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GPhC Exam > Blood and Nutrition > Flashcards

Blood and Nutrition Flashcards

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1
Q

Sickle cell anaemia description

A

Deformed, less flexible red blood cells

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2
Q

Acute complications of sickle cell anaemia

A
  • sickle cell crisis - restricted blood supply to organs
  • hospitalisation - fluid replacement, analgesia, tx infections
  • complications: anaemia, leg ulcers, renal failure, susceptibility to infections
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3
Q

Haemolytic anaemia treatment

A

increase folate - give folic acid supplementation

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4
Q

Treatment of sickle cell anaemia complications

A

hydroxycarbamide - reduces frequency of painful crises and reduces transfusion requirements

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5
Q

G6PR (glucose-6-phosphate dehydrogenase) deficiency anaemia

A
  • common in Africa and Asia, more common in males
  • susceptible to developing acute haemolytic anaemia (haemolysis = RBC destruction)
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6
Q

Drugs with definite risk of haemolysis in G6PR deficient people

A
  • dapsone and other sulfones
  • fluoroquinolone/quinolones
  • nitrofurantoin
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7
Q

Drugs with possible risk of haemolysis in G6PD deficient people

A
  • aspirin
  • chloroquine
  • menadione
  • quinine
  • sulfonylureas
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8
Q

What is megaloblastic anemia

A

Either a B12 or folate deficiency - 1st step = establish cause

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9
Q

Vit B12 deficiency treatment

A

Hydroxycobalamin initiated with frequent IM injections to replenish stores then
hydroxycobalamin 3 monthly

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10
Q

Folate deficiency treatment

A
  • due to poor nutrition, pregnancy, or antiepileptics (phenytoin, carbamazepine, phenobarbital)
  • folic acid daily for 4 months
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11
Q

Megaloblastic anaemia deficiency emergency

A
  • give hydroxycobalamin and folic acid together while plasma assay results are waiting
  • don’t give folic acid alone if undiagnosed - may cause neuropathy
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12
Q

Folic acid doses

A
  • regular pregnancy: 400mcg OD from before conception to week 12
  • risk of NTD: 5mg OD from before conception to week 12
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13
Q

Risk factors for neural tubular defects

A
  • smoking
  • sickle cell anaemia
  • diabetes
  • obesity
  • anti-epileptics
  • anti-malarials
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14
Q

Iron deficiency anaemia symptoms

A

tiredness, SOB, palpitations, pale skin

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15
Q

When is prophylaxis with iron appropriate in IDA

A

malabsorption, menorrhagia, pregnancy, after total/subtotal gastrectomy, in haemodialysis patient, in management of low birth-weight infants e.g. preterm neonates

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16
Q

Precautions before treating IDA with iron

A
  • must show iron deficiency to treat with iron
  • exclude underlying cause e.g. gastric erosion, GI cancer
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17
Q

Oral iron types and dose

A
  • fumarate, gluconate, sulfate, sulfate (dried)
  • daily elemental iron dose = 100 to 200mg per day
  • usually sulfate (dried)
  • sulfate (dried) can be MR too (reduced absorption)
  • when Hb in range - continued for 3 months
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18
Q

Oral iron side effects

A
  • constipation/diarrhoea, black tarry stools
  • stop in C. diff due to diarrhoea
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19
Q

Oral iron absorption

A
  • with vitamin C (orange juice) to aid absorption
  • before food to aid absorption
  • after food to reduce side effects
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20
Q

Iron toxicity treatment

A

desferrioxamine

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21
Q

Parenteral iron types

A

dextran, sucrose, carboxymaltose, densomaltose

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22
Q

When should parenteral iron be used

A
  • oral not tolerated/doesn’t work
  • chemo-induced anaemia
  • chronic renal failure who are receiving haemodialysis
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23
Q

Parenteral iron MHRA warning

A
  • serious hypersensitivity reactions
  • appropriately trained staff and resuscitation must be available
  • monitor for reaction for at least 30 minutes after every administration
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24
Q

What is neutropenia

A
  • low neutrophil count (<1.5 x 10^9/L)
  • increased risk of infection and sepsis, especially in chemotherapy
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25
Treatment for neutropenia
- recombinant human granulocyte-colony stimulating factor (rhG-CSF) - e.g. filgrastim, lenograstim, pegfilgrastim, lipefilgrastim - stimulates neutrophil production do decreased duration of chemo-induced neutropenia so reduces incidence of febrile neutropenia
26
Normal ranges for electrolytes in mmol/L
- Calcium: 2.2 - 2.6 - Magnesium: 0.6 - 1 - Phosphate: 0.87-1.45 - Potassium: 3.5 - 5.3 - Sodium: 133 - 146
27
Hypokalaemia side effects
muscle cramps, rhabdomyolysis, fatigue, palpitations, arrhythmias
28
Hyperkalaemia side effects
fatigue, numbness, nausea, SOB, chest pain, palpitations
29
Hyponatraemia side effects
nausea, headache, confusion, fatigue, irritability, seizures
30
Hypernatraemia side effects
thirst, fatigue, confusion
31
Hypocalcaemia side effects
muscle cramps, confusion, depressed, forgetful
32
Hypercalcaemia side effects
nausea, lethargy, muscle cramps, confusion, arrhythmias
33
Hyponatraemia and Lithium interaction
Hyponatraemia predisposes patient to lithium toxicity
34
Drugs that cause Hyponatraemia
Carbamazapine Diuretics Desmopressin/vasopressin SSRIs Certain Drugs Ditch Salt
35
Drugs that cause Hypernatraemia
Sodium bicarbonate/chloride Corticosteroids Effervescent formulations Oestrogens/androgens Salty CEO
36
Hyponatraemia treatment
mild - mod = oral supplements (sodium chloride/bicarbonate) severe = IV NaCl
37
Hypernatraemia treatment
dietary: reduce salt intake
38
Drugs that cause hypokalaemia
Aminophylline/theophylline Beta agonists Corticosteroids Diuretics (loop/thiazide) Erythro/clarithromycin Insulin ABCDEI
39
Drugs that cause hyperkalaemia
Trimethoprim Heparin ACEi/ARBs NSAIDs K-Sparing diuretics Beta - blockers THANKS B
40
Potassium imbalance causes:
cardiac side effects e.g. arrhythmias
41
Hypokalaemia and digoxin interaction
Hypokalaemia predisposes patients to digoxin toxicity
42
Hypokalaemia treatment
mild - mod = oral replacement (sando K) severe = IV KCl in NaCl K replaced cautiously in renal impairment - risk of hyperkalaemia secondary to renal impairment
43
Hyperkalaemia treatment
mild - mod = ion exchange resins to remove excess K (calcium resonium) acute sever (>6.5) = urgent tx: - IV calcium chloride 10%/ calcium glauconate 10% - IV soluble insulin (5-10 units) with 50mL glucose - 50% given over 5-15 minutes - salbutamol nebulisation or slow IV injection - drugs exacerbating hyperkalaemia reviewed/stopped
44
Use of magnesium
- essential in enzyme systems, energy generation - stored in skeleton - excreted by kidney so retained in renal failure = hypermagnesaemia
45
Drugs causing hypomagnesaemia
PPIs, diuretics
46
hypomagnesaemia treatment
mild = oral magnesium symptomatic = IV/IM magnesium sulfate (IM=painful)
47
hypermagnesaemia treatment
muscle weakness and arrhythmias calcium glutinate injection used for management of magnesium toxicity
48
hypocalcaemia cause and treatment
- from reduced dietary calcium - tx with calcium supplements and vitamin D - in osteoporosis - double the recommended amount of calcium to reduce rate of bone loss - severe = initial slow IV calcium glauconite with plasma calcium and ECG monitoring - repeat if needed or follow with continuous IV infusion to prevent recurrence
49
Drugs causing hypocalcaemia
rifampicin, phenytoin, phenobarbital, bisphosphonates
50
Drugs causing hypercalcaemia
thiazide diuretics, lithium, vit D
51
hypercalcaemia treatment
severe: - correct dehydration with IV NaCl 0.9% - stop drugs causing hyper, restrict dietary - bisphosphinates and pamidronate disodium used - corticosteroids if due to sarcoidosis or with vit D toxicity - calcitonin in hyper associated with malignancy
52
Hypercalciurea treatment
- increase fluid intake and give bendroflumethiazide - decrease dietary calcium but not severe restriction (harmful)
53
What is hyperparathyroidism
increase in parathyroid hormone= hypercalcaemia, hypercalciurea and hypophosphataemia
54
hyperparathyroidism symptoms
thirst, polyurea, constipation, fatigue, memory impaired, CVD, kidney stones, osteoporosis - affects 2x women than men, common in women 50 - 60 yrs
55
1st line treatment of primary hyperparathyroidism
parathyroidectomy surgery assess CVD risk and fracture risk
56
hyperparathyroidism drug treatment
- cincalcet if surgery unsuccessful/declined - in 2ndory care - measure vit D - supplement if needed - bisphosphonates to reduce fracture risk
57
Hypophosphataemia cause and treatment
- alcohol dependence or severe DKA - oral supplements
58
Hyperphosphataemia treatment
- phosphate binders (calcium or non-calcium based) - stage 4/5 CKD = manage diet and dialysis before starting tx 1. calcium acetate 2. sevelamer 3. CaCO3 (calcium based) or sucroferric oxyhydroxide (non-calcium based)
59
What is acute porphyrias
a metabolic, hereditary disorder of haem biosynthesis. Causes severe pain in belly, chest, legs or back, digestive problems, confusion, red/brown urine.
60
Drugs that can induce acute porphyria crises
amiodarone, carbamazepine, chloramphenicol, clindamycin, diltiazem, erythromycin, indapamide, isoniazid, mefenamic acid, methyldopa, nitrofurantoin, phenytoin, rifampicin, risperidone, spironolactone, tamoxifen, topiramate, trimethoprim, valproate, verapamil
61
acute porphyria treatment
mod - severe = IV haem arginate
62
Name the fat soluble vitamins
DEAK
63
Vitamin A
- is retinol - deficiency = ocular defects and increase risk of infections - avoid in pregnancy (teratogenic) - is in cheese, eggs, oily fish, milk, yogurt, liver products e.g. paté
64
Vitamin D
- is ergocalciferol (D2), cholecalciferol (D3), alfacalcidol, calcitriol - deficiency = rickets, from reduced sun and diet intake - vit D dose = 10mcg (400 units) - is in oily fish, red meat, liver, egg yolk, fortified foods e.g. cereal
65
Vitamin E
- is tocopherol - deficiency = neuromuscular abnormalities - is in plant oils, nuts, seeds, wheatgerm
66
Vitamin K
- is phytomenadione - blood clotting factors - reversal agent for warfarin - menadiol (water-soluble derivative) given orally in malabsorption syndromes - is in green leafy veg, veg oils, cereal grains
67
Name the water soluble vitamins
BC
68
Vitamin B
- B1 (thiamine) = deficiency = wernickes encephalopathy - B2 (riboflavin) = keeps skin, eyes and nervous system healthy - B6 (pyridoxine) = to treat isoniazid associated peripheral neuropathy - B12 (hydroxocobalamin) = treatment of megaloblastic anaemia - is in meats, cereals and vegetables
69
Vitamin C
- is ascorbic acid - deficiency = scurvy - helps with wound healing and maintains healthy skin, blood vessels, bone and cartilage - is in oranges, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
70
IV nutrition 2 methods
1. supplemental parenteral nutrition - addition to ordinary feeding 2. TPN - sole source of nutrition
71
How is IV nutrition given
via central venous catheter (central line) or a peripheral vein
72
What does IV nutrition contain
amino acids, glucose, fat, electrolytes, trace elements, vitamins - proteins as synthetic L-amino acids - source of energy - preferred card: glucose (infused through central venous catheter to avoid thrombosis) - phosphate - for phosphorylation of glucose and preventing hypophosphataemia - fructose and sorbitol - prevents hyperosmolar hyperglycaemic non-ketotic acidosis - fat emulsions - high energy to fluid volume ratio (not to mix in additives)

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