Blood/nutrition

Question 1

What common drugs have risk of haemolysis in G6PD deficient patients?

Answer 1

Nitrofurantoin, quinolones, rasburicase, sulfonamides

Possible - aspirin (usually not under 1g), chloroquine, quinine, sulfonylureas.

Question 2

What type of anaemia are corticosteroids used?

Answer 2

Hypoplastic or hemolytic

Question 3

What is used in aplastic anaemia?

Answer 3

Antilymphocyte immunoglobulin

Question 4

What anaemias is pyridoxine indicated?

Answer 4

Hypoplastic, hemolytic and sideroblastic

Question 5

What monitoring is needed with epoetins?

Answer 5

Hypertensive crisis and pure red cell aplasia have occurred - consider testing ethropoetin antibodies with latter.
Monitor blood pressure, retuculocyte counts, haemoglobin and electrolytes. Monitor for deficiencies.

Question 6

What advice should be given with oral Iron preparations?

Answer 6

Better absorbed on an empty stomach but taking after food can reduce gastro side effects. May discolour stools.

Question 7

What are megaloblastic anaemias usually a result of?

Answer 7

Lack of vitamin b12 or folate.

Question 8

What can occur if folic acid is given alone in undiagnosed megaloblastic anaemia?

Answer 8

Neuropathy precipitation. Administer with b12 concurrently

Question 9

Is hydroxocobalamin or cyanocobalamin more suitable for prescribing?

Answer 9

Hydroxocobalamin

Question 10

What should be given in iron overload?

Answer 10

Dexferrioxamine. Can add ascorbic acid if no cardiac dysfunction 1 month after.

Question 11

What treatment options are there for idiopathic thrombocytopenic purpura?

Answer 11

Usually self limiting in children
Corticosteroids
Immunoglobulins to raise platelet counts rapidly
Antineoplastic drugs
Tranexamic acid to reduce severity of haemorrhage
Splenectomy

Question 12

Who is at risk of essential thrombocytopenia?

Answer 12

Over 60yo. Platelets greater than 1000 x 10^9/L. History of thrombohaemorrhagic events

Question 13

When is compensation for potassium loss especially necessary?

Answer 13

Digoxin or antiarrhythmics
Secondary hyperaldosterism (cirrhosis, Nephrotic syndrome, severe heart failure)
Losses in faeces due to diarrhoea or laxatives

Question 14

When are smaller doses of potassium given?

Answer 14

Renal insufficiency which is common in elderly

Question 15

What else can be given instead of potassium salts with losses, and why might other options be preferred?

Answer 15

Often poor compliance due to nausea and vomiting so potassium sparing diuretics preferred.

Question 16

What is given if potassium levels are above 6.5mmol/l?

Answer 16

Calcium gluconate 10%

Soluble insulin or salbutamol

Question 17

When should rehydration occur slower than the usual aim of 3-4hours?

Answer 17

If hypernatreamic

Question 18

When should sodium products be cautioned?

Answer 18

Salt restricted diet - C/I with bicarbonate
Dilutional Hyponatreamia
Oedema
Hypertension

Question 19

What calcium intake should be recommended in osteoporosis?

Answer 19

Double normal recommendations

Question 20

When is calcium deficiency common?

Answer 20

Childhood, pregnancy, lactation, elderly (increased demands or poor absorption)

Question 21

Which drugs promote Hypercalcaemia?

Answer 21

Thiazides, vitamin D compounds

Question 22

What drugs can be given in Hypercalcaemia?

Answer 22

Bisphosphonate, corticosteroids, calcitonin

Question 23

What condition may be causing Hypercalcaemia?

Answer 23

Hyperparathyroidism

Question 24

What is given in idiopathic hypercalciuria

Answer 24

Increased fluid and bendroflumethiazide

Question 25

What conditions may worsen upon hypocalcaemia?

Answer 25

QT interval prolongation, seizures, congestive heart failure.

Question 26

What are the symptoms of hypermagneseamia?

Answer 26

Nausea, vomiting, flushing, thirst, hypotension, drowsiness, loss of tendon reflex, slurred speach, arrhythmia.

Question 27

What drug groups are unsafe with acute porphyria?

Answer 27

Anabolic steroids, antidepressants, barbiturates, hormonal contraceptives, HRT, triazole&imidazole antifungals, non nucleoside reverse transcriptase inhibitors, progestogens, protease inhibitors, sulfonamides, sulfonylureas, taxanes.

Question 28

What common drugs are unsafe in acute porphyria?

Answer 28

Alcohol, amiodarone, carbemazepine, clindamycin, diltiazem, erythromycin, hydralazine, Indapamide, nitrazepam, nitrofurantoin, phenytoin, pivmecillinam, pizotifen, rifampicin, rispeidone, Spironlolactone, tamoxifen, trimethoprim, valproate and Verapamil.

Question 29

What should be determined before treatment with Eliglustat?

Answer 29

CYP2D6 metabolised status

Question 30

Enzymes are used in different blood disorders. What can occur with these preparations?

Answer 30

Infusion related reactions

Question 31

A patient experiences gastric irritation when taking zinc acetate. How can this be reduced?

Answer 31

Take first dose mid morning or with protein.

Question 32

Most vitamins are given daily in TPN, which aren't and when are they given?

Answer 32

Hydroxocobalamin IM single dose unless nutrition continues for many months. Folic acid 15mg once or twice weekly.

Question 33

What should be done if high glucose amounts are given by TPN?

Answer 33

If over 180g in a day, monitor blood glucose. Insulin may be required.

Question 34

What sweetener effects the control of phenylketonuria?

Answer 34

Aspartame.

Question 35

What results from a deficiency in vitamin a?

Answer 35

Ocular defects and increase susceptibility to infections

Question 36

When is vitamin a deficiency most common?

Answer 36

Preterm neonates, liver disease (as less absorption of fat soluble), biliary obstruction

Question 37

When may vitamin b6 deficiency occur?

Answer 37

Isoniazid or penicillamine treatment

Question 38

What vitamin may be given in chronic alcoholism?

Answer 38

B. Pabrinex and thiamine.

Question 39

What extra conditions in children can be treated with vitamin B preparations?

Answer 39

Mitochondrial disorders, maple syrup urine disease (thiamine), congenital lactic acidosis.

Question 40

What are vitamin c supplements used for?

Answer 40

Scurrvy Increase excretion of iron Metabolic/mitochondrial disorders Not proven for colds or wound healing.

Question 41

What are the symptoms of vitamin D overdose?

Answer 41

Anorexia, nausea, vomiting, diarrhoea, constipation, sweating, headache, thirst, raised calcium and phosphate in urine.

Question 42

What are the risk factors for neural tube defects?

Answer 42

Maternal folate/b12 deficiency, history of infant with defects, smoking, diabetes, obesity, antiepileptics. Also sickle cell.