggs, milk

77
Q

What’s the benefit and source of vitamin B6

A

Benefits: helps make several neurotransmitters, haemoglobin

Sources: chicken, vegetable, cereal

78
Q

What’s the benefit and source of vitamin B7

A

Benefits: essential for fat metabolism

Sources: range of foods, whole cereal, vegetables

79
Q

What’s the benefit and source of vitamin B12

A

Benefits: healthy NS, makes red blood cells, processing folic acid

Sources: meat, salmon, fortified cereal

80
Q

When is thiamine used

A

Wernickes encelophalopathy
Alcohol abuse

Main told is the metabolism of carbohydrates

81
Q

What is pyridoxine used for

A

Prevents peripheral neuropathy

Given with isoniazid (as this can cause deficiency)

82
Q

What’s biotin used for?

A

To strengthen hair and nails

83
Q

What’s B12 used for

A

Treat megaloblastic anaemia

84
Q

What can scurvy symptoms nowadays indicate

A

Leukaemia

85
Q

Why may folic acid be taken in pregnancy

A

To reduce risk of neural defects

86
Q

Who’s at high risk of neural defects pregnancy

A

People on anti elliptic meds
People with diabetes
Previous neural defects pregnancy
Sickle cell disease

87
Q

What’s the dose of folic acid to reduce the risk of neural defects

A

Normal risk: 400mcg before conception daily till 12 weeks

High risk: 5mg daily before conception till 12 weeks

Sickle cell: taken for whole pregnancy

88
Q

What can a high dose of vitamin B6 be associated with

A

Neuropathy

89
Q

What’s the CHM alert for IV thiamine

A

Anaphylaxis can occur but don’t withhold the use of treatment required especially if patient is at risk of wernicke korsakoff syndrome

IV should be given over 30 minutes

Facilities for treating anaphylaxis should be readily available

90
Q

What is acute porphyrias

A

Group of disorders affecting the synthesis of Haem

Many drugs can induce acute crisis so canning be given or should be avoided

91
Q

What drug is taken 2 hours apart from iron and why

A

Levothyroxine

Oral iron salts reduce absorption of levothyroxine

92
Q

Drugs that cause hypercalcaemia

A

Thiazides
Vitamin A and D supplements
Lithium

93
Q

What can cause hypocacaemia

A

Vitamin D deficiency
Bisphosphonates
Phenytoin

94
Q

What can cause hypomagnesaemia

A

Alcoholism
Diuretics
Digoxin
PPI

95
Q

What can cause hypermagnesaemia

A

Antacids and laxatives

96
Q

When is parenteral iron preparations indicated

A

Chronic renal failure with haemodialysis
Malabsorption syndrome
Chemotherapy induced anaemia

97
Q

How is ORT administered in diarrhoea and hypernatraemia dehydration (eg: diabetes insipidus)

A

Over 3/4 hours in diarrhoea

Over 12 hours in hypernatraemia dehydration

98
Q

What do you give for high chloride

A

Sodium bicarbonate

If caused by low potassium give potassium bicarbonate

99
Q

Treatment for acute porphyric crisis

A

Haem Arginate

100
Q

What other electrolyte imbalance does hypomagnesaemia also lead to

A

Low calcium potassium and sodium

101
Q

What are epoetins used for?

A

Symptomatic anaemia in CKD or chemo patients

102
Q

What are the main side effects of epoetins?

A
  • Severe skin reactions and stop treatment and seek medical attention if they develop a rash (which often follow flu-like symptoms) - Hypertensive crisis with encepathalopathy and tonic clonic seizures- Pure red cell aplasia
103
Q

In what situations would you opt for IV iron over oral iron?

A 
Oral therapy is unsuccessful;
Intolerable of oral iron
Continuing blood loss
Malabsorption
CKD patients on dialysis
104
Q

IV iron does not work more quickly than oral iron except in what group of patients?

A

Patients with severe renal failure receiving haemodialysis

105
Q

What is the MHRA advice surrounding injectable iron?

A

Serious hypersensitivity reactions including anaphylaxis Pts should be monitored for such signs for 30 minutes after administration Not recommended 1st trim. of preg. and only in 2nd and 3rd if vital

106
Q

What is pernicious anaemia?

A

An autoimmune gastritis causing malabsorption of vitamin B12

107
Q

Why should folic acid never be given alone in pernicious anaemia?

A

Can cause compression of spinal cord

108
Q

Haemochromatosis is associated with an overload of what?

A

Iron Built up over several years

109
Q

How do you manage haemochromatosis (result of iron overload)?

A

Venesection (removal of blood)If contraindicated- long-term administration of the iron chelating compound Desferrioxamine mesilate - Vit C aids iron chelation started 1 month after desferrioxamine, taken daily, not with food.

110
Q

What drug inhibits platelet formation and is used for thrombocythaemia (when too many platelets are produced in the bone marrow)?

A

Anagrelide

111
Q

Chronic hyponatraemia from inappropriate secretion of ADH should ideally be managed by what?

A

Fluid restriction

112
Q

Why should calcium gluconate IV be given slowly?

A

If given too rapidly, risk of arrhythmias

113
Q

Calcium carbonate is used for what two indications?

A

Calcium deficiency Phosphate binding in renal failure

114
Q

What is sevelamer used for?

A

Phosphate binder for CKD patients including those on dialysis

115
Q

What is Wilson’s disease?

A

Genetic disorder causing build up of copper in body tissues e.g. brain

116
Q

Hypocalcaemia effects

A

convulsions, arrhythmias, numbness<= Ca salts

117
Q

In renal patients, why is alfacalcidol and calcitrol more appropriate for Vitamin D deficiency treatment over other Vitamin D replacement?

A

Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D

118
Q

If Vitamin D replacement is needed in severe renal impairment, what are the most appropriate to prescribe?

A

Alfacalcidol Calcitriol

119
Q

What vitamin should pregnant women avoid

A

Vitamin a

120
Q

What’s given to new borns to prevent haemorrhagic disease

A

Vitamin k

Pre-reg (27 decks)

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