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PPT Phase II > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

1
Q

What medication should be started in people with newly diagnosed hyperthyroidism before confirmation of the cause?

A

beta blocker (assuming there are no contraindications to its use).

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2
Q

List 3 symptoms of hyperthyroidism

A

palpitations, tachycardia, tremulousness, anxiety, heat intolerance

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3
Q

As well as reducing sympathoadrenal symptoms in hyperthyroidism, what additional effects do beta-blockers have on the condition?

A

They can decrease T3 concentrations by inhibiting the 5’-monodeiodinase that converts T4 to T3. However, it contributes little to the therapeutic effects of the drug.

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4
Q

What other classes of drugs can you use in hypertyroidism? Name an example

A

Thionamides e.g. carbimazole

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5
Q

what is the MOA of carbimazole

A

It inhibits thyroid peroxidase and thus decreases the synthesis of thyroid hormone.

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6
Q

How long does it take carbimazole to work and why?

A

it takes 4-6wks due to the long half life of T4.

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7
Q

What can be used to treat hyperthyroidism as an alternative to carbimazole in pregnant women?

A

Propylthiouracil (PTU)

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8
Q

What are the principle differences between carbimazole and PTU?

A

Carbimazole has a longer half life.
the intrathyroid concentration of carbimazole remians higher for longer than PTU.
Carbimazole inhibits iodine organification better than PTU.

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9
Q

What is the recommended treatment of hyperthyroidism in pregnancy?

A

Propylthiouracil (PTU) for first trimester as carbimazole is teratogenic. Can consider a switch to carbimazole in the second and third trimester due to the risk of hepatotoxicity with PTU.

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10
Q

What should you monitor in a patient who is on PTU for hyperthyroidism?

A

Liver enzymes as severe hepatic reactions have happened.

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11
Q

What is an important piece of information to tell pts about carbimazole?

A

It can cause neutropenia and agranulocytosis so ask the patine to report symptoms and signs suggested of infection, especially a sore throat. A WBC count (FBC) should be performed if there is any clinical evidence of infcetion. Stop carbimazole promptly if there is clinical or lab evidence of neutropenia

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12
Q

What are the two regimens for medically treating thyrotoxicosis with Carbimazole?

A

Titration therapy
and
block and replace.

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13
Q

What are two other methods of treating thyrotoxicosis other than anti-thyroid drugs?

A 
Radioiodine therapy,
surgical removal (thyroidectomy)
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14
Q

Why is thyrotoxicosis generally pre-treated with carbimazole before giving radioiodine?

A

Reduces the risk of exacerbation of hyperthyroidism from radiation thyroiditis immediately after isotope treatment.

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15
Q

How many days before radioactive iodine is given should carbimazole be stopped? and why?

A

At least 2 days otherwise it will prevent the uptake of radioiodine by the thyroid cells

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16
Q

How long can it take before the radioiodine effectively treats hyperthyroidism? What can be given to manage symptoms in the mean time?

A

8 wks.
can use an antithyroid drug e.g. carbimazole 7 days after radioiodine to cover the period before radioiodine is fully effective

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17
Q

Is there an increased risk of cancer or leukaemia following radioiodine treatment?

A

No

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18
Q

How long can it take levothyroxine to reach a new plateau once the dose has been adjusted, and why?

A

up to 6 wks

because it has a long half life

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19
Q

Name some drugs that interfere with the absorption of levothyroxine from teh gut

A 
iron
calcium carbonate
mineral supplements
colestyramine
sucralfate
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20
Q

Hepatic enzyme-inducing drugs can accelerate the metabolism of levothyroxine. What does this mean may have to be adjusted in the dose of levothyroxine?

A

May need to increase dose

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21
Q

Hepatic enzyme-inducing drugs can accelerate the metabolism of levothyroxine. Name two examples

A

carbamazepine, phenytoin, phenobarbital, rifampicin

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22
Q

In a pt with panhypopituitarism secondary to removal of a large, non-functional pituitary adenoma will need what hormonal replacement (assume normal posterior pituitary function)

A

hydrocortisone - to replace ACTH deficiency.
GH to replace GH.
Levothyroxine to replace TSH deficiency.
Testosterone to replace LH and FSH deficiency.

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23
Q

How does hormone replacement therapy differ between primary and secondary adrenal insufficiency?

A

Primary adrenal insufficiency needs glucocorticoid and mineralocorticoid replacement therapy whereas, secondary hypoadrenalism needs only glucocorticoid replacement as RAAS is intact (the intact adrenal glands can still produce aldosterone).

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24
Q

What is it important to tell pts who need to take adrenal replacement therapy?

A

That they should never stop taking their hydrocortisone. If unable to swallow it and keep it down, they should seek urgent medical assistance.

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25
Q

What should pts on long term corticosteriods for adrenal replacement carry with them?

A

steroid treatment card

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26
Q

What 4 steps are there to treating an Addisonian crisis?

A

IV fluid resuscitation.
IV hydrocortisone
Prevention of hypoglycaemia.
Treat underlying cause.

27
Q

What dose of hydrocortisone should you give immediately and through what method, in someone having an Addisonian crisis?

A

100mg hydrocortisone IV or IM followed by rapid rehydration with IV fluids

28
Q

What pharmacological therapy could you use to treat hyperprolactinaemia?
Give an example

A

Dopamine agonists

e.g. cabergoline, bromocriptin, quinaglolide

29
Q

What treatment can be considered if cabergoline or other dopamine agonists don’t treat the prolactinaemia

A

pituitary surgery

30
Q

Do macroprolactinomas often respond to dopamine agonist therapy?

A

Yes

31
Q

Serum calcium above what level is a medical emergency?

A

> 3.5 mmol/L

32
Q

What is the MOA of bisphosphonates

A

inhibit osteoclast resorptive action on bone.

33
Q

How should you tell pts to take bisphosphonates?

A

take with a large glass of water and stay upright for 30 mins (due to oesophageal injury being reported)

34
Q

Give 3 eamples of bisphosphonates

A 
sodium clodronate
alendronic acid
disodium pamidronate
risedronate sodium
zoledronic acid
35
Q

List 3 drug classes that can be used for hypercalcaemia

A

bisphosphonates
calcitonin
corticosteriods (if vit D is high, or in sarcoidosis)

36
Q

Name 2 main causes of hypocalcaemia

A

PTH deficiency

Vit D deficiency

37
Q

How is hypocalcaemia usually treated?

A

Vit D compounds

38
Q

Which vitamin D compounds can be used in renal failure?

A

alfacalcidol

calcitriol

39
Q

What two vit D compounds require a functioning kidney to work?

A

ergocalcierol

colecalciferol

40
Q

How would you treat severe hypocalcaemia? After what surgery might hypocalcaemia occur?

A

IV Ca gluconate followed by oral Ca supplements.
Sometimes occurs after parathyroidectomy.
If PTH is deficient, then Vit D supplements are given

41
Q

What other electrolyte do you need to correct in order to correct hypocalcaemia?

A

Magnesium - if low, it affects PTH activity and hypocalcaemia will be difficult to treat

42
Q

list 4 possible therapies for osteoporosis

A 
bisphosphonates
raloxifene
teriparatide
strontium ranelate
denosumab
calcitriol
43
Q

What is there a risk of if serum sodium levels rise or fall too quickly?

A

osmotic demyelination syndrome

44
Q

What should be the first thing that is done to treat hyponatraemia?

A

150ml 3% hypertonic saline IV infusion over 20 mins

45
Q

What is the next stage in treating someone with hyponatraemia after having given 150ml hypertonic saline IV over 20 mins?

A

check Na+,
IV infusion 150ml 3% hypertonic saline over 20 mins while awaiting result of Na+.
Repeat twice or until 5 mmol/L increase in Na

46
Q

What should you do in someone who had hyponatraemia but after fluids has had a 5 mmol/L increase in Na?

A

stop infusion of hypertonic saline,
start diagnosis-specific treatment,
limit increase Na to 10 mmol/L in first 24hrs

47
Q

What specific drug could an expert use to treat SIADH?

A

Tolvaptan, a competitive antagonist at vasopressin V2 receptors.

48
Q

what is the MOA of tolvaptan?

A

its major action is in the renal collecting ducts to reduce water reabsorption and produce aquaresis without sodium loss, thus increasing free water clearance and correcting dilutional hyponatraemia.

49
Q

What is first line management of a toxic nodular goitre and toxic adenoma?

A

radioiodine - extremely effective as the isotope is only taken up by abnromal nodules.

50
Q

What is the name of synthetic human GH used for GH deficiency?

A

somatropin

51
Q

What class of drugs can be used to treat acromegaly? Give 2 examples

A

somatostatin analogues.

e.g. lanreotide, ocreotide

52
Q

What is the treatment of choice for acromegaly?

A

surgery by trans-sphenoidal route, followed by radiotherapy if tumour is large

53
Q

what is persistent hyperprolactinaemia usually caused by?

A

microadenoma of the anterior pituitary or by the action of dopamine receptor antagonists.

54
Q

What are 3 causes of hypercalcaemia?

A

increased resorption of Ca from bone (e.g. primary hyperparathyroidism, secretion of parathyroid-related hormone by cancer cells and osteolysis in haematological malignancies).
Increased Ca absorption from gut through excessive Vit D use or sarcoidosis.
Reduced renal excretion of Ca e.g. caused by thiazide diuretics.

55
Q

List some symptoms of severe hypercalcaemia

A

anorexia, nausea, vomiting, constipation, drowsidness, confusion, eventually leading to coma.

56
Q

What is the effect of hypercalcaemia on kidney funciton?

A

prolonged moderate hypercalcaemia leads tto a progressive decline in renal funcion and formation of renal stones. hypercalcaemia impairs the ability of kidney to reabsorb salt and water which, in conjunction with vomiting, can lead to depletion of plasma volume and AKI from poor kidney perfusion.

57
Q

what can a serum level of calcium >3.5 cause ?

A

sudden death from cardiac arrest can occur

58
Q

What is the MOA of calcitonin?

A

Decreases bone mobilisation of Ca

59
Q

What are the two common uses of desmopressin?

A

Cranial diabetes insipidus.

Bleeding reductin in mild to moderate haemophilia

60
Q

What is terlipressin, a vasopressin analogue often used for?

A

to decrease oesophageal bleeding in oesophageal varicies. This is because it has potent vasocontrictor activity

61
Q

What is the MOA that means desmopressin can be used to reduce bleeding in mild to moderate haemophilia?

A

It increases clotting factor VIII in the blood.

62
Q

How do you treat nephrogenic diabetes insipidus?

A

treat cause e.g. remove drug that’s causing it.

63
Q

What are the unwanted effects of tolvaptan, a vasopressin receptor antagonist?

A 
thirts,
dry mouth, 
polyuria,
hypotension
hypernatraemia
hypoglycaemia

PPT Phase II (37 decks)

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