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Pre Reg- Furkan > Blood Disorders > Flashcards

Blood Disorders Flashcards

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1
Q

What is the dose for iron for anaemia?

A

One daily or on alternate days and continue for three months after reach normal levels

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2
Q

What is the MHRA warning for IV iron?

A

Hypersensitivity

At higher risk: those with severe atopic reactions e.g. asthma and eczema, immune or inflammatory conditions

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3
Q

Can iron supplements be given to pregnant women?

A

Avoid during 1st trimester

Can be given in 2nd-3rd trimester if benefit outweighs risks

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4
Q

What are the side effects of iron and how should a patient take it?

A

SE: constipation or diarrhoea
- counsel to take with or after food if GI effects otherwise take on empty stomach to allow better absorption
- can take with glass of orange juice as vitamin C enhances absorption of iron

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5
Q

What drugs interact with iron?

A

Antacids - leave 2 hr gap
Bisphosphonates - leave 2 hr gap
Levothyroxine - leave 4 hr gap
Quinolones - leave 2 hr gap
Tetracyclines - leave 2 hr gap

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6
Q

What is megaloblastic anaemia?

A

Enlarged RBC caused by low B12 or folate

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7
Q

What are the symptoms of megaloblastic anaemia?

A

Fatigue
Dyspnoea
Tingling hands and feet
Muscle weakness

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8
Q

Who are at higher risk of megaloblastic anaemia?

A

Pregnant women
Patients taking antifolate drugs e.g. methotrexate
Patients taking antiepileptic drugs

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9
Q

How do you treat patients with megaloblastic anaemia with a B12 deficiency?

A

IM Hydroxocobalamin

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10
Q

What is the MHRA warning for hydroxocobalamin?

A

Those with cobalt allergy - look out for hypersensitivity reaction

Counsel patients to report any skin reactions and seek medical help:
- extensive ir blistering rash
- wheeze
- difficulty breathing
- feeling faint

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11
Q

How do you treat patients with megaloblastic anaemia with a folate deficiency?

A

Folic acid daily for 4 months
- never give alone unless B12 also tested

If both low - treat B12 first as otherwise it can cause spinal cord neuropathy

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12
Q

What are the symptoms of neutropenia?

A

Fever
Sore throat
Mouth ulcers
Influenza

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13
Q

How do you treat neutropenia?

A

Recombinant human granulocyte colony-stimulating factor
- filgratism

stimulate more bone marrow to make more granulocytes including neutrophils

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14
Q

How do you treat sickle cell anaemia?

A

Folic acid

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15
Q

How do you treat sickle cell crises?

A

Hydroxycarbamide

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16
Q

Which increases the risk of haemolytic anaemia from G6PD anaemia?

A

Fava beans (broad-beans) = favism
Infections

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17
Q

Who are more at risk of G6PD deficiency?

A

Those from Africa, Asia and Mediterranean region and the Middle east
Males

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18
Q

Which drugs have a definite risk of haemolysis in most G6PD-deficient individuals?

A

Nitrofurantoin
Fluoroquinolones
Quinolones
Sulfonamides

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19
Q

Which drugs have a possible risk of haemolysis in most G6PD-deficient individuals?

A

Aspirin
Chloroquine
Quinine
Sulfonylureas

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20
Q

What is used as immunosuppressive treatment for aplastic anaemia?

A

IV horse antitymocyte globulin in combination with ciclosporin

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21
Q

What is used to prevent adverse effects associated with antithymocyte globulin treatment?

A

Prednisolone

Early reactions include:
- fever
- rash
- fluid retention
- rigors
- acute respiratory distress syndrome
- anaphylaxis
- serum sickness may occur 7-14 days later

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22
Q

How is idiopathic sideroblastic anaemia treated?

A

Pyridoxine

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23
Q

What is used to treat erythropoietins deficiency in chronic renal failure?

A

Epoetins (recombinant human erythropoietins

  • also used to shorten period of symptomatic anaemia in patients receiving cytotoxic chemotherapy
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24
Q

Which eythropoietin is licensed for preventing anaemia in pre-term neonates of low birth-weight

A

Epoetin beta

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25
What are the MHRA warnings associated with epoetins?
Recombinant human erythropoietins - very rare risk of severe cutaneous adverse reactions Erythropoietins - overcorrection of haemoglobin concentration in patients with chronic kidney disease may increase risk of death and serious cardiovascular events - haemoglobin concentrations between 10-12g/ 100ml should be maintained Erythropoietins - tumour progression and survival in patients with cancer
26
What are the side effects of epoetins?
Arthralgia Embolism and thrombosis Headache Hypertension Influenza like illness Skin reactions Stroke
27
What colour does hydroxocobalamin turn urine?
Reddish
28
How is immune thrombocytopenic purpura treated?
Corticosteroids - prednisolone
29
What are the symptoms of dehydration?
Thirst and reduced urine output Light-headed and fatigue Sunken eyes Dry skin Rapid breathing Low BP
30
How is severe dehydration treated?
IV sodium chloride, potassium and glucose
31
What enhances absorption of oral rehydration therapy?
Glucose and rice starch
32
How do you rehydrate in diabetes insipidus?
Slowly over 12 hours because you lose water without losing sodium which causes hypernatremic dehydration
33
What are the symptoms of hyponatraemia?
Drowsiness Muscle cramps Headache Confusion N/V Severe cases: coma/ seizure
34
What drugs can cause hyponatraemia?
Carbamazepine Antidepressants Desmopressin Diuretics
35
How do you treat mild to moderate hyponatraemia?
Oral sodium salts Chloride - if blood pH too alkaline Bicarbonate - if blood pH too acidic
36
How do you treat severe hyponatraemia?
IV saline If injection in peripheral vein - it has to be isotonic and have the same salt concentration as blood If higher saline concentration is required - use central vein Use glucose and sodium when theres a combined water and sodium depletion
37
What happens if you try to correct sodium imbalance too quickly?
risk of osmotic demyelination syndrome
38
When is Hartmann's solution used for hyponatraemia?
During or after surgery or in the initial management of the injured or wounded - reduces risk of hyperchloraemic acidosis
39
What are the symptoms of hypernatraemia?
Low urine output Thirst Muscle spasms Lethargy N/V Confusion Seizure and coma in severe cases
40
How is severe hypernatraemia treated?
IV glucose
41
Which drugs are known to cause hypernatraemia?
Oral contraceptives IV antibiotics Corticosteroids Lithium
42
What two electrolytes go hand in hand?
Potassium and sodium When sodium goes up, potassium goes down
43
What are the signs and symptoms of hyperkalaemia?
Muscle cramps Constipation Fatigue Arrhythmias Polyuria Polydipsia
44
What drugs are associated with hypokalaemia?
Loop and thiazide diuretics Insulin Theophylline Laxatives (overuse) B2 agonists Corticosteroids
45
What is the treatment for mild-moderate hypokalaemia?
Oral potassium salts - smaller doses required in renal insufficiency to reduce risk of hyperkalaemia
46
What is the treatment for severe hypokalaemia?
IV potassium chlroide - CAREFUL in overdose can be fatal
47
What is potassium depletion commonly associated with?
Chloride depletion and metabolic acidosis
48
What are the signs and symptoms of hyperkalaemia?
Muscle weakness Numbness Tingling Arrhythmias Cardiac arrest
49
Which drugs are associated with hyperkalaemia?
ACE/ARB BB Digoxin Potassium-sparing diuretics Heparins NSAIDs Drug causes- HAD BEANS: ➢ Heparin ➢ ACE-inhibitors/ARBs ➢ Digoxin ➢ Beta blockers ➢ Eplerenone ➢ Amiloride ➢ NSAIDs ➢ Spironolactone
50
How is acute severe hyperkalaemia treated in presence of ECG changes?
Potassium 6.5mmol/L or > or in the presence of ECG changes - IV calcium chloride OR - Calcium gluconate 10% These temporarily protect against myocardial excitability IV soluble insulin with 50ml of glucose 50% given over 5-10 minutes reduces serum-potassium concentration: can be repeated or infusion set-up Salbutamol by nebulisation or slow IV may be given to reduce plasma-potassium concentration --> caution in patients with CVD
51
How do you treat mild-moderate hyperkalaemia when there is no ECG changes?
Calcium resonium
52
How do you treat hypomagnesiaemia?
IV/IM magnesium sulfate
53
How do you treat hyperchloremia?
hyperchloremia can result in metabolic acidosis Treat using IV sodium bicarbonate If potassium levels low too - potassium bicarbonate
54
How do you treat hypercalcaemia?
Bisphosphonates or corticosteroids
55
How is hypercalciuria treated?
Increasing fluid and Bendroflumethiazide
56
What does Hyperparathyroidism result in?
Hypercalcaemia, hypophosphataemia and hypercalcuria
57
What are the symptoms of hypercalcaemia?
Thirst Increased urine output Constipation Fatigue Memory impairment Long-term effects - CVD - kidney stones - osteoporosis - fractures
58
What is the treatment for hyperparathyroidism?
1st line surgery 2nd line: cinacalcet increased risk of fractures - consider bisphosphonate BUT do not offer for chronic hypercalcaemia of primary hyperparathyroidism
59
What is used to treat magnesium toxicity?
Calcium gluconate injection
60
What is the MHRA warning for magnesium sulfate?
Risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy (administered for longer than 5-7 days)
61
Which vitamin is teratogenic?
Vitamin A
62
What is a sign of severe vitamin C deficiency?
Gingival bleeding
63
What is the contraindication or vitamin E?
Warfarin
64
What are the signs of vitamin A deficiency?
Ocular effects e.g. dry eyes, poor night vision, risk of infection
65
What are good sources of vitamin A?
Lives pates Fish liver oil Raw eggs Soft cheese
66
What are the signs of vitamin C deficiency?
Scurvy Gingival bleeding petechiae
67
When would you give an hydroxylated (activated) version of vitamin D?
In severe renal and hepatic impairment e.g. alfacalcidol, calcitriol
68
What are the signs of iron poisoning?
N/V Abdominal pain Diarrhoea Haematemesis Rectal bleeding Hypotension and hepatocellular necrosis can occur later
69
What is used to treat iron poisoning?
IV desferrioxamine mesilate
70
How do you treat hypercalcaemia of malignancy?
Calcitonin
71
What vitamins does orlistat impair?
Vitamins (fat-soluble vitamins); - A - D - K - E
72
What is used in Wernicke’s encephalopathy?
Vitamin B1 (thiamine)
73
Which vein should glucose be given via?
Central vein to avoid thrombosis
74
Why are Fructose and sorbitol given in parenteral nutrition?
avoid hyperosmolar hyperglycaemic acidosis
75
Why is phosphate given in parenteral nutrition?
allow phosphorylation of glucose
76
What ferritin level usually confirms a diagnosis of anaemia?
30 micrograms per litre
77
What levels of haemoglobin in men, women, children and pregnant women would be considered as anaemia?
In men aged over 15 years - Hb below 130 g/L In non-pregnant women aged over 15 years - Hb below 120 g/L In children aged 12–14 years of age - Hb below 120 g/L. Pregnant women: 1st trimester: 110g/L 2-3 trimester: 105g/L
78
What liver function test is raised when there is a liver blockage (blocked bile dutcs)?
ALP
79
What binds to acidic drugs?
Albumin
80
What electrolyte is found in dark chocolate, seeds and avocado?
Magnesium
81
What is the by-product of muscle breakdown?
Creatinine
82
Which vitamin, if given long-term, can cause peripheral neuropathy?
B6
83
What is a low neutrophil count?
Less than 1.5x10^9/L
84
How is severe acute hypocalcaemia treated?
IV calcium gluconate injection 10% - ECG monitoring (risk of arrythmias if given too rapidly) Calcium chloride injection is also available but it is more irritant - care should be taken to avoid extravasion Concurrent hypomagnesaemia should be corrected with magnesium sulfate
85
How is severe hypercalcaemia treated?
Rehydration using sodium chloride If persists - bisphosphonates and pamidronate disodium Corticosteroids sometimes given Calcitonin (Salmon) if associated with malignancy
86
How should hyperphosphataemia be treated?
Calcium acetate - phosphate binder 2nd line: sevelamer 3rd line: calcium carbonate
87
What vitamin is used to treat Wilson's disease?
Vitamin B6 - Pyridoxine

Pre Reg- Furkan (14 decks)

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