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Endocrine Type 2 DM november 23 > Endocrine Part 3 > Flashcards

Endocrine Part 3 Flashcards

Steroids| Thyroid | Osteoporosis|Gout| DMARD|

1
Q

Q143: What is adrenal suppression?

A

Condition where adrenal glands DO NOT produce enough amounts of corticosteroids (cortisol)

mineralocorticoid (aldosterone) which helps regulate Na+, K+ and water retention.

80% due to Addison’s disease.

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2
Q

Q144: Examples of 2 hormones released by adrenal cortex for water and electrolyte regulation?

A

Aldosterone (mineralocorticoid), Cortisol (Glucocorticoid)

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3
Q

Q145: Difference between Cushing’s and Addison’s disease?

A

Addisons:
Body has little cortisol,
Get thinner,
Hypoglycemia,
Hyperkalemia,
Hyponatremia,
Postural hypotension.
**Cushing’s: Bodyhas too much cortisol,
Get fat,
Hyperglycemia,
Hypokalemia,
Hypernatremia,
Hypertension.

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4
Q

Q146: Signs of adrenal suppression?

A

Fatigue,
gastrointestinal upset,
anorexia, weight loss,
musculoskeletal symptoms,
hypoglycemia,
hyperkalemia,
hyponatremia,
dizziness, syncope.

Life-threatening: severe dehydration, hypotension, shock, seizures, stroke, cardiac arrest.

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5
Q

Q147: How to minimize corticosteroid side effects?

A

Lowest dose,
single morning dose,
local vs. systemic,
short course,
use spacer devices.

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6
Q

Q148: Two corticosteroids that should never be given together and why?

A

Betamethasone—-or ———–dexamethasone

with fludrocortisone

due to severe side effects.

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7
Q

Q149: Beneficial use of drug with high mineralocorticoid activity?

A

If drug also has lower glucocorticoid activity, avoiding side effects.

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8
Q

Q150: Combo of corticosteroids for replacement physiological states?

A

Hydrocortisone + fludrocortisone.

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9
Q

Q151: Beneficial use of drug with high glucocorticoid activity?

A

When accompanied by low mineralocorticoid activity.

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10
Q

Q152: Drug with highest glucocorticoid activity?

A

Betamethasone and dexamethasone.

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11
Q

Q153: Side effects of systemic corticosteroids?

A

Chorioretinopathy,
adrenal suppression,
infections,
neuropsychiatric effects,
osteoporosis.

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12
Q

Q154: Are corticosteroids safe in pregnancy?

A

Yes, benefit > risk.

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13
Q

Q155: Gradual vs. abrupt corticosteroid dose reduction?

A

Gradual withdrawal for certain conditions, abrupt for short-term use.

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14
Q

Q156: What is hyperthyroidism?

A

Excessive production of thyroid hormones leading to thyrotoxicosis.

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15
Q

Q157: Blood test results for hyperthyroidism?

A

TSH (Low), T4 (High).

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16
Q

Q158: Signs and symptoms of hyperthyroidism?

A
  1. Goitre,
  2. hyperactivity,
  3. disturbed sleep,
  4. fatigue,
  5. palpitations,
  6. anxiety,
  7. weight loss,
  8. heat intolerance,
  9. diarrhea, complications.
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17
Q

Q159: Drugs for HYPERthyroidism?

A

Carbimazole, Propylthiouracil.

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18
Q

Q160: How do carbimazole and propylthiouracil work?

A
  • Carbimazole reduces iodine and diiodotyrosine,
  • propylthiouracil inhibits new thyroid hormone production.
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19
Q

BLANK

A

BLANK

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20
Q

Q161: What is blocking replacement therapy, and when should it be avoided?

A
  1. Using thyroid and antithyroid drugs together to bring thyroid activity back to normal.
  2. Avoid in pregnancy due to potential fetal goitre.
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21
Q

Q162: Name 3 less commonly used antithyroid drugs and their uses.

A
  1. Iodine (adjunct to antithyroid drugs),
  2. radioactive sodium iodide (treatment of thyrotoxicosis),
  3. Propranolol (relieve thyrotoxic symptoms).
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22
Q

Q163: What is a thyroid storm/thyrotoxic crisis, and how is it treated?

A
  1. Life-threatening OVERACTIVE thyroid.

Treatment: IV fluids,
1. propranolol,
2. hydrocortisone,
3. oral iodine solution,
4. carbimazole
5. Propylthiouracil.

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23
Q

Q164: Which antithyroid drugs are safe in pregnancy, and when can they be given?

A
  • **Propylthiouracil is safe in the 1st trimester;
  • carbimazole should be avoided due to potential congenital effects.

Switch to carbimazole in the 2nd trimester if necessary.

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24
Q

Q165: What is hypothyroidism?

A

When the thyroid gland doesn’t produce enough thyroid hormone (T4). TSH is high.

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25
Q

Q166: Blood test results for hypothyroidism?

A

LOW fT4, HIGH TSH.

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26
Q

Q167: Signs and symptoms of hypothyroidism?

A
  1. Fatigue,
  2. weight gain,
  3. constipation,
  4. menstrual irregularities,
  5. depression,
  6. dry skin,
  7. intolerance to cold, complications.
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27
Q

Q168: Make a table comparing the signs and symptoms of thyroid disorders.

A

See table in previous response.

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28
Q

Q169: Causes of hypothyroidism?

A
  1. Autoimmune disorders (Hashimoto’s),
  2. iodine deficiency,
  3. thyroid surgery,
  4. pregnancy (sometimes),
  5. drugs (lithium & amiodarone).
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29
Q

Q170: Uses of thyroid hormones?

A

Hypothyroidism, diffuse non-toxic goitre, thyroid carcinoma.

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30
Q

Q171: Drugs for HYPOthyroidism?

A

Levothyroxine, Liothyronine.

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31
Q

Q172: Contraindications for levothyroxine and liothyronine?

A

Thyrotoxicosis in both.

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32
Q

Q173: When is liothyronine indicated over levothyroxine?

A

When rapid reversal of severe hypothyroidism is needed; liothyronine works faster.

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33
Q

Q174: Why isn’t liothyronine recommended over levothyroxine by the NHS?

A

Uncertainty about long-term adverse effects and insufficient evidence of benefit.

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34
Q

Q175: Side effects of levothyroxine and liothyronine?

A
  1. Weight decreased,
  2. edema,
  3. vomiting,
  4. flushing,
  5. diarrhea,
  6. headache,
  7. anxiety, muscle weakness.
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35
Q

Q176: Safety information regarding levothyroxine?

A

Patients stabilized on a specific brand should continue with that brand; liquid formulation may be considered if symptoms persist after brand change.

36
Q

Q177: Are levothyroxine and liothyronine safe in pregnancy and breastfeeding?

A

Levothyroxine: crosses the placenta,
dosage may increase during pregnancy;

liothyronine doesn’t cross the placenta as much.

37
Q

Q178: What is osteoporosis?

A

Progressive bone disease with low bone mass, microarchitectural deterioration, and increased risk of fragility fractures.

38
Q

Q179: Risk factors for osteoporosis?

A
  1. Age,
  2. low BMI,
  3. smoking, —– alcohol,
  4. inactivity
  5. Vit D deficiency,
  6. low calcium intake,
  7. family history of hip fractures,
  8. early menopause, certain diseases.
39
Q

Q180: Main goal in managing osteoporosis?

A

To prevent fragility fractures in patients.

40
Q

Q181: Lifestyle modifications for managing osteoporosis?

A
  1. Weight loss,
  2. avoid injury-prone activities,
  3. quit smoking,
  4. exercise (especially weight-bearing),
  5. reduce alcohol,
  6. increase calcium and vitamin D intake.
41
Q

Q182: Drugs for postmenopausal osteoporosis?

A
  1. Alendronic acid,
  2. risedronate sodium,
  3. ibandronic acid,
  4. denosumab,
  5. raloxifene hydrochloride,
  6. hormone replacement therapy (HRT),
  7. tibolone.
42
Q

Q183: Why is HRT restricted to younger postmenopausal women?

A

Due to increased risks of cardiovascular disease and cancer in older postmenopausal women on long-term HRT.

43
Q

Q184: Drugs for glucocorticoid-induced osteoporosis and osteoporosis in men?

A

1st line: Alendronic acid, risedronate sodium;

2nd line: zoledronic acid, denosumab, teriparatide.

44
Q

Q185: How do bisphosphonates work?

A

Bind to bone crystals, reduce bone turnover.

45
Q

Q186: MHRA warning on bisphosphonates?

A

Femoral fracture, osteonecrosis of jaw, osteonecrosis of external auditory canal.

46
Q

Q187: Side effects of oral bisphosphonates?

A

Esophageal reactions,
dysphagia,
heartburn,
retrosternal pain.

47
Q

Q188: Dosage of bisphosphonates for men and women?

A

Women:

10mg daily or 70mg once weekly (postmenopausal).

Men: 10mg daily.

48
Q

Q189: Counseling points for patients taking bisphosphonates?

A

Swallow whole with plenty of water,
take while standing/sitting,

stay upright for 30 minutes,

take on an empty stomach.

49
Q

Q190: Drugs for treating osteoporosis?

A

Calcium and vitamin D.

50
Q

Q191: Contraindications of bisphosphonates?

A

Abnormalities of esophagus,
hypocalcemia,
delayed stomach emptying.

51
Q

Q192: Important safety advice regarding levothyroxine?

A

Patients stabilized on a specific brand should continue with that brand; consider liquid formulation if symptoms persist after brand change.

52
Q

Q193: What should be done if a patient is going to have surgery while on HRT?

A

Stop HRT 4-6 weeks before surgery and restart after full patient mobilization; provide prophylaxis if unable to stop HRT.

53
Q

Q194: Symptoms warranting immediate discontinuation of HRT?

A

Chest pain,
breathlessness/cough with blood-stained sputum,
calf swelling/severe pain,
severe stomach pain,
neurological effects,
hepatitis/jaundice,
prolonged immobility,

memory trick: think heart attacks, strokes, VTE, PE.

54
Q

Q195: What is ethinyl estradiol used for?

A

Short-term relief of estrogen deficiency symptoms,
osteoporosis prophylaxis,
female hypogonadism,
menstrual disorders.

55
Q

Q196: What are the symptoms of menopause?

A

Loss of breast tissue, bone and muscle loss, sexual dysfunction, hot flushes, mood swings, vaginal dryness, variations among women.

56
Q

Q197: Why are different HRT regimens used?

A

To balance symptom relief with long-term risks; continuous estrogen plus cyclical progestogen for women with intact uterus, continuous estrogen alone for those with no uterus.

57
Q

Q198: Risks of HRT?

A

Increased risk of breast cancer,
endometrial cancer,
ovarian cancer,
VTE, stroke,
and CAD.

58
Q

Q199: When should HRT be initiated in menopausal women?

A

Before 60 or within 10 years of menopause onset for symptom relief; NOT for prevention of heart disease or osteoporosis.

59
Q

Q200: What is VTE, and how can it be prevented in HRT users?

A

Venous thromboembolism. Use the lowest effective dose for the shortest duration, consider risk factors, advise patients to report leg swelling and pain.

60
Q

Flashcard

61
Q

Q201: What is osteoarthritis (OA)?

A

The most common type of arthritis characterized by the breakdown of joint cartilage and underlying bone.

62
Q

Q202: Common sites of osteoarthritis?

A

Knees, hips, hands, spine.

63
Q

Q203: Symptoms of osteoarthritis?

A

Joint pain, stiffness, swelling, reduced range of motion.

64
Q

Q204: Non-pharmacological management of osteoarthritis?

A

Weight management, exercise, physical therapy, joint protection techniques, assistive devices.

65
Q

Q205: Pharmacological management of osteoarthritis?

A

Acetaminophen, NSAIDs (topical and oral), opioids (for severe pain), corticosteroid injections, hyaluronic acid injections.

66
Q

Q206: Potential side effects of long-term NSAID use?

A

GI bleeding, ulcers, renal impairment, cardiovascular events.

67
Q

Q207: How does acetaminophen work, and why is it preferred over NSAIDs in some cases?

A

Acetaminophen reduces pain and fever but doesn’t have anti-inflammatory effects. It may be preferred due to a lower risk of GI and cardiovascular side effects compared to NSAIDs.

68
Q

Q208: What is gout?

A

A form of inflammatory arthritis caused by the deposition of urate crystals in the joints, leading to sudden and severe pain and swelling.

69
Q

Q209: Factors that increase the risk of developing gout?

A

Genetics, diet (high purine intake), obesity, alcohol consumption, certain medications (e.g., diuretics).

70
Q

Q210: How is gout managed acutely?

A

NSAIDs, colchicine, corticosteroids, and lifestyle modifications like dietary changes.

71
Q

Q211: What is colchicine, and how does it work in gout?

A

Colchicine is an anti-inflammatory medication that reduces the inflammatory response to urate crystals in gout.

72
Q

Q212: Long-term management of gout?

A

Lifestyle modifications (diet, alcohol), urate-lowering therapy (allopurinol, febuxostat), prophylaxis during initiation of urate-lowering therapy (colchicine or NSAIDs).

73
Q

Q213: What is allopurinol, and how does it work in gout?

A

Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid, helping to lower urate levels in the blood.

74
Q

Q214: What is fibromyalgia?

A

A chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

75
Q

Q215: Common symptoms of fibromyalgia?

A

Widespread pain, fatigue, sleep disturbances, cognitive difficulties (fibro fog), and mood disorders (anxiety, depression).

76
Q

Q216: Non-pharmacological management of fibromyalgia?

A

Exercise, sleep hygiene, stress management, physical therapy, and cognitive-behavioral therapy.

77
Q

Q217: Pharmacological management of fibromyalgia?

A

Antidepressants (duloxetine, milnacipran), anticonvulsants (pregabalin), muscle relaxants (cyclobenzaprine), and pain relievers (acetaminophen, NSAIDs).

78
Q

Q218: What is sciatica?

A

A painful condition caused by irritation or compression of the sciatic nerve, often resulting in pain that radiates down the back of the leg.

79
Q

Q219: Common causes of sciatica?

A

Herniated discs, spinal stenosis, degenerative disc disease, piriformis syndrome.

80
Q

Q220: Non-pharmacological management of sciatica?

A

Rest, physical therapy, heat/ice, and exercises to improve flexibility and strength.

81
Q

Q221: Pharmacological management of sciatica?

A

Pain relievers (NSAIDs, acetaminophen), muscle relaxants, and in some cases, corticosteroid injections.

82
Q

Q222: What is rheumatoid arthritis (RA)?

A

A chronic autoimmune disease that causes inflammation and deformity of the joints.

83
Q

Q223: Common symptoms of rheumatoid arthritis?

A

Joint pain, stiffness, swelling, fatigue, and potentially joint deformities.

84
Q

Q224: Pharmacological management of rheumatoid arthritis?

A

Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, and biologics like etanercept and adalimumab.

85
Q

Q225: How do DMARDs work in rheumatoid arthritis?

A

They suppress the immune system’s inflammatory response, slowing the progression of joint damage.

Endocrine Type 2 DM november 23 (4 decks)

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