t100 Iron and vitamins

Question 1

Management of iron defieicny anaemia

Answer 1

• see if any referral needed quickly eg 2ww
• FIT testing

1. Address any underlying causes that can be managed in primary care (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

+ 65 mg elemental iron (ferrous sulfate 200 mg) once daily (on an empty stomach)

+ advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian

Question 2

main adverse effects iron supplements? what to do in that cirucmstance?

Answer 2

gastrointestinal disturbance

For people with significant intolerance to oral iron replacement therapy options include alternate day dosing, oral ferric maltol, or parenteral iron preparations.

Question 3

management b12 deficieny

Answer 3

With neurological involvement
Replacement therapy:
- IM hydroxocobalamin 1mg once daily on alternative days until no further improvement
Maintenance therapy:
- IM Hydroxocobalamin 1mg, which usually lasts for life, once every 2 months

Without neurological involvement
Replacement therapy:
- IM Hydroxocobalamin 1mg three times a week for 2 weeks
Maintenance therapy (diet related):
- IM Hydroxocobalamin 1mg twice a year
Maintenance therapy (non-diet related):
- IM Hydroxocobalamin 1mg once every 2-3 months for life

Within 7 to 10 days of starting treatment, FBC should be performed to check for treatment response.
No response: check serum folate level
Haemoglobin level and reticulocyte index above normal range: adequate treatment

Question 4

management folate deficiency

Answer 4

Prescribe oral folic acid 5 mg daily — in most people, treatment will be required for 4 months.
However, folic acid may need to be taken for longer (sometimes for life) if the underlying cause of deficiency is persistent.

Question 5

what do you need to check before giving folate

Answer 5

Check vitamin B12 levels in all people before starting folic acid

ALWAYS CORRECT B12 BEFORE FOLATE

Question 6

who may be at risk of anaphylaxis with IV iron

Answer 6

atopic predisposition

Question 7

what may iron exarcebate

Answer 7

intestinal disease eg IBD, diverticualr disease, intetsinal strictures

Question 8

important interactions iron

Answer 8

can reduce absorption of drugs inc levothyroxine and bisphosphonates, take these 2 hours before iron

Question 9

on iron and need colonoscopy? prep?

Answer 9

stop iron 7 days beforevir

Question 10

what vitamin is thaimine

Answer 10

vitamin B1

Question 11

who gets thiamine defieicny, what should you prescribe

Answer 11

high alcohol intake
used to prevent wenikes encephalopathy and korsakoffs

pabrinex IM injection - provides additional vitamins B and C to correct deficiencies that may have occurred,

Question 12

what is the pharmacological vitamin K called? when is it used?

Answer 12

phytomenadione

given to all newborn abbies to prevent bleeding

used to reverse anticoagualnt effect of warfarin (alongside prothrombin complex)

Question 13

administartion of pabrinex

Answer 13

each carton of pabrinex contains 2 ampules labelled no1 and no2, thesea re added to a small bag (50-100ml of 0.9% sodium chloride or 5% glucose and infused over 30 mins