G6PD deficiency, Oral Hydration therapy, Hydroxocobalamin, Folic acid, Epoetins, Sickle cell, Folinic acid

Question 1

G6PD Deficiency (Glucose-6-Phosphate dehydrogenase)

Answer 1

G6PD - enzyme needed for carbohydrate metabolism to make energy and protects RBC from damage

Genetic disorder - more common in Africans, Asians, Oceania, southern Europe. More common in men

This makes ppl more likely to develop acute haemolytic anaemia when they on certain drugs and eat fava beans

Manufactures dont test for this when making drugs.
- Risk/severity of haemolysis (destruction of RBC) is almost always dose related

Have drugs with definite risk and some with possible risk: (EXAM Q)
Definite common drugs -
- Nitrofurantoin, fluoroquinolones (floxacin), Co-trimoxazole, quinolones
Possible common drugs -
- Sulphonylureas, Aspirin, Quinine

Question 2

Oral rehydration

Answer 2

ORS (Dioralyte)
Intestinal absorption of Na+ & H2O is enhanced by glucose & other carbs
- Replaces electrolyte deficiency safely
- Has alkalinising agent to counter acidosis
- Slightly hyperosmolar - prevent possible induction of osmotic diarrhoea
- easy use/Palatable

Question 3

Hydroxycobalamin (Injection)

Answer 3

Prophylaxis of B12 Anaemias

• perinicous anaemia - autoimmune condtion lack of RBC caused by b12 deficiency

Replaced cyanocobalamin as hydroxy stays in the body longer.
- 3 Months intervals

Question 4

Folic acid megaloblastic anaemia

Answer 4

These happen due to either lack of B12 or Folic acid.
- Folic acid is used for around 4 months until body is replenished

Question 5

Folic acid

Answer 5

Give in pregnancy, poor nutrition and vs methotrexate AEs.

Taken b4 and till 12th week pregnancy to prevent neural tube defects
- Low risk women 400mcg daily
- High risk - 5mg daily
– High risks couples - sickle cell, diabetes, AEDs, Family Hx other malabsorption state

Question 6

Epoetins

Answer 6

Epoetin injection is used to treat anemia in patients with CKD who may/may not be on dialysis

Used for anaemia basc

Question 7

Sickle cell disease

Answer 7

Structurally abnormal shape of haemoglobin more sickle shape.
- Reduced 02 to organs and severe pain
- Increase infection risk and vaccines needed for protection

Hydroxycarbamide can reduce frequency of crisis and for blood transfusions.

Chronic complication - Skin ulcers, renal failure, increase infection risk

Question 8

Folinic acid

Answer 8

Effective for treating folate deficient megaloblastic anaemia but used mainly with cytotoxics
- Given as calcium foliate

Given mainly with cytotoxics but folic acid used in normal circumstance i.e. pregnancy