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
2
Q
First line route for iron replacement
A
Oral
3
Q
MHRA alert for parenteral iron
A
Severe hypersensitivity reaction and Incidence of anaphylaxis
4
Q
Side effects of oral iron
A
GI irritation: nausea, epigastric pain and diarrhoea or constipation
Can discolour the stool
5
Q
How should oral iron be taken
A
Best taken before food but if GI effects are bad can take after food
6
Q
What are some foods naturally rich in iron?
A
Pork
Beans
Red meat
7
Q
What’s the choice of iron salt treatment dependent on
A
Side effects
Cost
8
Q
What can be given in sickle cell disease to reduce the frequency of crisis
A
Hydroxycarbamide
9
Q
Who is G6PD Deficiency more common in
A
People from Africa, Asia, Oceania and Southern Europe
Also more common in men
10
Q
What are individuals with G6PD deficiency at risk of developing
A
Haemolytic anaemia
11
Q
Drugs that may be harmful to patients with D6PD deficiency
A
Definite: nitrofurantoin, ciprofloxacin, co-trimoxazole
Potential: aspirin, quinine, gliclazide
12
Q
When is prophylaxis with iron prep indicated
A
Malabsorption Menorrhagia Pregnancy Post gastrectomy Haemodialysis Low birth weight infants
13
Q
What can be given to aid iron absorption
A
Ascorbic acid (Vit C)
14
Q
What is megaloblastic anaemia usually due to
A
Lack of either vitamin B12 or folate
15
Q
When should vitamin b12 be given prophylactically?
A
After total gastrectomy or ileal resection
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)
17
Q
What can cause vitamin b12 deficiency?
A
Being Vegeterian
People who’ve had total or partial gastrectomy
18
Q
What can cause folate deficiency
A
Poor diet
Pregnancy
Anti epileptic drugs
19
Q
What’s a good dietary source of folic acid
A
Broccoli
20
Q
What is iron overload usually as a result of
A
Repeated blood transfusion
21
Q
How can you treat iron overload
A
Iron cheating compound (desferrioxamine)
Enhanced by administration of ascorbic acid
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
23
Q
What’s more likely to occur with agranulocytosis and neutropenia
A
Acquiring an infection
24
Q
Warning signs for agaranulocytosis and neutropenia
A
Fever Headache Sore throat Mouth ulcer Fatigue Flu like symptoms
25
Drugs that may cause bone marrow suppression
```
Carbimazole
Clozapine
Co-trimoxazole
Mesalazine
Sulfalazine
Methotrexate
Mirtazapine
```
26
What’s the normal plasma level for sodium, potassium, bicarbonate, chloride and calcium. (mmol/L)
```
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
```
27
How is acute sever hyperkalaemia treated
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
28
What is considered hyperkalaemia and what is acute severe hyperkalaemia
Serum potassium >5 mmol/L
Acute severe >6.5mmol/L
29
Symptoms of hyperkalaemia
```
Fatigue
Numbness
Tingling
Nausea and vomiting
Trouble breathing
Chest pain
Irregular heart beat
```
30
Drugs that can cause hyperkalaemia (HADBEANS)
```
Heparin
ACEi/arbs
Digoxin
BB
Eplerenone
Amoloride
NSAIDs
Spironolactone
```
31
Treatment for hypokalaemia
Ready mixed infusion containing potassium (potassium chloride)
Given via slow infusion at a rate not exceeding 20mmol potassium per hour
32
Symptoms of hypokalaemia
```
Constipation
Irregular heartbeat
Fatigue
Muscle damage
Muscle spasm
Tingling
Dumbness
```
33
What can rapid infusion of potassium chloride cause
Arrhythmia as it can be cardiotoxic
34
Drugs that can cause hypokalaemia
```
Diuretics
Beta 2 agonist
Insulin
Corticosteroids
Laxative
Theophylline
```
35
Symptoms of hypernatremia
```
Dehydration
Thirst
Osmotic damage to cells
Confusion
Muscle twitching or spasms
Seizures
```
36
Drugs that can cause hypernatremia
Corticosteroids
IV abx with sodium
Oral contraceptive
Sodium bicarbonate
37
Treatment for hypernatremia
Dextrose or saline infusion
38
Symptoms of hyponatremia
```
Nausea and vomiting
Headache
Confusion
Fatigue
Loss of appetite
Irritable
Osmotic damage to cells
```
39
Drugs that can cause hyponatremia
```
Anti-depressants
Desmopressin
Carbamazepine
Diuretics
Lithium
Gliclazide
Amphotericin
Quetiapine
```
40
Treatment of hyponatremia
Hypovolemia= IV saline
Hypervolemia= address underlying HF or liver failure
Euvolemic= fluid restriction and remove stimuli for ADH
41
When is replacement of potassium loss especially necessary
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
42
Symptoms of hypercalaemia
Bone pain
Kidney Stones
Psychiatric issues
Constipation
43
Drug Treatment for hypercalaemia
Cincalcet
44
Symptoms of hypocalcaemia
Convulsion
Arrhythmia
Numbness
Diarrhoea
45
Treatment for hypocalcaemia and hypercalcaemia
Hypo:
Calcium salts
```
Hyper:
bisphosphonates/ steroids
Calcitonin
Cinalcet
Paracalcotil
```
46
Why is magnesium retained in renal failure
Is excreted by the kidneys
47
Symptoms of hypomagnesaemia
Arrhythmia
Hypokalaemia
Hypocalcaemia
(Common in alcoholism)
48
Drug treatment for hypomagnesium imbalance
Magnesium salts
Iv mangesium sulphate
49
Symptoms of hyperphosphataemia
Ectopic calcification
| Hyperparathyroidism
50
Drug treatment for hyperphosphate imbalance
Aluminium hydroxide
Phosex
Sevlamer
Or calcium containing preps
51
Symptoms of hypophosphate
Weak muscles
Mental issues
Blood disorder
52
Treatment for hypophosphate
Phosphate salts
53
Where is magnesium not absorbed
GI tract
54
What should oral rehydration therapy do
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
How is intestinal absorption of sodium and water enhanced
By glucose and other carbohydrates (eg: rice starch)
56
If calcium is high would phosphate be low or high?
Low
They work in opposites
57
What’s supplemental parenteral nutrition
Nutrition given by IV infusion in addition to ordinary oral or tube feeding
58
What’s total parenteral nutrition
Nutrients given by IV infusion as the sole source of nutrition
59
What does parenteral nutrition contain
What route is it given via
```
Amino acids
Glucose
Fat
Electrolytes
Trace elements
Vitamins
```
Via central or peripheral vein
60
What is vitamin A and what is deficiency associated with
Retinol
Associated with ocular defects, dry eyes and in increased susceptibility to infections
61
What are the vitamin B’s
```
B1- thiamine
B2- riboflavin
B3- Nicotinamide/ nicotininic acid
B6- pyridoxine
B7- Biotin
B12- cyan/ hydroxycobalamin
```
62
What’s vitamin C and what’s it essential in
Ascorbic acid
Essential in scurvy, gingivial bleeding and helps wound healing, common colds and aids iron absorption
63
What’s vitamin D and what’s it essential in
Colecalicerol/ alfacalcidol
Preventing or curing rickets
Needed for dietary absorption of calcium
64
What’s vitamin E and what’s the benefits
Tocopherol
Inhibits platelet aggregation and a powerful antitoxidant which protects free radical
65
What’s vitamin K and what’s the benefits
Phytomenadione
Necessary for the production of blood clotting factors and proteins necessary for the normal calcification of bones
66
Sources for vitamin A, C, D, E, K
```
A- fish liver oil, raw eggs
C- orange, pepper, tomato, blackcurrent
D- natural sunlight
E- plant oils
K- green leafy vegetable
```
67
Which are fat soluble vitamins and which are water soluble?
Fat soluble- ADEK
| Water soluble- BC
68
Benefits of vitamin A
Night vision
Immune system
Healthy skin
69
Benefits of vitamin c
Protects cells
Wound healing
Collagen formation
70
Benefits of vitamin D
Maintains calcium and phosphate levels
| Healthy bones and teeth
71
Benefits of vitamin E
Powerful antioxidant which protects free radicals
Healthy skin
Eyes
72
What is straight forward vitamin D deficiency treated with
D2- ergocalciferol
| D3- cholecalciferol
73
What is complicated vitamin D deficiency caused by malabsorption or chronic renal disease treated with?
The hydroxylated version (active form)= alfacalcidol or calcitriol
74
What’s the benefit and source of vitamin B1
Benefit: releases energy from food, healthy CNS
source: whole grain, cereal
75
What’s the benefit and source of vitamin B2
Benefits: healthy skin, nerves and eyes
Source: milk, eggs, cereal, rice
76
What’s the benefit and source of vitamin B3
Benefits: healthy skin and eyes
Sources: meat, fish. Wheat flour, eggs, milk
77
What’s the benefit and source of vitamin B6
Benefits: helps make several neurotransmitters, haemoglobin
Sources: chicken, vegetable, cereal
78
What’s the benefit and source of vitamin B7
Benefits: essential for fat metabolism
Sources: range of foods, whole cereal, vegetables
79
What’s the benefit and source of vitamin B12
Benefits: healthy NS, makes red blood cells, processing folic acid
Sources: meat, salmon, fortified cereal
80
When is thiamine used
Wernickes encelophalopathy
Alcohol abuse
Main told is the metabolism of carbohydrates
81
What is pyridoxine used for
Prevents peripheral neuropathy
| Given with isoniazid (as this can cause deficiency)
82
What’s biotin used for?
To strengthen hair and nails
83
What’s B12 used for
Treat megaloblastic anaemia
84
What can scurvy symptoms nowadays indicate
Leukaemia
85
Why may folic acid be taken in pregnancy
To reduce risk of neural defects
86
Who’s at high risk of neural defects pregnancy
People on anti elliptic meds
People with diabetes
Previous neural defects pregnancy
Sickle cell disease
87
What’s the dose of folic acid to reduce the risk of neural defects
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
What can a high dose of vitamin B6 be associated with
Neuropathy
89
What’s the CHM alert for IV thiamine
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
What is acute porphyrias
Group of disorders affecting the synthesis of Haem
Many drugs can induce acute crisis so canning be given or should be avoided
91
What drug is taken 2 hours apart from iron and why
Levothyroxine
| Oral iron salts reduce absorption of levothyroxine
92
Drugs that cause hypercalcaemia
Thiazides
Vitamin A and D supplements
Lithium
93
What can cause hypocacaemia
Vitamin D deficiency
Bisphosphonates
Phenytoin
94
What can cause hypomagnesaemia
Alcoholism
Diuretics
Digoxin
PPI
95
What can cause hypermagnesaemia
Antacids and laxatives
96
When is parenteral iron preparations indicated
Chronic renal failure with haemodialysis
Malabsorption syndrome
Chemotherapy induced anaemia
97
How is ORT administered in diarrhoea and hypernatraemia dehydration (eg: diabetes insipidus)
Over 3/4 hours in diarrhoea
| Over 12 hours in hypernatraemia dehydration
98
What do you give for high chloride
Sodium bicarbonate
If caused by low potassium give potassium bicarbonate
99
Treatment for acute porphyric crisis
Haem Arginate
100
What other electrolyte imbalance does hypomagnesaemia also lead to
Low calcium potassium and sodium
101
What are epoetins used for?
Symptomatic anaemia in CKD or chemo patients
102
What are the main side effects of epoetins?
- 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
In what situations would you opt for IV iron over oral iron?
```
Oral therapy is unsuccessful;
Intolerable of oral iron
Continuing blood loss
Malabsorption
CKD patients on dialysis
```
104
IV iron does not work more quickly than oral iron except in what group of patients?
Patients with severe renal failure receiving haemodialysis
105
What is the MHRA advice surrounding injectable iron?
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
What is pernicious anaemia?
An autoimmune gastritis causing malabsorption of vitamin B12
107
Why should folic acid never be given alone in pernicious anaemia?
Can cause compression of spinal cord
108
Haemochromatosis is associated with an overload of what?
Iron Built up over several years
109
How do you manage haemochromatosis (result of iron overload)?
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
What drug inhibits platelet formation and is used for thrombocythaemia (when too many platelets are produced in the bone marrow)?
Anagrelide
111
Chronic hyponatraemia from inappropriate secretion of ADH should ideally be managed by what?
Fluid restriction
112
Why should calcium gluconate IV be given slowly?
If given too rapidly, risk of arrhythmias
113
Calcium carbonate is used for what two indications?
Calcium deficiency Phosphate binding in renal failure
114
What is sevelamer used for?
Phosphate binder for CKD patients including those on dialysis
115
What is Wilson's disease?
Genetic disorder causing build up of copper in body tissues e.g. brain
116
Hypocalcaemia effects
convulsions, arrhythmias, numbness<= Ca salts
117
In renal patients, why is alfacalcidol and calcitrol more appropriate for Vitamin D deficiency treatment over other Vitamin D replacement?
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
If Vitamin D replacement is needed in severe renal impairment, what are the most appropriate to prescribe?
Alfacalcidol Calcitriol
119
What vitamin should pregnant women avoid
Vitamin a
120
What’s given to new borns to prevent haemorrhagic disease
Vitamin k
