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PPT > metabolic MC2 > Flashcards

metabolic MC2 Flashcards

1
Q

iron deficicny anaemia treatment

A

Iron deficiency anaemia

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2
Q

how to decide which type or oral iron

A

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.

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3
Q

when to parentral iron

A

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

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4
Q

where is iron absorbed

A

duodenum and upper jejunum

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5
Q

what food is iron mainly absorbed from

A

meat as heam

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6
Q

haem structure

A

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

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7
Q

non haem iron diet

A

veggie

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8
Q

non haem iron

A

ferric state (Fe3+)

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9
Q

non heam iron absoprtion

A

bad

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10
Q

what helps the absorption of non haem iron

A

vit C

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11
Q

what inhibits iron absorption

A

tannates, bran foods rich in phosphates, and phytates

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12
Q

gastric acid affect on ferric iron absorption

A

increases

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13
Q

where is DMT-1

A

duodenum

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14
Q

what is increased in iron deficiency anaemia and haemochromatosis

A

DMT-1

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15
Q

what happens to iron in enterocytes

A

oxidized to the ferric state

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16
Q

how does iron get from enterocyte into the blood

A

ferroportin

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17
Q

what is ferric bound to in the blood

A

transferrin

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18
Q

where is iron taken in blood

A

bone marrow and iron stores

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19
Q

how is iron taken up be cells

A

transferrin receptors

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20
Q

how is iron mostly stored

A

ferritin

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21
Q

what is ferritin

A

a complex of iron with the apoferritin protein

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22
Q

what is haemosiderin

A

degraded forms of ferritin

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23
Q

hwo are RBCs broken down

A

reticuloendothelial system

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24
Q

how is iron recycled

A

macrophages

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25
Q

normal iron loss

A

shedding of mucosal cells containing ferritin

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26
Q

iron adverse effects

A 
nausea, dyspepsia and constipation Diarrhoea
Epigastric pain (dose related)
Faecal impaction
Gastro-intestinal irritation
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27
Q

what do iron induced Nausea and dyspepsia depend on

A

elemental iron not the salt

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28
Q

are diarrhoea and constipation dose related

A

no

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29
Q

when not to give oral iron

A

prior to endoscopy - black poop

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30
Q

things that reduce the absoprtion of iron

A 
Levothyroxine
Bisphosphonates
Ciprofloxacin
Tetracyclines
Calcium and zinc salts
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31
Q

iron def anaemia dose

A

100 to 200 mg daily.

32
Q

initial increase after oral iron

A

blood haemoglobin concentration by about 20 g/L

33
Q

oral iron increase after 4 weeks

A

10 g/L

34
Q

how long to give iron

A

3 months after hb achieved

35
Q

how to stop neural TD

A

folic acid

36
Q

where do you get folate

A

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

37
Q

polyglutamates conversion and for what

A

Before absorption, the polyglutamates are deconjugated to the monoglutamate

38
Q

where is Folate monoglutamate is absorbed

A

duodenum and jejunum

39
Q

what happens to Folate monoglutamate during absoprtion

A

methylated and reduced to 5-methyltetrahydrofolate by dihydrofolate reductase

40
Q

what happens to Methyltetrahydrofolate in cells

A

converted back to folate polyglutamates

41
Q

folate in circulation

A

5-methyltetrahydrofolate

42
Q

how does folate contribute to DNA synthesis

A

donates a carbon unit for pyramidine and thymadine synthesis

43
Q

folate can donate a carbon what else can it do

A

accept a carbon atom from serine

44
Q

what is B12

A

cofactor of methionine synthase

45
Q

what does B12 do

A

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

46
Q

adverse effects of folic acid

A

arent any

47
Q

anticonvulsants associated with developing NTD

A

valproate, carbamazepine

48
Q

who is at risk of having a child with NTD

A

anticonvulsants and previous child with NTD

49
Q

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

A

70%

50
Q

how much folic acid for low risk women

A

400mg

51
Q

do most women who have children with NTD have risk factors

A

no

52
Q

who should have pre conceptual folic acid

A

all women

53
Q

B12 anaemia

A

macrocytic

54
Q

B12 bone marrow

A

megaloblastic

55
Q

changes to the tongue in B12 def

A

smooth

56
Q

changes to the GI in B12 def

A

change to the lining = malabsorption

57
Q

B12 and the spine

A

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.

58
Q

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

A

B12 to avoid subacute degen of the spinal cord

59
Q

B12 def treatment

A

hydroxycobalamin IM

60
Q

why do people get B12 deficiecny

A

lack of absorption

61
Q

causes of B12 def

A 
crohns
lack of intrinsic
veggie
lymphoma
gastrectomy
62
Q

first line treatment for BPH

A

alpha blocker

63
Q

examples of alpha blocker

A

Alfuzosin
Doxazosin
Tamsulosin
Terazosin

64
Q

special about BPH alpha blockers

A

highly selective for the α1-adrenoceptor

65
Q

where are α1-adrenoceptor found

A

smooth muscle cells

66
Q

stimulation of α1-adrenoceptor causes

A

contraction

67
Q

alpha blocker affect on vessel

A

vasodilaton = hypotension

68
Q

alpha blockers side effects

A

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

69
Q

enlarged prostate and high risk treatment

A

5-alpha reductase inhibitor

70
Q

5-alpha reductase inhibitor example

A

finesteride

71
Q

who is 5-alpha reductase inhibitor more efficient in

A

larger prostate

72
Q

what does 5-alpha-reductase do

A

catalyzes the conversion of testosterone to dihydrotestosterone

73
Q

how long does it take to improve BPH symptoms with medication

A

6 months-1yr

74
Q

5 alpha reductase inhibitors side effects

A 
Breast enlargement 
Breast tenderness
Decreased libido
Ejaculation disorders
Impotence
75
Q

what increases the conc of dutasteride

A

Verapamil and diltiazem

PPT (8 decks)

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