Drugs and the Endocrine System

Question 0

Thyroid disease, reproductive steroids, corticostercoids, pituitary hormones, calcium metabolism, osteoporosis and insulin are all related to which system?

Answer 0

The endocrine system

Question 1

Hormones have widespread and diverse effects. What implications does this have for the management of endocrine disorders?

Answer 1

They are difficult to treat

Question 2

1 in 13 people have issues with me. I can be hyper or hypo and I am related to T3 and T4. What am I?

Answer 2

Thyroid disease

Question 3

The CNS, CV system and metabolic rate are all affected by which hormone disease?

Answer 3

Thyroid disease

Question 4

What disease is linked to slow speak, lethargy, hyporeflexia (CNS), hypotension, bradycardia, anemia (CV), weight gain, low body temperature and intolerance to cold?

Answer 4

HYPOthyroidism

Question 5

What is goitre?

Answer 5

A massive, noticeable thyroid gland

Question 6

Do people with overactive or underactive thyroid get goitre?

Answer 6

Both.
In underactive this is because a lack of iodine leads to insufficient T3/T4, negative feedback is disrupted so it becomes bigger to try and compensate.

In overactive, antibodies are produced that activate TSH, which increases the size and function of the gland

Question 7

What is Graves’ disease?

Answer 7

The most common form of hyperthyroidism.

Where antibodies stimulate thyroid cells.

Question 8

What drugs can we use to treat hyperthyroidism?

Answer 8

Carbimazole and propylthiouracil

Question 9

Before medical treatment, what can a patient try and do to regulate hyperthyroid issues?

Answer 9

Limit iodine (salt) intake - as this is used to produce thyroxine.

Question 10

Which drug is taken to inhibit the synthesis of thyroxine, is absorbed at the gut to be converted at the liver to active form, is excreted in the urine and has a short 1/2 life?

Answer 10

Carbimazole

Question 11

If a pregnant woman is taking Carbimazole, what are the potential side effects?

Answer 11

It could cross the placenta/into breast milk causing neonatal hypothyroidism

Question 12

What are possible side effects of carbimazole?

Answer 12

Nausea, allergic rash, agranulocytosis, insomnia

Question 13

As part of what type of treatment/method is carbimazole given?

Answer 13

Block and Replace.
Lots is taken at first, then the dosage is reduced so some thyroxine can be produced - but lack of thyroxine is replaced with synthetic thyroxine

Question 14

How long does it take carbimazole to become effective?

Answer 14

4-6 weeks. It cannot get rid of thyroxine that has already been produced, it can only stop new thyroxine being produced.

Question 15

For what condition is levothyroxine or triiodothyronine prescribed? And what are they substituting?

Answer 15

HYPOthyroidism
LevO = T4
TriiO = T3 (for more severe)

Question 16

Lithium (depression) and amiodarone (anti arrhythmic) drugs can cause what type of hormone disease?

Answer 16

Hypothyroidism

Question 17

When would we inject radioactive iodine into a patient?

Answer 17

If someone is severely hyperthyroid. The iodine will collect in the thyroid gland and the radioactive isotope will kill off tissue. This is the last step before resorting to surgery.

Question 18

What does carbimazole target?

Answer 18

The thyroid gland. It stops it producing thyroxine (T4).

Question 19

What is levothryoxine used to replace?

Answer 19

T4, thyroxine

Question 20

What is triiodothyronine used to replace?

Answer 20

T3. This would be used in cases where there has been a dramatic loss of thyroxine, as T3 gives a much quicker response than T4.

Question 21

What can a patient take to reduce the secondary EFFECTS of too much thyroxin?

Answer 21

Beta-blockers. They dampen the sympathetic nervous system.

Question 22

Which hormone promotes Calcium reabsorption from the kidney?

Answer 22

Parathyroid hormone

Question 23

What does calcitonin inhibit?

Answer 23

Osteoclasts and reabsorption from the kidney, resulting in decreased calcium plasma levels
BECAUSE less calcium comes back out of the kidney

tonin = tone = decrease

Question 24

What does calcitriol (vitamin D3) do?

Answer 24

It increases calcium levels in the plasma by increasing bone mobilisation and reabsorption from the gut

Question 25

What disease is caused by inadequate calcium intake, deficiency in parathyroid hormone/lack of vitamin D and renal problems?

Answer 25

HYPOcalcaemia

Question 26

If someone had neuromuscular problems, muscle cramps and later mental deficiency, fits or cataracts, what might they have?

Answer 26

HYPOcalcaemia

Question 27

When would we give someone Ergocalciferol (vitamin D) and which groups of patients can we not give it to?

Answer 27

People with hypocalcaemia. We cannot give this drug to people with compromised kidney function however. (more complicated name - can't give to compromised patients)

Question 28

Who can we give calcium glucoronate (as an I.V. infusion) or calcitriol?

Answer 28

Anyone with hypocalcaemia

Question 29

What disease can cause problems with kidney stones/renal failure and muscle problems/cardiac arrest, that needs urgent attention?

Answer 29

HYPERcalcaemia

Question 30

What drugs can we use to treat hypercalcaemia?

Answer 30

Calcitonin and Biphosphonates Think about how calcitonin inhibits calcium reabsorption from the kidney, so it will reduce levels in the blood

Question 31

What drug is expensive (from salmon) and has a very short 1/2 life, and becomes ineffective with continued use?

Answer 31

Calcitonin

Question 32

How can calcitonin be administered?

Answer 32

By nasal spray or subcutaneous/IM injection

Question 33

What is alendronic acid an example of? It is used to slow the rate of bone growth and turnover to prevent calcium loss from bones. It is used to treat hypercalcaemia/osteoporosis.

Answer 33

A biphosphonate.

Question 34

What hypercalcaemic drugs have side effects of abdominal pain, GI disturbances such as oesophageal problems and will not be absorbed properly if the patient eats within half an hour of consumption?

Answer 34

Biphosphonates

Question 35

Steroids are artificial what?

Answer 35

Hormones

Question 36

What hormones do corticosteroids emulate?

Answer 36

Hormones from the cortex of the adrenal gland

Question 37

What are mineralocorticoids and glucocorticoids examples of?

Answer 37

Hormones

Question 38

What do mineralocorticoids affect?

Answer 38

Electrolyte balance

Question 39

What does fludrocortisone treat?

Answer 39

Adrenal insufficiency - lack of mineralocorticoid production

Question 40

What type of hormone increases glucose mobilisation and resistance to stress, and decreases white blood cells?

Answer 40

Glucocorticoids

Question 41

What hormones beginning with M and G can be given synthetically to people with endocrine dysfunction or autoimmune disorders?

Answer 41

Mineralocorticoids and Glucocorticoids

Question 42

If a person has low blood pressure and low glucose, what corticoid are they likely to be low on?

Answer 42

Glucocorticoid

Question 43

What synthetic hormone or steroid is used to treat Addisons' disease/crisis-adrenal insufficiencey (as a low oral dose), or to reduce inflammation during an acute allergy (as a higher topical dose e.g. eczema)

Answer 43

Hydrocortisone

Question 44

Where is hydrocortisone metabolised after oral administration?

Answer 44

The liver

Question 45

When administering hydrocortisone for inflammation you start at a high dose. At which point should this be reduced?

Answer 45

When the inflammation is supressed

Question 46

What glucocorticoid is used for acute asthma attacks that is given orally, is 5x more potent than hydrocortisone and has less mineralcorticoid activity? P

Answer 46

Prednisolone

Question 47

What glucocorticoid is used to prevent rejection in transplant patients that is given parenterally?

Answer 47

Methylprednisolone I'd want meth if I had to have a transplant op

Question 48

What glucocorticoid is administered orally or parenterally, has high anti-inflammatory action and is used to treat cerebral oedema? It is 20x more potent than hydrocortisone.

Answer 48

Dexamethasone Dexter - brainy - cerebral

Question 49

What glucocorticoid is used to treat asthma in a brown inhaler?

Answer 49

Beclametasone

Question 50

What route of administration minimises systemic adverse effects of steroids/glucocorticoids?

Answer 50

Topical

Question 51

If hydrocortisone is given in a high dose, what effect will it have other than glucocorticoid effects?

Answer 51

Mineralcorticoid

Question 52

What specific drug types can result in a buffalo hump, hypertension, muscle wasting, osteoporosis, moon face, increased abdominal fat, thinning of the skin, cushioned features and poor wound healing?

Answer 52

ORAL glucocorticoids

Question 53

What specific drug types can cause local immunosuppression resulting in oral thrush/candida albicans, and have local effects on the vocal chords causing dysphonia/hoarseness?

Answer 53

INHALED glucocorticosteroids

Question 54

What can reduce unwanted side-effects of inhaled glucocorticoids?

Answer 54

Using a spacer device or rinsing mouth after inhaler use

Question 55

When withdrawing gluco/mineralcorticoid treatment what is important?

Answer 55

It must be gradual

Question 56

What happens if the withdrawal of G or M steroids is not gradual?

Answer 56

It may disrupt the feedback mechanism of ACTH/cortisol sending a patient into an Addisonian crisis = low BP, low glucose, high pottasium and low sodium

Question 57

What types of steroid are oral contraceptives and hormone replacement therapy (treats osteoporosis)?

Answer 57

Reproductive Steroids

Question 58

What are oestriol, oestradiol and oesterone?

Answer 58

Synthetic oestrogen

Question 59

What is progestin?

Answer 59

Synthetic progesterone

Question 60

What type of oral contraceptive inhibits ovulation?

Answer 60

The combined pill. It has artificial oestrogen and progesterone, which sends signals to the AP, inhibiting FSH and LH therefore inhibiting ovulation

Question 61

What can be prescribed for dysmenorrhoea, is absorbed orally, metabolised by the liver and excreted in bile?

Answer 61

Combined Pill

Question 62

What can be used in a high dose, up to 72 hours as a morning after pill?

Answer 62

Combined Pill

Question 63

What steroid drug can cause MI and strokes (particularly in smokers), hypertension, cervical/breast cancer, headaches and venous thromboembolytic disease?

Answer 63

Combined pill VTD is due to high oestrogen/progesterone = increased clotting capacity

Question 64

How does the mini pill work? | What hormone does it use?

Answer 64

It uses progesterone and is taken every day. | This pill alters endometrium and cervical mucus to prevent implantation and sometimes inhibits ovulation

Question 65

What contraceptive is given by injection every 3 months?

Answer 65

Medroxyprogesterone

Question 66

What are the side effects of the mini pill and medroxyprogesterone?

Answer 66

Nausea, vomiting and breast discomfort

Question 67

What can the combined and mini pill interact with that may increase drug metabolism, thereby reducing its effectiveness?

Answer 67

Hepatic enzyme inducers and antibiotics

Question 68

What drug is used to treat a decrease in oestrogen levels in post menopausal women, who have increased LH and FSH and potentially osteoporosis?

Answer 68

HRT

Question 69

What are the common side effects of HRT?

Answer 69

Cardiovascular disease, increased risk of endometrial/breast cancer and thromboembolytic disorders

Question 70

What hormone modulator is used to treat breast cancer? It decreases oestrogen levels by binding to oestrogen receptors

Answer 70

Tamoxifen

Question 71

What hormone modulator is used to stimulate ovulation as a fertility treatment, by binding to oestrogen receptors in the hypothalamus to inhibit negative feedback of FSH/LH?

Answer 71

Clomiphene It can result in multiple births however

Question 72

What hormone modulator is an analogue of hGH, is administered parentally for short children, Turner's syndrome or after pituitary surgery?

Answer 72

Somatatrophin

Question 73

What are the adverse effects of somatatrophin?

Answer 73

Insulin resistance, swelling of injection site, joint pain and headaches

Question 74

Prostaglandins are used to induce labour/abortion and reduce post-partum haemorrhage. What hormone is it affecting?

Answer 74

Oxytocin-Peptide hormone