Endocrine System Part 1 Flashcards
What is diabetes insipidus?
large amounts of dilute urine are produced which causes extreme thirst
What are the 2 types of diabetes insipidus
- Carnal
- Nephrogenic
What is Carnal diabetes insipidus?
the hypothalamus does not make enough ADH
What is nephrogenic diabetes insipidus?
the kidneys do not respond to ADH
Medications for Carnal diabetes insipidus
Vasopressin/ Desmopressin
Medications for nephrogenic diabetes insipidus
Thiazide diuretics
Desmopressin mode of action
more potent analogue of vasopressin. it has a longer duration of action and vasoconstrictor effects
Desmopressin indications
- diabetes insipidus
- nocturnal enuresis (involuntary loss of urine during sleep)
What are the side effects of desmopressin
- hyponatraemic
convulsions
(low sodium convulsion)
What is syndrome of inappropriate antidiuretic hormone secretion
Hyponatraemia (low sodium) caused by inappropriate secretion of ADH
First Line for Hyponatraemia correction
fluid restriction
second line for hyponatraemia correction
- Demeclocycline (blocks renal tubular effect of ADH)
- Tolvaptan (vasopressin agent)
What needs to be avoided when dealing with hyponatraemia
avoid rapid correction of hyponatraemia. it can cause osmotic demyelination of neurones (serious CNS effect)
Example of Corticosteroids
- betamethasone
- deflazcort
- dexamethasone
- fludrocortisone
- hydrocortisone
- prednisolone
Uses of Corticosteroids
- inflammatory (long term disease)
- immunosuppressant
Uses of Dexamethasone
- palliative care
- anorexia
- raised intracranial pressure
Uses of fludrocortisone
postural hypotension
Uses of hydrocortisone
- surgery
- emergency (anaphylaxis)
Uses of Prednisolone
- Asthma
- COPD
- Irritable bowel disease
- severe eczema
What high does mineral corticoid activity cause?
fluid retention
Which corticosteroids act using mineral corticoid activity
- fludrocortisone (most potent)
- hydrocortisone (high)
Example of mineral corticoids
aldosterone
What corticosteroid is used for fluid retention in low blood pressure
fludrocortisone
What corticosteroid is used for fluid retention in surgeries or emerency (but not for long term)
hydrocortisone (sometimes IV)
Mineralcorticoid activity side effects
hypertension
What does high activity of glucocorticoid activity cause
anti-inflammatory effect
What corticosteroids act with glucocorticoid activity
- Dexamethasone (most potent)
- Betamethasone (most potent)
- Prednisolone (high)
- Prednisone (high)
- Deflazcort (high)
Which corticosteroids are used if fluid retention is a disadvantage (such as heart failure)
- Dexamethasone
- Betamethasone
Which corticosteroids are used via mouth for asthma, COPD and IBD
- Prednisolone
- Prednisone
Glucocorticoid activity side effects: Endocrine
- Diabetes
(hyperglycaemia)
Glucocorticoid activity side effects: Musculoskeletal
- muscle wasting
- osteoporosis
Glucocorticoid activity side effects: Psychiatric reactions
- paranoid state
- depression with suicide risk
- mood changes
(report this immediately)
Glucocorticoid activity side effects: Immunosuppression
Avoid close contact with:
- chicken pox
- shingles
- measles
Glucocorticoid activity side effects: Adrenal suppression
1 year after stopping
- fatigue
- anorexia
- nausea
- vomiting
- hyponatraemia
- hypotension
- hyperkalaemia
- hypoglycaemia
Glucocorticoid activity counseling points: Adrenal suppression
- avoid abrupt withdrawal if using for more than 3 weeks
- patients must mention they are taking steroids or have stopped for less than a year
- anaesthesia can produce fall in blood pressure. Fix with IV hydrocortisone
Glucocorticoid activity side effects: Opthalmic
- glaucoma
- cataracts
- local and systemic use corticosteroids can cause Chorloretinopathh (fluid build up under retina)
Glucocorticoid activity side effects: Skin
- skin thinning
- purple-red striae
- bruising
Glucocorticoid activity side effects: Central nervous system
- aggravated epilepsy
- schizophrenia
- growth restrictions in children
Glucocorticoid activity side effects: high doses
- cushing’s syndrome
Methylprednisolone MHRA advice
- do not give methylprednisolone injectable containing lactulose in patients with cow milk allergy
PIL and Steroid Card
- all patients on systemic steroids need a PIL in their medication
- all patients taking corticosteroids long term need a steroid card (more than 3 weeks)
Corticosteroids: Pregnancy and Breastfeeding
- generally safe
- monitor fluid retention in pregnant women
Adrenal Replacement Therapy
- Corticosteroid (steroid) replacement therapy for life.
- Corticosteroid medicine is used to replace the hormones cortisol and aldosterone that your body no longer produces.
What 3 instances would you need Adrenal Replacement Therapy
- Adrenalectomy
(removal of adrenal glands) - Addison’s Disease
(adrenal glands do not produce enough hormones) - Hypopituitarism
(reduced hormone production in pituitary glands)
How to treat Adrenalectomy and Addison’s disease
hydrocortisone and fludrocortisone
How to treat Hypopituitarism
hydrocortisone
What is Cushing’s syndrome and disease
characterised by hypercortisolism (high cortisol)
Cushing’s Syndrome symptoms
- skin thinning
- easy bruising
- reddish purple stretch marks
- fat deposits in face
Causes of Cushing’s Syndrome and treatments
- corticosteroids (reduce dose/ withdraw)
- tumour
(surgery or cortisol-inhibiting drugs)
Treatment for Cushing’s Syndrome
Cortisol-Inhibiting Drugs
- Ketoconazole
Ketoconazole Patient counselling
report signs of liver toxicity
- anorexia
- abdominal pain
- dark urine
- jaundice
- nausea/vomiting
What can cortisol inhibiting drugs cause
adrenal insufficiency
Signs of Adrenal insufficiency
- fatigue
- anorexia
- nausea
- abdominal pain
- hypokalaemia
- hypoglycaemia
What is Osteoporosis
a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes
What are risk factors for osteoporosis
- low body weight
- elderly (65+)
- smoking
- lack of exercise
- excess alcohol
- history
- menopause
- long term oral corticosteroids
What should at risk patients do to prevent osteoporosis
maintain adequate calcium levels and vitamin D levels
How long does someone need to take corticosteroids to be at risk of osteoporosis
> = 3 months
Treatment of corticosteroid induced osteoporosis
Bisphosphonates
Other options:
- Vitamin D3
- HRT in women
- Testosterone in men (unlicensed)
Treatment of post-menopausal osteoporosis
1st Line: Bisphosphonates
(Alendrotnic Acid)
2nd Line:
Strontium Renelate
3rd Line:
Teriparatide (parathyroid hormone)
Bisphosphonates mode of action
Slows the rate of bone growth and dissolution by adsorbing onton the hydroxyapatite crystals in the bone
Examples of Bisphosphonates
- Alendronic Acid
- Risedronate sodium
- ibandronic acid
- Zolendronic Acid
- Pamidronate
Which Bisphosphonates are given as IV
- Zolendronic Acid
- Pamidronate
Patient counselling: Alendronic Acid
70mg weekly
- swallow tablet whole with water
- swallow while upright
- swallow on empty stomach 30 mins before breakfast or another oral medication
- remain upright 30 mins after
Patient counselling: Risedronate
35mg Weekly
- anytime of day
- leave 2 hour gap between it and food/drink
- upright for 30 mins
Which medications and foods do you need to leave a2 hour gap when taking risedronate
- Antacids
- Calcium containing products
(milk, iron/mineral supplements)
Side effects of Bisphosphonates
- Oesophageal reactions
- Atypical femoral fractures
- Osteonecrosis of Jaw
- Osteonecrosis of external auditory canal
Side effects of Bisphosphonates: Oesophageal reactions
- oesophagitis (inflammation of oesophagus)
- Strictures (abnormal restriction of blood vessels)
- Ulcers
Side effects of Bisphosphonates:
Atypical femoral fractures
- greater risk with long term therapy
- review after 5 or more years use
Side effects of Bisphosphonates: Osteonecrosis of Jaw
- before starting treatment course, do dental checkup
- have good oral hygiene
- higher risk with IV
- zolendronic acid most potent
- provide patient card and inform of risk
Side effects of Bisphosphonates: Osteonecrosis of external auditory canal
- mainly in patients with long term therapy >2 years
risk factors include:
- ear operation
- chemotherapy
- steroid use
- cotton bud use
Patient counselling for Bisphosphonates
- stop and report dysphagia, new or worsening heartburn
- report hip, thigh or groin pain
- report dental mobility, pain, swelling, non-healing sores
- report ear pain, ear discharge, ear infection
Strontium Ranelate mode of action
bone formation stimulant and reduces bone resorption
Side Effects of Strontium Ranelate: Serious cardiovascular disease
- myocardial infarction
- VTE
- do cardiovascular risk assessment, every 6-12 months
Side Effects of Strontium Ranelate: Severe allergic reaction
DRESS
Drug reaction with eosinophilia and systemic symptoms
- drug rash
- fever
- swollen glands
- high white cell count
can affect kidneys, liver and lungs (can be fatal)
(if rash stop and report)
Other drugs used in osteoporosis
- HRT
- Raloxifene (HRT)
- Calcitonin (salmon)
- Denosumab (human monoclonal antibody)
