metabolic MC2 Flashcards
iron deficicny anaemia treatment
Iron deficiency anaemia
how to decide which type or oral iron
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.
when to parentral iron
patient cannot tolerate oral iron, or does not take it reliably, or if there is continuing blood loss, or in malabsorption
where is iron absorbed
duodenum and upper jejunum
what food is iron mainly absorbed from
meat as heam
haem structure
ferrous form of iron (Fe2+) complexed with a porphyrin ring
non haem iron diet
veggie
non haem iron
ferric state (Fe3+)
non heam iron absoprtion
bad
what helps the absorption of non haem iron
vit C
what inhibits iron absorption
tannates, bran foods rich in phosphates, and phytates
gastric acid affect on ferric iron absorption
increases
where is DMT-1
duodenum
what is increased in iron deficiency anaemia and haemochromatosis
DMT-1
what happens to iron in enterocytes
oxidized to the ferric state
how does iron get from enterocyte into the blood
ferroportin
what is ferric bound to in the blood
transferrin
where is iron taken in blood
bone marrow and iron stores
how is iron taken up be cells
transferrin receptors
how is iron mostly stored
ferritin
what is ferritin
a complex of iron with the apoferritin protein
what is haemosiderin
degraded forms of ferritin
hwo are RBCs broken down
reticuloendothelial system
how is iron recycled
macrophages
normal iron loss
shedding of mucosal cells containing ferritin
iron adverse effects
nausea, dyspepsia and constipation Diarrhoea Epigastric pain (dose related) Faecal impaction Gastro-intestinal irritation
what do iron induced Nausea and dyspepsia depend on
elemental iron not the salt
are diarrhoea and constipation dose related
no
when not to give oral iron
prior to endoscopy - black poop
things that reduce the absoprtion of iron
Levothyroxine Bisphosphonates Ciprofloxacin Tetracyclines Calcium and zinc salts
iron def anaemia dose
100 to 200 mg daily.
initial increase after oral iron
blood haemoglobin concentration by about 20 g/L
oral iron increase after 4 weeks
10 g/L
how long to give iron
3 months after hb achieved
how to stop neural TD
folic acid
where do you get folate
leaf vegetables (in which it is heat-labile) and in liver (where it is more heat-stable)
polyglutamates conversion and for what
Before absorption, the polyglutamates are deconjugated to the monoglutamate
where is Folate monoglutamate is absorbed
duodenum and jejunum
what happens to Folate monoglutamate during absoprtion
methylated and reduced to 5-methyltetrahydrofolate by dihydrofolate reductase
what happens to Methyltetrahydrofolate in cells
converted back to folate polyglutamates
folate in circulation
5-methyltetrahydrofolate
how does folate contribute to DNA synthesis
donates a carbon unit for pyramidine and thymadine synthesis
folate can donate a carbon what else can it do
accept a carbon atom from serine
what is B12
cofactor of methionine synthase
what does B12 do
involved in the transfer of the methyl group from 5-MeTHF to homocysteine.
adverse effects of folic acid
arent any
anticonvulsants associated with developing NTD
valproate, carbamazepine
who is at risk of having a child with NTD
anticonvulsants and previous child with NTD
how much do pre conceptual folic acid reduce the liklihood of NTD
70%
how much folic acid for low risk women
400mg
do most women who have children with NTD have risk factors
no
who should have pre conceptual folic acid
all women
B12 anaemia
macrocytic
B12 bone marrow
megaloblastic
changes to the tongue in B12 def
smooth
changes to the GI in B12 def
change to the lining = malabsorption
B12 and the spine
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.
macrocytic anaemia what should the first treatment be if you dont know the cause
B12 to avoid subacute degen of the spinal cord
B12 def treatment
hydroxycobalamin IM
why do people get B12 deficiecny
lack of absorption
causes of B12 def
crohns lack of intrinsic veggie lymphoma gastrectomy
first line treatment for BPH
alpha blocker
examples of alpha blocker
Alfuzosin
Doxazosin
Tamsulosin
Terazosin
special about BPH alpha blockers
highly selective for the α1-adrenoceptor
where are α1-adrenoceptor found
smooth muscle cells
stimulation of α1-adrenoceptor causes
contraction
alpha blocker affect on vessel
vasodilaton = hypotension
alpha blockers side effects
Orthostatic hypotension (mostly first dose)
Headache
Dizziness
Erectile disorders
Rhinitis
Asthenia - abnormal physical weakness or lack of energy
Oedema
enlarged prostate and high risk treatment
5-alpha reductase inhibitor
5-alpha reductase inhibitor example
finesteride
who is 5-alpha reductase inhibitor more efficient in
larger prostate
what does 5-alpha-reductase do
catalyzes the conversion of testosterone to dihydrotestosterone
how long does it take to improve BPH symptoms with medication
6 months-1yr
5 alpha reductase inhibitors side effects
Breast enlargement Breast tenderness Decreased libido Ejaculation disorders Impotence
what increases the conc of dutasteride
Verapamil and diltiazem
