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Pradeepa's notes > Blood + nutrition > Flashcards

Blood + nutrition Flashcards

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1
Q

sickle cell anaemia

A

-deformed, less flexible RBC
-acute complication; restrict blood supply to organs; hospitalisation - fluid replacement, andlgenia, trat any infections. complications-anaemia, leg ulcers, renal failure, infections = more likely
-if haemolytic anaemia = more folate (folic acid supplement)
-hydroxycarbamide lower freq of painful crises + lower transfusion requirments

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2
Q

G6PD deficiency

A

-glucose-6phosphate dehydrogenase
-more common in africa + asia
-more common in males
-susceptible to developing acute haemloytic anemia

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3
Q

drugs with DEFINITE risk of haemolysis

A

dapasone, sulfones, fluoroquinolones, nitrofurantoin, quinolones

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4
Q

drugs with POSSIBLE risk of haemolysis

A

aspirin, chloroquinine, menadione, quinine, sulfonylureas

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5
Q

iron deficiency

A

-must show sings of iron deficiency before tx
-exclude serious underlying causes; gastric erosion, GI cancer

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6
Q

prohylaxis with iron

A

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

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7
Q

signs and symptoms of iron deficiency

A

-tiredness
-SoB
-palpitations
-pale skin

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8
Q

different types of iron

A

ferrous fumarate, gluconate, sulfate, dried sulfate

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9
Q

daily elemental dose of iron

A

100-200mg
(if MR = low absorption)
-take after food to lower S/E

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10
Q

s/e of iron

A

-constipation
-diarrhoea
-black tarry stools

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11
Q

iron extra

A

-take before food for better absorption
-take with vit C to aid absorption
-when haemoglobin range = reached continued for 3MT
-toxicity tx = deferoxamine

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12
Q

parental iron types

A

-iron dextran
-iron sucrose
-ferric carboxymaltose
-ferric derisomaltose

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13
Q

when to use parental iorn

A

-oral therapy x work
-chemotherapy induced anaemia
-chronic renal failure - receiving haemodialysis

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14
Q

parental iron MHRA warning

A

-serious hypersensitivity reactions with IV iron
-appropriately trained staff + resuscitation = available
-monitor for hypersens 30mins after admin.

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15
Q

megaloblastic anaemia

A

-can be due to vit B12 or folate deficiency - determine cause 1st

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16
Q

megaloblastic anaemia malabsorption of vit B12 tx

A

-give hydroxocabalamin (vit b12) at intervals up to 3MT
-tx initiated frequent IM inj to replenish stores then maintenance

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17
Q

causes of megaloblastic anaemia folate deficiency + tx

A

-due to poor nutrition, pregnancy, antiepiletic drugs
-daily folic + supplements 4MT

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18
Q

megaloblastic anaemia emergencies

A

-admin both while waiting for plasma assay results
-x give folic acid alone if undiagnosed = neuropathy

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19
Q

folic acid in pregn

A

-two doses
-regular pregn = 400mcg OD from before conception till WK12 of pregnancy
-risk of NTDs - 5mg OD from before coception till WK12 pregn

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20
Q

folic acid risk factors

A

-smoking
-sickle cell anaemia
-diabetes
-obesity
-use of antieplieptic/anti-malarial drugs

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21
Q

neutropenia - high risk of?

A

-low neutrophil count (<1.5)
-high risk of infections/sepsis esp chemotherpay

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22
Q

neutropenia tx

A

-recombinant human granulocyte colony stimulating factior (MG-CSF)
->filagrastim, lenograstim, lipefilgrastim
->stimulates production redcues duration of chemo induced neutropenia - dec incidence of febrile neutropenia

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23
Q

normal range of calcium

A

2.20-2.60mmol/l

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24
Q

normal range of magnesisum

A

0.6-1.00mmol/l

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25
normal range of phosphate
0.87-1.45mmol/l
26
normal range of potassium
3.5-5.4mmol/l
27
normal range of sodium
133-146mmol/l
28
signs + symptoms of hypokalaemia
muscle cramps rhabdomyolysis fatigue palpitation arrythmias
29
signs + symptoms of hyperkalaemia
fatigue numbness nausea SoB chest pain palpitations
30
signs + symptoms of hyponatraemia
nausea headache confusion fatigue irritability seizures
31
signs + symptoms of hypernatraemia
thirst fatigue confusion
32
signs + symptoms of hypocalcaemia
muscle cramps confusion depression forgetful
33
signs + symptoms of hypercalcaemia
nausea lethargy muscle cramp confusion arrythmia
34
drugs that cause hypokalaemia
-aminophylline / theophylline - beta agonists -corticosteroids -diuretics (loop/thiazide) -erythromycin/clarith -insulin - hyperkala - predisposes pt taking digoxin to toxicity
35
drugs that cause hyperkalaemia
-trimethoprim -heparins -ACEi/ARBs -NSAIDs -K-S diuretics -beta blockers -imbalance = cardiac s/e = arrythmia
36
hypokalaemia tx + caution
-mild-moderate = oral replacement therapy - sando-k tabs -severe=IV KCL in NaCl -potassium replaced caution in pt = renal impairment risk of hyperkal secondary to impaired k+ secretion
37
hyperkalaemia tx
-mild to moderate ->ion exhange resin - remove excess k+ -acute severe (>6.5) ->urgent tx ->IV CaCL 10% calcium gluconate 10% ->IV soluble insulin 5-10 units with 50ml glucose given over 5-15 mins ->salbutamol (nebulisation/slow IV in) ->drugs exacerbating hyperkalaemia = review + stop
38
drugs that cause hyponatraemia
-carbamazepine -diuretics -desmopressin/ vasopressin - SSRI - mild to moderate;oral supplements NaCl or sodium biocarbonate
39
drugs that cause hypernatraemia
-sodium biocarbonate/chloride -corticosteroids -effervescent formulations -osteogens/androgens -
40
calcium
-if dietary Ca intake = deficient -> supplements -osteoporosis - double so rate of bone less reduction -oral supplement of Ca given = vit D -
41
severe hypocalcaemia/hypercalcaemic tetany tx
-initial slow IV ca+ gluconate 10% with plasma cat+ + ECG monitoring arrythmia if given rapidly -repeated PRN or follow with continuous IV infusion to prevent recurrence
42
hypercalcaemia severe tx
-severe -correct dehydration = IV NaCl 0.9% -x drugs cause hypercal _ restrict dietary Ca+ -bisphosphonates + pamidronate disodium used -corticosteroids used if hypercal due to sacoldoris or vit D toxicity -calcitonin used if assoc with maligancy
43
hypocalcaemia tx
-inc fluid intake + GV bendroflumethazide -dec dietary CA+ intake byt x severe rescrition
44
hyperparathyroidism
-excessive parathyroid hormone - hypercalc, hypophosphatemia, hypercalcinia, -thirst polyurea, constipation, fatigue, memory, impairment, CVD kidney stones + osteoporosis -affect twice as many women than men 50-60yr -parathyroidectomy surgery =1st line -assess CVD risk + fracture risk
45
hyperparathyroidism tx
-cinacalcet (if surgery x successful) -vit d supplement -bisphosphonates dec bone fractures
46
magnesium
-essential in enzyme systems, energy generation = stored skeleton - excreted by kidneys therefore retained in renal failure - hypermagn
47
what does hypermagnesaemia cause? Mg toxicity tx?
-causes muscle weakness + arrythmias -Ca+ gluconate in = mg toxicity
48
hypomagnesaemia tx
-symptomatic IV/IM mg sulfate (im=painful) -mild - oral mg
49
hypophosphatemia pt = alcohol dependence or severe DKA tx
-oral phosphate supplements
50
hyperphosphatemia
-phosphate binding agents (Ca+ or non-Ca+ based preparations) -pt = CKD 4/5 = manage diet + dialysis before starting agents -1st = calcium acetate -2nd = sevelamar -3rd = caco4 or sucrofemic oxhydroxide
51
metabolic disorders acute prophylaxis
-hereditary disorder of haem biosynthesis 1 in 75000 -certain drugs can induce acute porphyric crises -> no alternate = drug tx for serious/life threatening conditions x withheld
52
which drugs is IV haem arginate administrated in moderate-severe acute porphyria crisis
amiodarone, carbamazepine, chloramphenicol, clindamycin, diltiazem, erythromycin, indapamide, isoniazid, mefenamic acid, methyldopa, nitrofurantoin, phenytoin, rifampicin, risperidone, spironolactone, tamoxifen, topiramate, trimethoprim, valproate, verapamil
53
IV nutrition
-given when adequate = x possible -infused through central venous catheter or peripheral vein
54
what are the two methods if IV nutrition
-supplemental parental nutrition (additional to ordinary feed) -total parental nutrition (TPN) sole source of nutrition
55
what does IV nutrition contain
-protein given = synthetic L-amino acids (source of energy) -preferred carb = glucose (infused through central venous catheter to avoid thrombosis -phosphate for phosphorylation of glucose + preventing hypophosphatemia -fructose + sorbitol = prevents hyperosmolar hyperglycaemic non-ketoic acidosis -fat emulsions icn energy to fluid vol ratio
56
vitamin a
-retinol -deficiency - ocular defects = high risk of infections -avoid in pregn tetratogenic - cheese, eggs, fish, milk, yogurt, liver porducts = pate
57
vitamin d
-ergocalciferol D2, colecalciferol D3, alfacalcidol, calcitriol -deficiency = rickets -occurs in less sunlight + diet intake -normal dose = 10mcg - 400IU -oily fish, red meat, liver, egg yolk, fortified foods - cereal
58
vitamin e
-tocopherol -deficiency = neuromuscular abnormalities -plant oils, nuts, seeds, wheatgerm
59
vitamin k
-phytomenadione -blood clotting factors reversal agents for warfarin -menadiol water soluble derivate given orally - malabsorption -greeny leaf vegs, veg oil, cereal grains
60
vitamin c
-ascorbic acid -def leads to scurvy -helps in wound healing, maintains healthy skin, blood vessels, bones + cartilage -orange, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
61
vitamin b
-B1 (thiamine) ->wernicke's encephalopathy -B2 (riboflavin) ->keeps skin, eyes, nervous system healthy -B6 (pyrodixine) ->tx peripheral neuropathy assoc isoniazid -B12 (hydrocabalamin) -> tx megablastic anaemia ->found = meats, cereal, veg

Pradeepa's notes (12 decks)

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