metabolic MC2

Question 1

iron deficicny anaemia treatment

Answer 1

Iron deficiency anaemia

Question 2

how to decide which type or oral iron

Answer 2

Haemoglobin regeneration rate is little affected by the type of salt used provided sufficient iron is given, and in most patients the speed of response is not critical. Choice of preparation is thus usually decided by the incidence of side-effects and cost.

Question 3

when to parentral iron

Answer 3

patient cannot tolerate oral iron, or does not take it reliably, or if there is continuing blood loss, or in malabsorption

Question 4

where is iron absorbed

Answer 4

duodenum and upper jejunum

Question 5

what food is iron mainly absorbed from

Answer 5

meat as heam

Question 6

haem structure

Answer 6

ferrous form of iron (Fe2+) complexed with a porphyrin ring

Question 7

non haem iron diet

Answer 7

veggie

Question 8

non haem iron

Answer 8

ferric state (Fe3+)

Question 9

non heam iron absoprtion

Answer 9

bad

Question 10

what helps the absorption of non haem iron

Answer 10

vit C

Question 11

what inhibits iron absorption

Answer 11

tannates, bran foods rich in phosphates, and phytates

Question 12

gastric acid affect on ferric iron absorption

Answer 12

increases

Question 13

where is DMT-1

Answer 13

duodenum

Question 14

what is increased in iron deficiency anaemia and haemochromatosis

Answer 14

DMT-1

Question 15

what happens to iron in enterocytes

Answer 15

oxidized to the ferric state

Question 16

how does iron get from enterocyte into the blood

Answer 16

ferroportin

Question 17

what is ferric bound to in the blood

Answer 17

transferrin

Question 18

where is iron taken in blood

Answer 18

bone marrow and iron stores

Question 19

how is iron taken up be cells

Answer 19

transferrin receptors

Question 20

how is iron mostly stored

Answer 20

ferritin

Question 21

what is ferritin

Answer 21

a complex of iron with the apoferritin protein

Question 22

what is haemosiderin

Answer 22

degraded forms of ferritin

Question 23

hwo are RBCs broken down

Answer 23

reticuloendothelial system

Question 24

how is iron recycled

Answer 24

macrophages

Question 25

normal iron loss

Answer 25

shedding of mucosal cells containing ferritin

Question 26

iron adverse effects

Answer 26

``` nausea, dyspepsia and constipation Diarrhoea Epigastric pain (dose related) Faecal impaction Gastro-intestinal irritation ```

Question 27

what do iron induced Nausea and dyspepsia depend on

Answer 27

elemental iron not the salt

Question 28

are diarrhoea and constipation dose related

Answer 28

no

Question 29

when not to give oral iron

Answer 29

prior to endoscopy - black poop

Question 30

things that reduce the absoprtion of iron

Answer 30

``` Levothyroxine Bisphosphonates Ciprofloxacin Tetracyclines Calcium and zinc salts ```

Question 31

iron def anaemia dose

Answer 31

100 to 200 mg daily.

Question 32

initial increase after oral iron

Answer 32

blood haemoglobin concentration by about 20 g/L

Question 33

oral iron increase after 4 weeks

Answer 33

10 g/L

Question 34

how long to give iron

Answer 34

3 months after hb achieved

Question 35

how to stop neural TD

Answer 35

folic acid

Question 36

where do you get folate

Answer 36

leaf vegetables (in which it is heat-labile) and in liver (where it is more heat-stable)

Question 37

polyglutamates conversion and for what

Answer 37

Before absorption, the polyglutamates are deconjugated to the monoglutamate

Question 38

where is Folate monoglutamate is absorbed

Answer 38

duodenum and jejunum

Question 39

what happens to Folate monoglutamate during absoprtion

Answer 39

methylated and reduced to 5-methyltetrahydrofolate by dihydrofolate reductase

Question 40

what happens to Methyltetrahydrofolate in cells

Answer 40

converted back to folate polyglutamates

Question 41

folate in circulation

Answer 41

5-methyltetrahydrofolate

Question 42

how does folate contribute to DNA synthesis

Answer 42

donates a carbon unit for pyramidine and thymadine synthesis

Question 43

folate can donate a carbon what else can it do

Answer 43

accept a carbon atom from serine

Question 44

what is B12

Answer 44

cofactor of methionine synthase

Question 45

what does B12 do

Answer 45

involved in the transfer of the methyl group from 5-MeTHF to homocysteine.

Question 46

adverse effects of folic acid

Answer 46

arent any

Question 47

anticonvulsants associated with developing NTD

Answer 47

valproate, carbamazepine

Question 48

who is at risk of having a child with NTD

Answer 48

anticonvulsants and previous child with NTD

Question 49

how much do pre conceptual folic acid reduce the liklihood of NTD

Answer 49

70%

Question 50

how much folic acid for low risk women

Answer 50

400mg

Question 51

do most women who have children with NTD have risk factors

Answer 51

no

Question 52

who should have pre conceptual folic acid

Answer 52

all women

Question 53

B12 anaemia

Answer 53

macrocytic

Question 54

B12 bone marrow

Answer 54

megaloblastic

Question 55

changes to the tongue in B12 def

Answer 55

smooth

Question 56

changes to the GI in B12 def

Answer 56

change to the lining = malabsorption

Question 57

B12 and the spine

Answer 57

Damage to the posterior and lateral neuronal tracts in the spinal cord can also occur, leading to a condition known as subacute combined degeneration of the cord.

Question 58

macrocytic anaemia what should the first treatment be if you dont know the cause

Answer 58

B12 to avoid subacute degen of the spinal cord

Question 59

B12 def treatment

Answer 59

hydroxycobalamin IM

Question 60

why do people get B12 deficiecny

Answer 60

lack of absorption

Question 61

causes of B12 def

Answer 61

``` crohns lack of intrinsic veggie lymphoma gastrectomy ```

Question 62

first line treatment for BPH

Answer 62

alpha blocker

Question 63

examples of alpha blocker

Answer 63

Alfuzosin Doxazosin Tamsulosin Terazosin

Question 64

special about BPH alpha blockers

Answer 64

highly selective for the α1-adrenoceptor

Question 65

where are α1-adrenoceptor found

Answer 65

smooth muscle cells

Question 66

stimulation of α1-adrenoceptor causes

Answer 66

contraction

Question 67

alpha blocker affect on vessel

Answer 67

vasodilaton = hypotension

Question 68

alpha blockers side effects

Answer 68

Orthostatic hypotension (mostly first dose) Headache Dizziness Erectile disorders Rhinitis Asthenia - abnormal physical weakness or lack of energy Oedema

Question 69

enlarged prostate and high risk treatment

Answer 69

5-alpha reductase inhibitor

Question 70

5-alpha reductase inhibitor example

Answer 70

finesteride

Question 71

who is 5-alpha reductase inhibitor more efficient in

Answer 71

larger prostate

Question 72

what does 5-alpha-reductase do

Answer 72

catalyzes the conversion of testosterone to dihydrotestosterone

Question 73

how long does it take to improve BPH symptoms with medication

Answer 73

6 months-1yr

Question 74

5 alpha reductase inhibitors side effects

Answer 74

``` Breast enlargement Breast tenderness Decreased libido Ejaculation disorders Impotence ```

Question 75

what increases the conc of dutasteride

Answer 75

Verapamil and diltiazem