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PRE-REG-Thuri > ENDOCRINE- HYPOTHALAMUS + PITUITARY HORMONES > Flashcards

ENDOCRINE- HYPOTHALAMUS + PITUITARY HORMONES Flashcards

1
Q

what is menopause?

A

Oestrogen levels decline in women between 45-55 years

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2
Q

What is treatment for vaginal atrophy?

A

Topical oestrogens- cream, tablet, rings

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3
Q

What is treatment of vasomotor instability?

A

Systemic oestrogen or Tibolone (tablet, patch)

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4
Q

What is patient counselling for systemic oestrogen or tibolone?

A

Apply below waistline

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5
Q

What is MOA of HRT?

A

Replaces reduced oestrogen levels to alleviate menopausal symptoms

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6
Q

What are 3 natural oestrogens?

A

Estrone

estradiol

estriol

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7
Q

What are 2 synthetic oestrogens?

A

Ethinylestradiol

mestanol

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8
Q

What are 3 tibolones?

A

Oestrogenic

Progestogenic

weak androgenic

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9
Q

What extra drug is needed for HRT if uterus is INTACT?

A

Progesterone

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10
Q

What is cyclical progesterone?

A

Use for 12-14 days of cycle
then have bleeding

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11
Q

What is continuous progesterone?

A

Avoids withdrawal bleeding

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12
Q

Who is continuous progesterone not suitable for?

A

Not for peri-menopause or if it has been less than 12 months since last period

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13
Q

What do we need to rule out if women bleed during continuous progresterone?

A

Rule out endometrial cancer

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14
Q

What are 3 SEs of HRT? (CVS)

A

Potential cancer- breast, cervical, ovarian (endometrial cancer- important to give progesterone)

VTE

CVD

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15
Q

What are some contraindications of HRT?

A

Untreated endometrial hyperplasia, vaginal bleeding, oestrogen dependent cancer, hx of breast cancer

VTE

Angina , MI

liver disease

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16
Q

What are 4 reasons to stop HRT?

A

VTE- unexplained

Liver dysfunction- jaundice, hepatitis, severe abd pain, liver enlargenment

Stroke- serious neurological effects

BP- above 160/95 mmhg

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17
Q

What to do with HRT if patient is undergoing major surgery?

A

Stop HRT 4-6 weeks before

Major VTE risk factor so restart when fully mobile

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18
Q

MOA of testosterone?

A

Role in masculine development

Spermatogenesis

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19
Q

What is a SE of testosterone?

A

Masculinisation

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20
Q

What are 3 symptoms of Masculinisation?

A

Acne

Anxiety

Male pattern baldness

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21
Q

What is MHRA warning regarding topical testosterone?

A

Risk of harm to children after accidental exposure

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22
Q

What is one caution of topical testosterone?

A

Not to be applied on genital area.

ONLY SHOULDER + ARMS

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23
Q

What is moa of clomifene?

A

Causes ovulation
anti- oestrogen

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24
Q

What is indication of clomifene?

A

Infertility

PCOS, oligomeorrhoea (infrequent perioids

25
What are 2 SEs of Clomifene?
Risk of cancer (above 6 cycles) Multiple pregnancies
26
What is hyperthyroidism?
High level of thyroid hormones (T3/4 + low TSH)
27
What does high t3/4 do to the TSH?
Low TSH
28
What is treatment for hyperthyroidism?
anti-thyroid drugs
28
What are 8 symptoms of hyperthyroidism?
Heat intolerance weight loss tachycardia diarrhoea anxiety tremors sweating bulging eyes
29
What 5 things is the thyroid gland important in?
Muscle control Metabolic rate HR brain development digestive system
30
What is MOA of Carbimazole + Propylthiouracil?
Interferes with synthesis of thyroid hormones T3 +T4
31
What is indication of carbimazole?
Hyperthyroidism
32
What are 3 Main SEs of Carbimazole? (BAR-T)
Blood dyscrasias Acute pancreatitis Rashes/ itching
33
What monitoring is needed for carbimazole?
FBCs
34
Can carbimazole be used in pregnanacy?
Not in 1st trimester- congential effects but can be used 2nd + 3rd trimester - risk benefit
35
What to do if patient has acute pancreatitis when taking carbimazole?
STOP
36
What is patient counselling for carbimazole?
Report signs of infection or blood disorders. e.g. sore throat, fever, mouth ulcer, bruising, bleeding
37
What is a SE of propylthiouracil?
Hepatotoxicity report signs of liver disorder
38
What is propylthiouracil monitoring?
LFTs - stop if 3x ALT or AST
39
What is hypothyroidism?
Low level of T3/T4 + high TSH
40
What happens if low T3 + T4 ?
High TSH
41
What are 9 symptoms of hypothyroidism?
Cold intolerance weight gain bradycardia constipation depression muscle cramps Fatigue Loss of eyebrow/ hair loss Dry skin
42
What is hypothyroidism treatment?
Thyroid hormones
43
MOA of levothyroxine + liothyronine?
Fake thyroid hormones, replacement therapy.
44
What is indication of levothyroxine + liothyronine?
Hypothyroidism - choice drug (levo)
45
When is liothyronine used?
In emergencies - rapid metabolism
46
Wha is a SE of levothyroxine/liothyronine?
Thyrotoxic symptoms e.g. diarrhoea, rapid pulse, insomnia, anxiety, tremors, anginal pain where latent ischaemia
47
What is a caution of levothyroxine/liothyronine?
CVD, DM
48
What is 20-25 mcg of liothyronine equal to?
100mcg levothyroxine
49
How to take levothyroxine?
Take in morning at least 30 mins before breakfast, caffeine or any other medication.
50
What is an MHRA warning regarding levothyroxine?
New advice if symptoms arise when switching brands If you get symptoms= check TFTS + use specific tolerated brand If still symptoms or poor control of thyroid level = use oral solution
51
How long gap to leave between levothyroxine and antacids, calcium or iron?
4 HRS
52
What is used for hyperthyroidism (graves) in 1st trimester of pregnancy?
Propylthiouracil (as carbimazole congenital effects)
53
What is 1st line for grave's disease?
Radioactive iodine Then if above not suitable, can use carbimazole.
54
What is carbimazole given with for grave's disease?
Levothyroxine (to find perfect balance)
55
What monitoring is done for levothyroxine?
TSH every 3 months, then yearly
56
What should patients be cautious of when taking propylthiouracil?
Liver disorder
57
What are 3 MHRA warnings for carbimazole?
Neutropenia + agranulocyrosis Congenital malformations acute pancreatitis

PRE-REG-Thuri (44 decks)

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