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PRE-REG own > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what is appropriate advice to give to a patient who takes hydrocortisone and fludocortisone for addisons disease when they have concurrent illness e.g. infection?

A

Increase CCS dose during illness to prevent adrenal crisis

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2
Q

What medication is used for hyperthyroidism in 1st trimester of pregnancy

A

Propylthiouracil

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3
Q

A patient is on: levothyroxine and initiated on ferrous fumarate and now blood tests show low T4, Low T3, and high TSH, what is the issue here?

A

Ferrous fumarate (iron) reduces absorption of levo so no control - should wait 4 hours before taking - take levo on empty stomach 30 min before any food /caffeine

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4
Q

what is an MHRA warning for corticoteroids relating to the eyes

A

rare risk of central serous chorioretinopathy with local and systemic use - counsel pts to report blurred vision and visual disturbances

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5
Q

What situations should you NOT withdraw steroids abruptly?

A
  • Recent repeated courses
  • long term>3wks
  • > 40mg pred daily >1 week or equiv
  • repeated doses in evening
  • addisons
  • short course within 1 year of stopping
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6
Q

What is ketoconazole used for in endocrine?

A

Cushings disease caused by a tumour - only used in this situation now - risk of hepatotoxicity so no longeer sused for other things

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7
Q

what is 1st line for treatment of post menopausal osteoporosis

A

Alendronic acid

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8
Q

State key counselling points for bisphosphonates

A

Swallow whole plenty of water
sitting upright or standing
remain upright or ~30 mins
on empty stomach 30mins before any breakfast/oral meds

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9
Q

What would blood tests show if patient has hyperthyroidism?

A

High T3/T4

Low TSH

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10
Q

What would blood tests show if patient has hypothyroidism?

A 
Low T3/T4 
High TSH (because its a feedback loop-senses low and hormone stimulated to produce more hormones but hormones aren't produced) - needs to be replaced
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11
Q

What are the symptom of hyperthyroidism?

A

Hyper e.g.

  • sweating/heat intolerance
  • weight loss
  • tachycardia
  • diarrhoea
  • excitable, tremors, arrhythmias, angina
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12
Q

What are the symptoms of hypothyroidism?

A 
HYPO
lethargy/tiredness
weight gain
bradycardia
constipation
cold intolerance
muscle cramps, slow movement, slow thoughts, depression
hair thinning
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13
Q

What are the 2 main treatments for hyperthyroidism?

A
  1. Carbimazole

2. Propylthiouracil

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14
Q

What is key side effect of propylthiouracil?

A

Hepatotoxicity - counsel patients

3x UPPER LIMIT

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15
Q

What are 4 key side effects of carbimazole?

A
  1. neutropenia and agranulocytosis-counsel pts
  2. congenital malformations in pregnancy esp 1st trimester. Childbearing potential should be on effective contraception. (MHRA)
  3. Acute pancreatitis- counsel pts to report severe abdominal pain
  4. Rash/itch - antihistamine or switch
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16
Q

what medications are used for hyperthyroidism in pregnancy?

A

1st trimester: propylthiouracil

2nd trim: carbimazole

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17
Q

What regimens are contraindicated in pregnancy for hyperthyroidism?

A

Blocking replacement regimen and radioactive iodine

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18
Q

Describe symptoms of thyrotoxicosis?

A 
High HR >140bpm 
tachycardia, arrhythmias 
heat intolerance (high temp)
diarrhoea, N&V, dehydration
sizures, delirium, psychosis
19
Q

What is treatment for thyrotoxicosis?

A 
propranolol beta blocker for symptoms
antithyroid medication 
fluids
hydrocortisone 
radioactive iodide
20
Q

What is the mainstay treatment for hypothyroidism?

A

Levothyroxine 1st line

or liothyronine but not used much

21
Q

If a patient experiences hyperthyroid symptoms e.g. irritability, diarrhoea when on levothyroxine (e.g.dose too high) what is done?

A

Refer to GP: Reduce dose or withhold for 1-2 days and start again at a lower dose

22
Q

What is counselling point for levothyroxine?

A

Take in morning at least 30 min before breakfast / caffeine containing liquids or other medicines

23
Q

What is the MHRA alert regarding levothyroxine?

A

Prescribing advice for patients who experience symptoms when switching between different products - consider TFT
consider specific tablet known to be well tolerated by patient
If still symptoms or poor control despite this: have oral solution

24
Q

In patients with existing CVD - what is recommended when initiating levothyroxine?

A

baseline ECG because changes induced by levo can be confused with ischaemia

25
Q

What is the importance of levothyroxine and diabetics?

A

Levo increases thyroid hormone levels which can increase BG levels - may need to increase doses of anti-diabetic drugs and insulin

26
Q

Why is liothyronine not used? what situations is it more beneficially used?

A

Very potent and rapid effects but rapidly metabolised by liver and may cause toxicity
More use in hypothyroid emergencies - effects last 24-48hrs

27
Q

Are brands of liothyronine bioequivalent?

A

No

28
Q

What are risk factors for osteoporosis

A 
Elderly,65+ women,75+ men 
Family history
smoking
Females menopause esp early
long term CCS including inhaled high dos
29
Q

What is 1st line prophylaxis and treatment of osteoporosis

A

Bisphosphonates (oral-alendronic, risedronate), (IV=ibandronicacid, zoledronic acid)

30
Q

What are other 2nd line options in prophylaxis and treatment of osteoporosis?

A

Denosumab
Raloxifene
Teriparatide
pamidronate

31
Q

What drugs are induced for prophylaxis/treatment post menopausal OP?

A

bisphosphonates
calcitrol
HRT e.g. tibolone
Raloxifene

32
Q

When is HRT used in post menopausal OP?

A

Where others C/I or not tolerated

in women who are high risk esp early onset menopause

33
Q

When would HRT not be used?

A

In women >50 due to CV and cancer risk

34
Q

For treating osteporosis, what is the length of time bisphosphonates are used

A

3 years - no benefit if more

35
Q

What is the dosing for alendronic acid and risedronate

A

AA: 70mg week or 10mg day
Risedronate: 35mg week (or 5mg day)

36
Q

What is the administration counselling for risedronate

A

Can be taken at any time of day but leave a 2 hour gap with food/drink/antacids/calcium products/iron/milk

Remain upright for 30 mins

37
Q

What are MHRA warnings for bisphosphonates (4)

A
  1. Osteonecrosis of jaw
  2. osteonecrosis of auditory canal
  3. Atypical femoral fractures
  4. Oesophageal reactions
38
Q

What are the counselling points for osteonecrosis of jaw for bisphosphonates?

A

Oral symptoms (dr and dentist) - mobility, pain, swelling, sores
Dental check ups and any work done
Oral hygeine
Appropriate denture fit

39
Q

Which bisphosphonate has highest risk of osteonecrosis of jaw?

A

IV zolendronic acid - potent

40
Q

What are the counselling points for osteonecrosis of auditory canal for bisphosphonates?

A

report ear pain, discharge, infection

Mainly in >2 yrs

41
Q

What are the counselling points for atypical femoral fractures for bisphosphonates?

A

Reporting any thigh, hip or groin pain

42
Q

What are the counselling points for oesophageal irritation in bisphosphonates?

A

Dysphagia, new or worsening heartburn or retrosternal pain - report
Be aware of people purchasing gaviscon etc

43
Q

Which drug used in osteoporosis is not recommended due to long term risk of malignancy?

A

Calcitonin /calcitrol

44
Q

Name 3 key side effects of denosumab (60mg use in osteoporosis) ?

A
  1. Atypical femoral fractures long term after discontinuation
  2. hypocalcaemia
  3. osteonecrosis of auditory canal and jaw

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