Chapter 9: Blood and Nutrition COPY Flashcards Preview

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Flashcards in Chapter 9: Blood and Nutrition COPY Deck (67)
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1
Q

What are the MHRA warnings associated with epoetins?

A
  • Risk of severe cutaneous adverse reactions including Stevens-Johnsons syndrome.
  • Overcorrection of haemoglobin concentration may increase the risk of death and serious cardiovascular events. CKD or chemotherapy patients should not receive this unless symptoms of anaemia are present
  • Unexplained excess mortality and increased risk of tumour progression in patients with anaemia associated with cancer who have been treated with erythropoietins
2
Q

What are the main side effects of epoetins?

A
  • Severe skin reactions and stop treatment and seek medical attention if they develop a rash (which often follow flu-like symptoms)
  • Hypertensive crisis with encepatholopathy and tonic clonic seizures
  • Pure red cell aplasia
3
Q

What are epoetins used for?

A

Symptomatic anaemia in CKD or chemotherapy patients

4
Q

The daily oral dose of elemental iron for iron-deficiency anaemia should be what?

A

100-200mg

5
Q

Are modified release iron preparations recommended in anaemias?

A

No - have no therapeutic advantage

6
Q

In what situations would you opt for IV iron over oral iron?

A

Reserved for use when oral therapy is unsuccessful because the patient cannot tolerate oral iron, or does not take it reliably, or if there is continuing blood loss, or in malabsorption

CKD patients on dialysis also require IV iron regularly

7
Q

What are the IV forms of iron?

A

Iron dextran
Iron sucrose
Ferric carboxymaltose
Iron isomaltoside

8
Q

Does IV iron work more quickly than oral iron?

A

Parenteral iron does not produce a faster haemoglobin response than oral iron provided that the oral iron preparation is taken reliably and is absorbed adequately.

Exception - patients with severe renal failure receiving haemodialysis

9
Q

IV iron does not work more quickly than oral iron except in what group of patients?

A

Patients with severe renal failure receiving haemodialysis

10
Q

What is the MHRA advice surrounding injectable iron?

A

Serious hypersensitivity reactions including anaphylaxis

Patients should be monitored for such signs for 30 minutes after administration

Not recommended 1st trimester of pregnancy and only in 2nd and 3rd if vital

11
Q

When should iron for iron deficiency anaemia be stopped?

A

3 months after haemoglobin is in the normal range

12
Q

Are iron tablets best absorbed with or without food?

A

Without food

However because of the GI side effects, they can be taken with food

13
Q

What are the main side effects of iron?

A

Constipation and diarrhoea
GI upset
Darkened stools

14
Q

Most megaloblastic anaemias result from a deficiency of what?

A

Either vitamin B12 or folate

It is important to establish which deficiency before treatment but in an emergency can give both

15
Q

What is pernicious anaemia?

A

An autoimmune gastritis causing malabsorption of vitamin B12

16
Q

What is the choice of therapy for vitamin B12 replacement?

A

Hydroxocobalamin - initiated with frequent IM injections and then every 3 months

(used to be cyanocobalamin however hydroxocobalamin lasts longer in the body)

17
Q

Why should undiagnosed megabloblastic anaemia not be treated with folic acid alone?

A

May precipitate neuropathy

If undiagnosed and needs to be given, always give vitamin B12 as well

18
Q

What can be the causes of folate-deficient megaloblastic anaemia?

A

Poor nutrition
Pregnancy
Antiepileptic drugs

19
Q

How do you treat folate-deficient megaloblastic anaemia and how long for?

A

Daily folic acid for 4 months

(Folic acid has few indications for long-term therapy since most causes of folate deficiency are self-limiting or will yield to a short course of treatment)

20
Q

Why should folic acid never be given alone in pernicious anaemia?

A

Can cause compression of spinal cord

21
Q

Haemochromatosis is associated with an overload of what?

A

Iron

22
Q

How do you manage haemochromatosis (result of iron overload)?

A

Venesection (removal of blood)

If this is contraindicated- long-term administration of the iron chelating compound desferrioxamine mesilate

23
Q

What drug inhibits platelet formation and is used for thrombocythaemia (when too many platelets are produced in the bone marrow)?

A

Anagrelide

24
Q

What is used in sickle cell anaemia to reduce the frequency of crises and need for blood transfusions?

A

Hydroxycarbamide

25
Q

How do you manage severe acute hyperkalaemia?

A
1st = Calcium gluconate 10% slow IV injection
2nd = Soluble insulin IV injection
3rd = Salbutamol nebulised or slow IV injection [unlicensed].

Drugs that exacerbate hyperkalaemia should be stopped as appropriate.

26
Q

What is classed as acute severe hyperkalaemia?

A

> 6.5 mmol/L or presence of ECG changes

27
Q

What is classed as hypokalaemia?

A

< 3.5 mmol/L

28
Q

How do you manage hypokalaemia?

A

Potassium chloride
Or
Potassium bicarbonate with potassium acid tartrate.

29
Q

Chronic hyponatraemia from inappropriate secretion of antiduretic hormone should ideally be managed by what?

A

Fluid restriction

30
Q

What is Hartmann’s solution?

A

Compound sodium lactate

31
Q

How is severe hypercalcaemia managed?

A

Dehydration should be corrected with IV NaCl
Drugs that promote hypercalcaemia e.g. thiazides and Vitamin D should be stopped

Pharmacological management includes bisphosphonates, corticosteroids, calcitonin

32
Q

When treating hypokalaemia, why shouldn’t you include glucose infusions?

A

That can cause a further decrease in plasma potassium concentrations

33
Q

What can be given for severe metabolic acidosis?

A

IV sodium bicarbonate

34
Q

What can be given for chronic acidotic states?

A

Oral sodium bicarbonate

35
Q

Compared to crystalloid solution, would a larger or smaller amount of colloid solution be required for fluid resuscitation?

A

Smaller amount would be required of colloid

36
Q

True or false:

In osteoporosis, a calcium intake which is double the recommended amount reduces the rate of bone loss.

A

True

37
Q

What is given in severe acute hypocalcaemia/hypocalcaemic tetany?

A

Slow IV calcium gluconate 10%

38
Q

Why should calcium gluconate IV be given slowly?

A

If given too rapidly, risk of arrhythmias

39
Q

What is cinacalcet used for?

A

Hyperparathyroidism and hypercalcaemia in parathyroid carcinoma

Reduces parathyroid hormone which leads to a decrease in serum calcium concentration

40
Q

Calcium carbonate is used for what two indications?

A

Calcium deficiency

Phosphate binding in renal failure

41
Q

Aluminium hydroxide can be used for the treatment of what in renal failure?

A

Hyperphosphataemia

42
Q

What is sevelamer used for?

A

Phosphate binder for CKD patients including those on dialysis

43
Q

How do you manage hypercalciuria?

A

Find the underlying reason

Increase fluid intake and give bendroflumethiazide

44
Q

What is Wilson’s disease?

A

Genetic disorder causing build up of copper in body tissues e.g. brain

45
Q

How do you manage Wilson’s Disease?

A

Zinc acetate as it prevents the absorption of copper

Chelating agents are given for the first 2-3 weeks as well as zinc as zinc has a slower onset of action

46
Q

Vitamin A deficiency is associated with what?

A

Occular defects

47
Q

Thiamine is what vitamin?

A

B1

48
Q

Riboflavin is what vitamin?

A

B2

49
Q

Severe Vitamin B deficiency can lead to what?

A

Wernicke’s encephalopathy and Korsakoff’s psychosis

50
Q

Pyridoxine is what vitamin?

A

B6

51
Q

Pyridoxine may be needed in patients taking what drugs?

A

Isoniazid therapy

or penicillamine treatment in Wilson’s disease

52
Q

Penicillamine is what kind of drug?

A

Chelating agent used for e.g. Wilson’s Disease, RA

53
Q

Vitamin C deficiency can result in what condition?

A

Scurvy

54
Q

What are the fat soluble vitamins?

A

ADEK

55
Q

What are the water soluble vitamins?

A

B and C

56
Q

Vitamin A is otherwise known as?

A

Retinol

57
Q

Vitamin D deficiency can result in what condition?

A

Rickets

58
Q

In renal patients, why is alfacalcidol and calcitrol more appropriate for Vitamin D deficiency treatment over other Vitamin D replacement?

A

Vitamin D requires hydroxylation by the kidney to its active form, therefore the hydroxylated derivatives alfacalcidol or calcitriol should be prescribed if patients with severe renal impairment require vitamin D

59
Q

If Vitamin D replacement is needed in severe renal impairment, what are the most appropriate to prescribe?

A

Alfacalcidol

Calcitriol

60
Q

What is the water soluble Vitamin K preparation called?

A

Menadiol

61
Q

What is the MHRA advice surrounding IV thiamine?

A

Risk of serious allergic reaction
Should be given over 30 mins
Facilities to treat anaphylaxis should be close by

62
Q

Calcichew D3 is used for what?

A

Prevention and treatment of Vitamin D and calcium deficiency

63
Q

What is cholecalciferol used for?

A

Prevention and treatment of Vitamin D deficiency

64
Q

When would the higher dose of 5mg folic acid be recommended in pregnancy?

A
High risk of neural tube defects:
Epilepsy
Diabetes
Sickle cell  
Previous infant with neural tube defect e.g. spina bifida

Otherwise the dose would be 400mcg folic acid daily

65
Q

What is a Coombs test?

A

Test for autoimmune hemolytic anaemia

Methyldopa can cause a positive test result

66
Q

What is the treatment regimen for hydroxocobalamin in the treatment of pernicious anaemia (without neurological involvement)?

What route?

A

IM injection

Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months.

If neurological involvement- this would be 1mg on alternate days until improvement

67
Q

Iron absorption is impaired if having what foods/drinks?

A

Tea
Milk
Eggs

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