Chapter 9 BNF (Blood and Nutrition)

Question 1

What treatments can be given for sickle cell disease and sickle cell crises?

Answer 1

Folate supplements for sickle cell disease and hydroxycarbamide for sickle cell crises

Question 2

What are the symptoms of iron deficiency anaemia

Answer 2

Shortness of breath palpitations pallor

Trechess

Question 3

What advice would you give someone taking iron supplements

Answer 3

take with food
Take with vitamin C such as orange juice
Continue for three months after normal blood tests
Side-effects includes constipation and diarrhoea

Question 4

What is the indication for folic acid and iron

Answer 4

Pregnant women only

Question 5

What is the MHRA alerts on parenteral iron And what precautions should be taken?

Answer 5

Hypersensitivities therefore monitor for 30 minutes after dose

Avoid in pregnancy

Question 6

What are the two causes of megaloblastic anaemia

Answer 6

Vitamin B 12 deficiency

Folate deficiency

Question 7

How is megaloblastic anaemia caused by battery deficiency treated

Answer 7

Oral hydroxycobalamin

Question 8

How is megaloblastic anaemia caused by vitamin B12 deficiency caused by malabsorption treated

Answer 8

Intramuscular hydroxycobalamin

Question 9

How is megaloblastic anaemia caused by folic deficiency treated

Answer 9

Folic acid daily for four months

Question 10

What should be given in megaloblastic anaemic emergencies

Answer 10

Both folic acid and vitamin B12 because folic acid alone causes spinal neuropathy

Question 11

What is used to treat iron overload

Answer 11

Desferrioxamine

Question 12

What is used to treat neutropenia

Answer 12

Filgrastin

Question 13

What are the symptoms of hypernatraemia

Answer 13

Convulsions, hypovolaemia, thirst, dehydration, tachycardia, postural hypotension

Question 14

What medication is cause hypernatraemia?

Answer 14

Contraceptives
Steroids
Sodium bicarbonate
Lithium

Question 15

What are the symptoms of hyponatraemia

Answer 15

Convulsions
Confusion 
N andV 
Headaches 
Cramps

Question 16

What medications cause hyponatraemia

Answer 16

Antidepressants
Diuretics
Carbamazepine
Desmopressin

Question 17

How is hyponatraemia treated

Answer 17

Mild: sodium chloride/ sodium bicarbonate

Severe: iv saline (isotonic via peripheral, concentrated via central)
Correct slowly

Question 18

What is metabolic acidosis?

Answer 18

High chloride in blood

Question 19

What is the treatment for metabolic acidosis?

Answer 19

Sodium bicarbonate

If low potassium: potassium bicarbonate

Question 20

What is the treatment for hypercalcaemia?

Answer 20

Bisphosphonates
Corticosteroids
Calcitonin

Question 21

What is the treatment for hypercalcaemia caused by hyperparathyroidism?

Answer 21

Cinacalcet

Paracalcitol (renal failure)

Question 22

How is hypercalcuria treated?

Answer 22

Bendroflumethazine

Question 23

How is mild/moderate and severe hypocalcaemia treated?

Answer 23

Vit d and supplements

Severe: slow iv calcium flu onset

Question 24

How is Hypomagnesaemia treated ?

Answer 24

Magnesium sulphate

Question 25

How is Hyperphosphataemia treated?

Answer 25

Calcium containing preparations

Question 26

How is hypophosphataemia treated?

Answer 26

Phosphate I’ve

Question 27

What are the symptoms of hyperkalaemia?

Answer 27

Ventricular fibrillation | Cardiac arrest

Question 28

What drugs cause hyperkalaemia?

Answer 28

``` Heparin Ace Digoxin Beta blockers Potassium sparing diuretics NSAIDs ```

Question 29

What is the treatment for mild/moderate hyperkalaemia?

Answer 29

Calcium resonium

Question 30

What is the treatment for acute hyperkalaemia?

Answer 30

IV insulin, Glucose, Salbutamol can be added to CALCIUM GLUCONATE Add sodium bicarbonate but not via the same line (thrombosis)

Question 31

What are symptoms of hypokalaemia?

Answer 31

Muscle Hypotonia, arrhythmia

Question 32

What drugs cause hypokalaemia?

Answer 32

``` Diuretics Insulin B2 agonists Theophylline Steroid ```

Question 33

What is the treatment for mild hypokalaemia?

Answer 33

Oral slow potassium chloride

Question 34

What is the treatment for severe hypokalaemia?

Answer 34

IV KCl do not add glucose in initial dose KCl is fatal in overdose

Question 35

What is acute porphyrias?

Answer 35

Defect in haem biosynthesis Lead to haemolytic anaemia with certain drugs

Question 36

How is acute porphyrias treated?

Answer 36

Haem arginate

Question 37

How is glucose given in TPN?

Answer 37

Central vein to avoid thrombosis

Question 38

What can be added to avoid hyperosmolar hyperglycaemic nonketonic acidosis?

Answer 38

Fructose and sorbitol

Question 39

Which vitamin affects vision skin and immune system and is found liver fish liver oil and raw eggs?

Answer 39

A - retinol

Question 40

Which vitamin affects gums, iron absorption and is found in oranges and peppers blackcurrant?

Answer 40

C ascorbic acid

Question 41

Which vitamin affects bones and teeth and is found in the sun. Which version of this vitamin should be given in renal impairment?

Answer 41

D2 ergocalciferol D3 cholecalciferol Renal impairment: alfacalcidol, calcitriol

Question 42

Which vitamin inhibits platelet aggregation and is an antioxidant and is found in plant oils?

Answer 42

E tocopherol

Question 43

Which vitamin is given to all newborns and is found in green leafy vegetables?

Answer 43

K Phytomenadione Menadiol: water soluble

Question 44

What doses of folic acid are available?

Answer 44

400mcg 5mg for high risk groups

Question 45

Which groups should receive 5mg Folic acid?

Answer 45

Diabetes, antiepileptic, history, sickle cell (give throughout pregnancy)