Quiz4.CCA,diuretics,anticoag,ADME(5,6),blood,renal(1,2)

Question 1

Name phase 1 metabolic processes

Answer 1

-reduction
-oxidation
-hydrolysis
-isomerisation

Question 2

Name phase 2 metabolic processes

Answer 2

-acetylation
-methylation
-sulfonation
-glutathione conjugation
-glucaronic acid conjugation
-aminoacid conjugation

Question 3

What does a cytochrome p450 inhibitor do?

Answer 3

Increases risk of toxicity, eg grapefruit juice, erythromycin, diltiazem and verapamil

Question 4

What does a cytochrome p450 enzyme inducer do?

Answer 4

They can render the drug useless eg giving St John’s wort alongside a contraceptive could stop the contraceptive effect

Question 5

What does the enzyme esterase do?

Answer 5

converts prodrug dabigatran etexilate to active thrombin inhibitor, dabigatran

Question 6

5 facts about acute kidney injury

Answer 6

1. Often the damage is reversible
2. Rapid reduction in renal function
3. Rise in creatinine from baseline
4. eGFR decreases
5. Decreased urine output

Question 7

Give examples of potential cause (pre-renal, intrinsic, post-renal) of renal failure.

Answer 7

Pre-renal
1. Volume depletion (hypokalaemia due to excess sweating, diarrhoea/vomiting, haemorrhage)
2. Decreased cardiac output
3. Drugs (NSAIDs, ACEi, diuretics)
Intrinsic
1.Acute tubular necrosis
2. interstitial disease
3. glomerular disease
Post-renal
A blockage or obstruction in the urinary tract-eg urinary stones, tumour, enlargement of prostate

Question 8

How can AKI be classed?

Answer 8

AKI is classed on the cause. So it will be either pre renal, intrarenal/intrinsic or post renal AKI

Question 9

What do Hct, RBCC and MCV mean?

Answer 9

-Hct is haemacratic and and refers to the proportion of blood, which is made up of red blood cells
-RBCC is the number of red blood cells
-MCV is mean corpuscular volume - average size of red blood cells

Question 10

What can affect MCV?

Answer 10

Different anaemias can affect the average size of red blood cells

Question 11

Who does anaemia of chromic disease affect?

Answer 11

Patients with inflammatory conditions such as infections, autoimmune disease and CKD

Question 12

Iron deficiency anaemia results in what?

Answer 12

Low serum ferritin and low serum iron

Question 13

What is sideroblastic anaemia?

Answer 13

When the body produces enough iron but is unable to put it into haemoglobin

Question 14

Causes of iron deficiency anaemia?

Answer 14

-Blood loss (nose bleeds, menstrual blood loss, freq blood donations, post partum haemorrhage, GI bleed)
-inadequate iron absorption, dietary deficiency
-haemorrhoids/piles

Question 15

What method is used to treat iron deficiency anaemia?

Answer 15

The cause is determined and then this is the focus of management. Supplementary iron may also be given

Question 16

Symptoms of iron deficiency anaemia?

Answer 16

1. Pallor
2. Fatigue
3. Breathlessness
4. Tachycardia
5. Headache
6. Sensitivity to cold

Question 17

Symptoms of vitamin B12 def anaemia?

Answer 17

-painful enlarged tongue
-weakness
-dementia
-anorexia, ataxia

Question 18

Folate deficiency anaemia symptoms?

Answer 18

-cardiac symptoms
-pallor
-fatigue

Question 19

Give two examples of morphologic anaemia classification

Answer 19

1. Hypochromic microcytic = iron deficiency
2. Macrocytic = b12 and folate deficiency

Question 20

What are 3 supplemental treatment options for anaemia?

Answer 20

1. 200mg ferrous sulphate once daily for iron deficiency
2. 5mg folic acid once daily for folate deficiency
3. 1mg hydroxocobalamin 2-3months for b12 deficiency

Question 21

What are 2 side effects of ferrous sulphate

Answer 21

GI disturbances and stool discolouration

Question 22

How would you counsel ferrous sulphate?

Answer 22

1. Take on an empty stomach to allow better absorption
2. CAN take with food to reduce GI effects
3. Avoid antacids (gaviscon)
4. Regular blood tests required (check Hb)