IPE tutorial 1

• What problems can be caused by taking iron supplements with some other medications (e.g. antacids)?


  absorption of iron and expected haematological response can be reduced by the concurrent use of antacids
• what advice is given when taking both antacids and iron supplements?

  separate the administration as much as possible (2 hours preferably) to avoid admixture in the gut
• aspirin is the causal agent for what percentage of adverse drug reactions (ADRs) ?


  18 %
• how does aspirin contribute to death?

  GI bleeds, perforated ulcers and intercranial haemorrhage
• how many yearly admissions were related to ADRs?

  1225
• what is the fatality rate in ADR cases?

  0.5 %
• what are the side effects of using aspirin as a suppository?

  GI side effects (icl. bloody vomit, blood in stool) as mechanisms of action are similar
• what are the advantages of using a suppository?

  allows administration of medication when the patient is vomiting, unable to tolerate oral medication, has a blockage that stops the movement of drugs through the digestive system, unable to swallow, seizures and less potential for some side effects (e.g. local irritation)
• what is a suppository?

  a solid dosage form for insertion into body orfices (usually rectum), where it melts, softens or dissolves and exerts local or systematic effects
• what is an enteric coated tablet?

  the tablet is resistant to the acid pH of the stomach and therefore dissolution is delayed until the tablet enters the alkaline environment of the intestine
• what is a soluble tablet?

  they dissolve in water prior to taking, thus eliminating the dissolution phase. it is supposed to reduce the risk of peptic ulceration, because it is not sitting on the lining of the stomach
• what is a soluble aspirin tablet useful for?

  it is useful for acute pain as it decreases the time onset of action
•  What is the major site of absorption in the GI tract for drugs that are taken by mouth?

  The small intestine and stomach
• what factors contribute to the GI bleed?

  aspirin, particularly at maximum dose, increases risk of GI bleed, as well as mefenamic acid (a NSAID)

  • the patient also had a history of antacid use which could have meant there was an underlying GI irritation or undiagnosed ulcer
• what is a NSAID?

  Nonsteroidal anti-inflammatory drug
• what is anaemia?

  anaemia is a deficiency of haemoglobin in the blood due to a lack of RBCs and/or their haemoglobin content
• what are the different types of anaemia?

  volume of haemoglobin in the blood: microcytic (too low), normocytic (normal) or macrocytic (too high)

  conc. of haemoglobin in RBCs: normochromic (normal colour) or hypochromic (too pale)
• what are the normal haemoglobin ranges for males and females?

  male : 13.5 - 18 g/dL

  female : 11.5 - 16 g/dL
• what are the normal RBC count for males and females?

  males : 4.5 - 6.5 x 10^12 /L

  females : 3.9 - 5.6 x 10^12 /L
• what are the normal haematocrit ratio (packed cell volume) for males and females?

  males : 40 - 54 %

  females : 37 - 47 %
• what are the normal ESR for males and females?

  males : 1 - 13 mm/hr

  females : 1 - 20 mm/hr
• what are the normal MCV value for males and females?

  76 - 96 fl
• what are the normal MCH for males and females?

  27 - 32 pg
• what are the normal MCHC for males and females?

  30 - 36 g/dl
• what is ESR in blood tests?

  Erythrocyte sedimentation rate
• what is the Mean Corpuscular Haemoglobin Concentration (MCHC)?

  it is a measure of the average concentration of haemoglobin in RBCs

  • measures the weight of haemoglobin and hence colour in average cells
• what is the Mean Corpuscular Haemoglobin (MCH)

  the average amount of haemoglobin per RBC in a blood sample

  haemoglobin conc. per unit volume / no. of RBCs per unit volume
• what is the Mean Corpuscular Volume (MCV)?

  measures the average size of RBCs

  MCV is elevated or decreased in accordance with average red cell size: low MCV indicates microcytic, normocytic or macrocytic (large size)

  Reference range is 80-96 fL/red blood cell in adult
• Calculate the Mean Corpuscular Volume (MCV)

  MCV = (PCV or HCT) x 10 / RBC x10^6