Anaemia Drugs - Folic Acid

Question 1

Folate or folic acid (vitamin B9) is a vitamin found in fruits, vegetables, nuts etc. In foods it comes as polyglutamate that is converted into monoglutamate, which can then be absorbed. Which part of the small intestines does the monoglutamate get absorbed?

1 - 2nd part of duodenum
2 - jejunum
3 - proximal ileum
4 - terminal ileum

Answer 1

2 - jejunum

Question 2

Once processed monoglutamate is converted into tetrahydrofolic acid (THF), which is then converted into methyl-tetrahydrofolic acid. Here is travels in the blood stream to tissues and which organ?

1 - liver
2 - kidneys
3 - spleen
4 - bone marrow

Answer 2

1 - liver
- can be stored for 2-3 months

Question 3

Methyl-tetrahydrofolic acid (folic acid) can enter cells through the folic acid transport in the membrane of cells. Which of the following can Methyl-tetrahydrofolic acid then be used to make?

1 - thymidine (nucleoside used to build DNA)
2 - methionine (amino acid)
3 - central nerve development
4 - all of the above

Answer 3

4 - all of the above
- crucial for closure of anterior and posterior neuropore

Question 4

Which of the following is NOT caused by folate deficiency?

1 - neural tube defects
2 - raised homocysteine
3 - impaired cell division
4 - raised lactate

Answer 4

4 - raised lactate

Question 5

Macrocytic anaemia can be causes by folate deficiency and is due to impaired ability of bone marrow to make RBCs. The large Macrocytic RBCs are functional, but are destroyed by which organ?

1 - liver
2 - kidneys
3 - spleen
4 - pancreas

Answer 5

3 - spleen
- causes a drop in RBC number and haemoglobin

Question 6

Does folate deficient only lead to abnormal macrocytic/megaloblastic RBCs?

Answer 6

• no
• can affect WBC and platelets

Question 7

Folate deficiency can lead to abnormal:

• macrocytic/megaloblastic anaemia
• hypersegmented nuclei (neutrophils)
• reduced megakaryocytes

When all of 3 of the above occur due to Folate deficiency, what is this called?

1 - thrombocytopenia
2 - pancytopenia
3 - leukopenia
4 - myoleamia

Answer 7

2 - pancytopenia

Question 8

Which 2 of the following are indications for folic acid administration?

1 - microcytic anaemia
2 - macrocytic anaemia
3 - normocytic anaemia
4 - 1st trimester of pregnancy

Answer 8

2 - macrocytic anaemia
4 - 1st trimester of pregnancy
- crucial for anterior and posterior nanopore closure

Question 9

When prescribing folic acid, we need to be careful if they have any co-exisiting B12 deficiency with what other vitamin?

1 - B1
2 - vitamin D
3 - vitamin B12
4 - vitamin C

Answer 9

3 - vitamin B12
- if folate is given alone it can accelerate myelin sheath damage

Question 10

What is the standard dose for women considering getting pregnant of folic acid?

1 - 1mg
2 - 400ug
3 - 5mg
4 - 1g

Answer 10

2 - 400ug
- can be increased to 5mg in high risk patients of neural tube abnormalities