Endocrine Flashcards
Which bisphosphonate needs to be discontinued if a skin rash develops?
Strontium ranelate
Severe allergic reaction:
Symptoms known as DRESS ‘Drug rash with eosinophilia and systemic symptoms’
Starts with: fever, rash, swollen glands, high WCC
What is the side effect we need to be vigilant about with Bisphosphonate treatment?
Osteonecrosis of the Jaw
The risk is higher with IV therapy for cancer treatment than it is with oral.
Patients have a dental check up before starting and need to maintain good oral hygiene and attend regular check ups.
They should report any oral symptoms: Pain, inflammation, difficulty swallowing
If patients taking Alendronic acid experience dysphagia, heartburn, pain on swallowing or retrosternal pain what should they do?
Stop taking and Report it- may be an oesophageal reaction: can be serious
Desmopressin, used for diabetes insipidous and first line for nocturnal enuresis, can cause electrolyte disturbance: hyponatreamia. What can this lead to, and what can be done to stop this?
Hyponatreamic convulsions mentioned in the BNF.
This can be minimised by sticking to the recommended start dose and avoiding drugs that increase secretion of vasopressin such as TCA’s.
Clomifene is a drug used to treat female infertility as it is anti-oestrogen. The CSM have advised that it should not be used for more than __ cycles, due to increased risk of _____ cancer.
Not for more than 6 cycles
Increased risk of ovarian cancer with clomifene use.
Which drug used in thyroid therapy can cause agranulocytosis and neutropenia? what is this drug used for?
Carbimazole
Used for Hyperthyroidism
Used in the 18 month blocking-replacement regimen together with levothyroxine.
What test is indicated prior to therapy with levothyroxine and Liothyronine?
Baseline ECG- this is because we want to check we haven’t mistaken hypothyroidism with ischaemia/ cardiovascular disease.
Which antithyroid drug is used if carbimazole is contraindicated?
What do we need to monitor with this drug?
Propylthiouracil
Liver function- severe hepatic reactions have taken place.
What drugs are used for management of thyrotoxic symptoms (when too much thyroid hormone has been given)?
Beta blockers- propranolol
IV fluids
hydrocortisone
What side effect of carbimazole is common and can be treated with antihistamines without the need to discontinue?
Rashes and pruritis- don’t say ‘discontinue’ in exam cause you’ve mistaken it for neutropenia/agran
Sick day rule for patients on a systemic steroid and fall mildly ill?
Double dose for 2 days
Sick day rule for patients on a systemic steroid and severely ill?
Double dose until symptoms improve
If a patients has severe diarrhoea or vomiting and can’t keep their steroid down?
Hydrocortisone emergency injection may be needed from GP
Difference between Addisons and Cushings (hint: they are opposites)?
Addisons is a deficiency of ACTH- (adrenocorticotropic hormone) because the immune system has turned against the adrenal glands. Symptoms: anorexia, Nausea and vomiting, weightloss- treat with glucocorticoids
Cushings- too much ACTH, caused by long term glucocorticoid therapy or tumour. Moon face, buffalo hump, mood swings, weight gain. Treatment- withdraw the steroid
