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
Symptoms of DKA?(8)
Rapid weight loss Abdominal pain Nausea and vomiting Rapid and deep breathing? Sweet smelling breath Sweet/metallic tasting breath Altered odour of urine/sweat Sleepiness
In adults:
Gradual withdrawal of systematic corticosteroids is considered in those where the disease is unlikely to relapse and have….? (6)
Received more than 40mg of prednisolone (or equiv) daily in the last week
Given repeated doses in the evening
Received more than 3 weeks treatment
Recently received repeated courses (particularly for longer than 3 weeks)
Taken short-course within a 1 year of stopping long-term treatment
Other possible causes of adrenal suppression
How to withdraw corticosteroids from adults and children?
Adult:
Dose may be reduced rapidly down to physiological dose (equivalent to 7.5mg prednisolone daily) and then reduced more slowly
Child:
Dose may be reduced rapidly down to physiological dose (equivalent to 2-2.5 mg/m2 prednisolone daily) and then reduced more slowly
When can systemic steroids be stopped abruptly?
When disease is unlikely to relapse and those who have received less than 3-weeks treatment (and those not included in the patient groups described on page 659)
How long can corticosteroid-induced adrenal suppression last for after stopping drug
1 year or more
What is the duration of dexamethasone and betamethasone?
Long duration of action
Makes it good for suppression of corticotrophin secretion (e.g. congenital adrenal hyperplasia)
Steroid with high mineralocorticoid activity
Fludrocortisone acetate
Can be used to treat postural hypotension
Steroid with very high glucocorticoid activity and insignificant mineralocorticoid activity?
Betamethasone
and
Dexamethasone
Corticosteroid with moderate glucocorticoid activity and high mineralocorticoid activity - good for topical use because side-effects are less marked?
HYDROCORTISONE
What are prednisolone and prednisones predominant activity on?
Glucocorticoids
Side effects of glucocorticoids? (6)
Diabetes
Osteoporosis (particularly in elderly)
At high doses - avascular necrosis of femoral head
Muscle wasting
Weekly linked with peptic ulcer/perforations
Psychiatric reactions
Side effects of mineralocorticoids (5)
Think minerals
2 increase, 2 decrease
Hypertension (hence why it can tx postural hypo)
Sodium retention
Water retention
Potassium loss
Calcium loss
What is Deflazacort?
Derived from prednisolone
Has high glucocorticoid activity
What happens to prednisolone when it crosses the placenta in pregnancy?
88% is inactivated
What is the advise with ketoconazole and hepatic inpairment?
In treating Cushing syndrome
Avoid in acute or chronic impairment
Do not initiate the drug if liver enzymes are greater than 2X the normal upper limit
Symptoms suggestive of adrenal Insufficiency?
Fatigue Anorexia Nausea and vomiting Hypotension Hyponatraemia Hypoglycaemia Hyperkalaemia
