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Pradeepa's notes > Blood + nutrition > Flashcards

Blood + nutrition Flashcards

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
Q

normal range of phosphate

A

0.87-1.45mmol/l

26
Q

normal range of potassium

A

3.5-5.4mmol/l

27
Q

normal range of sodium

A

133-146mmol/l

28
Q

signs + symptoms of hypokalaemia

A

muscle cramps
rhabdomyolysis
fatigue
palpitation
arrythmias

29
Q

signs + symptoms of hyperkalaemia

A

fatigue
numbness
nausea
SoB
chest pain
palpitations

30
Q

signs + symptoms of hyponatraemia

A

nausea
headache
confusion
fatigue
irritability
seizures

31
Q

signs + symptoms of hypernatraemia

A

thirst
fatigue
confusion

32
Q

signs + symptoms of hypocalcaemia

A

muscle cramps
confusion
depression
forgetful

33
Q

signs + symptoms of hypercalcaemia

A

nausea
lethargy
muscle cramp
confusion
arrythmia

34
Q

drugs that cause hypokalaemia

A

-aminophylline / theophylline
- beta agonists
-corticosteroids
-diuretics (loop/thiazide)
-erythromycin/clarith
-insulin

  • hyperkala - predisposes pt taking digoxin to toxicity
35
Q

drugs that cause hyperkalaemia

A

-trimethoprim
-heparins
-ACEi/ARBs
-NSAIDs
-K-S diuretics
-beta blockers

-imbalance = cardiac s/e = arrythmia

36
Q

hypokalaemia tx + caution

A

-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
Q

hyperkalaemia tx

A

-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
Q

drugs that cause hyponatraemia

A

-carbamazepine
-diuretics
-desmopressin/ vasopressin
- SSRI
- mild to moderate;oral supplements NaCl or sodium biocarbonate

39
Q

drugs that cause hypernatraemia

A

-sodium biocarbonate/chloride
-corticosteroids
-effervescent formulations
-osteogens/androgens
-

40
Q

calcium

A

-if dietary Ca intake = deficient -> supplements
-osteoporosis - double so rate of bone less reduction
-oral supplement of Ca given = vit D
-

41
Q

severe hypocalcaemia/hypercalcaemic tetany tx

A

-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
Q

hypercalcaemia severe tx

A

-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
Q

hypocalcaemia tx

A

-inc fluid intake + GV bendroflumethazide
-dec dietary CA+ intake byt x severe rescrition

44
Q

hyperparathyroidism

A

-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
Q

hyperparathyroidism tx

A

-cinacalcet (if surgery x successful)
-vit d supplement
-bisphosphonates dec bone fractures

46
Q

magnesium

A

-essential in enzyme systems, energy generation = stored skeleton - excreted by kidneys therefore retained in renal failure - hypermagn

47
Q

what does hypermagnesaemia cause? Mg toxicity tx?

A

-causes muscle weakness + arrythmias
-Ca+ gluconate in = mg toxicity

48
Q

hypomagnesaemia tx

A

-symptomatic IV/IM mg sulfate (im=painful)
-mild - oral mg

49
Q

hypophosphatemia pt = alcohol dependence or severe DKA tx

A

-oral phosphate supplements

50
Q

hyperphosphatemia

A

-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
Q

metabolic disorders acute prophylaxis

A

-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
Q

which drugs is IV haem arginate administrated in moderate-severe acute porphyria crisis

A

amiodarone, carbamazepine, chloramphenicol, clindamycin, diltiazem, erythromycin, indapamide, isoniazid, mefenamic acid, methyldopa, nitrofurantoin, phenytoin, rifampicin, risperidone, spironolactone, tamoxifen, topiramate, trimethoprim, valproate, verapamil

53
Q

IV nutrition

A

-given when adequate = x possible
-infused through central venous catheter or peripheral vein

54
Q

what are the two methods if IV nutrition

A

-supplemental parental nutrition (additional to ordinary feed)
-total parental nutrition (TPN) sole source of nutrition

55
Q

what does IV nutrition contain

A

-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
Q

vitamin a

A

-retinol
-deficiency - ocular defects = high risk of infections
-avoid in pregn tetratogenic
- cheese, eggs, fish, milk, yogurt, liver porducts = pate

57
Q

vitamin d

A

-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
Q

vitamin e

A

-tocopherol
-deficiency = neuromuscular abnormalities
-plant oils, nuts, seeds, wheatgerm

59
Q

vitamin k

A

-phytomenadione
-blood clotting factors reversal agents for warfarin
-menadiol water soluble derivate given orally - malabsorption
-greeny leaf vegs, veg oil, cereal grains

60
Q

vitamin c

A

-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
Q

vitamin b

A

-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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