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Victor BNF Notes > Endocrine System Part 1 > Flashcards

Endocrine System Part 1 Flashcards

1
Q

What is diabetes insipidus?

A

large amounts of dilute urine are produced which causes extreme thirst

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2
Q

What are the 2 types of diabetes insipidus

A
  • Carnal
  • Nephrogenic
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3
Q

What is Carnal diabetes insipidus?

A

the hypothalamus does not make enough ADH

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4
Q

What is nephrogenic diabetes insipidus?

A

the kidneys do not respond to ADH

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5
Q

Medications for Carnal diabetes insipidus

A

Vasopressin/ Desmopressin

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6
Q

Medications for nephrogenic diabetes insipidus

A

Thiazide diuretics

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7
Q

Desmopressin mode of action

A

more potent analogue of vasopressin. it has a longer duration of action and vasoconstrictor effects

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8
Q

Desmopressin indications

A
  • diabetes insipidus
  • nocturnal enuresis (involuntary loss of urine during sleep)
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9
Q

What are the side effects of desmopressin

A
  • hyponatraemic
    convulsions
    (low sodium convulsion)
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10
Q

What is syndrome of inappropriate antidiuretic hormone secretion

A

Hyponatraemia (low sodium) caused by inappropriate secretion of ADH

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11
Q

First Line for Hyponatraemia correction

A

fluid restriction

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12
Q

second line for hyponatraemia correction

A
  • Demeclocycline (blocks renal tubular effect of ADH)
  • Tolvaptan (vasopressin agent)
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13
Q

What needs to be avoided when dealing with hyponatraemia

A

avoid rapid correction of hyponatraemia. it can cause osmotic demyelination of neurones (serious CNS effect)

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14
Q

Example of Corticosteroids

A
  • betamethasone
  • deflazcort
  • dexamethasone
  • fludrocortisone
  • hydrocortisone
  • prednisolone
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15
Q

Uses of Corticosteroids

A
  • inflammatory (long term disease)
  • immunosuppressant
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16
Q

Uses of Dexamethasone

A
  • palliative care
  • anorexia
  • raised intracranial pressure
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17
Q

Uses of fludrocortisone

A

postural hypotension

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18
Q

Uses of hydrocortisone

A
  • surgery
  • emergency (anaphylaxis)
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19
Q

Uses of Prednisolone

A
  • Asthma
  • COPD
  • Irritable bowel disease
  • severe eczema
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20
Q

What high does mineral corticoid activity cause?

A

fluid retention

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21
Q

Which corticosteroids act using mineral corticoid activity

A
  • fludrocortisone (most potent)
  • hydrocortisone (high)
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22
Q

Example of mineral corticoids

A

aldosterone

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23
Q

What corticosteroid is used for fluid retention in low blood pressure

A

fludrocortisone

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24
Q

What corticosteroid is used for fluid retention in surgeries or emerency (but not for long term)

A

hydrocortisone (sometimes IV)

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25
Q

Mineralcorticoid activity side effects

A

hypertension

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26
Q

What does high activity of glucocorticoid activity cause

A

anti-inflammatory effect

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27
Q

What corticosteroids act with glucocorticoid activity

A
  • Dexamethasone (most potent)
  • Betamethasone (most potent)
  • Prednisolone (high)
  • Prednisone (high)
  • Deflazcort (high)
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28
Q

Which corticosteroids are used if fluid retention is a disadvantage (such as heart failure)

A
  • Dexamethasone
  • Betamethasone
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29
Q

Which corticosteroids are used via mouth for asthma, COPD and IBD

A
  • Prednisolone
  • Prednisone
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30
Q

Glucocorticoid activity side effects: Endocrine

A
  • Diabetes
    (hyperglycaemia)
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31
Q

Glucocorticoid activity side effects: Musculoskeletal

A
  • muscle wasting
  • osteoporosis
32
Q

Glucocorticoid activity side effects: Psychiatric reactions

A
  • paranoid state
  • depression with suicide risk
  • mood changes

(report this immediately)

33
Q

Glucocorticoid activity side effects: Immunosuppression

A

Avoid close contact with:
- chicken pox
- shingles
- measles

34
Q

Glucocorticoid activity side effects: Adrenal suppression

A

1 year after stopping

  • fatigue
  • anorexia
  • nausea
  • vomiting
  • hyponatraemia
  • hypotension
  • hyperkalaemia
  • hypoglycaemia
35
Q

Glucocorticoid activity counseling points: Adrenal suppression

A
  • 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
36
Q

Glucocorticoid activity side effects: Opthalmic

A
  • glaucoma
  • cataracts
  • local and systemic use corticosteroids can cause Chorloretinopathh (fluid build up under retina)
37
Q

Glucocorticoid activity side effects: Skin

A
  • skin thinning
  • purple-red striae
  • bruising
38
Q

Glucocorticoid activity side effects: Central nervous system

A
  • aggravated epilepsy
  • schizophrenia
  • growth restrictions in children
39
Q

Glucocorticoid activity side effects: high doses

A
  • cushing’s syndrome
40
Q

Methylprednisolone MHRA advice

A
  • do not give methylprednisolone injectable containing lactulose in patients with cow milk allergy
41
Q

PIL and Steroid Card

A
  • 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)
42
Q

Corticosteroids: Pregnancy and Breastfeeding

A
  • generally safe
  • monitor fluid retention in pregnant women
43
Q

Adrenal Replacement Therapy

A
  • Corticosteroid (steroid) replacement therapy for life.
  • Corticosteroid medicine is used to replace the hormones cortisol and aldosterone that your body no longer produces.
44
Q

What 3 instances would you need Adrenal Replacement Therapy

A
  • Adrenalectomy
    (removal of adrenal glands)
  • Addison’s Disease
    (adrenal glands do not produce enough hormones)
  • Hypopituitarism
    (reduced hormone production in pituitary glands)
45
Q

How to treat Adrenalectomy and Addison’s disease

A

hydrocortisone and fludrocortisone

46
Q

How to treat Hypopituitarism

A

hydrocortisone

47
Q

What is Cushing’s syndrome and disease

A

characterised by hypercortisolism (high cortisol)

48
Q

Cushing’s Syndrome symptoms

A
  • skin thinning
  • easy bruising
  • reddish purple stretch marks
  • fat deposits in face
49
Q

Causes of Cushing’s Syndrome and treatments

A
  • corticosteroids (reduce dose/ withdraw)
  • tumour
    (surgery or cortisol-inhibiting drugs)
50
Q

Treatment for Cushing’s Syndrome

A

Cortisol-Inhibiting Drugs
- Ketoconazole

51
Q

Ketoconazole Patient counselling

A

report signs of liver toxicity
- anorexia
- abdominal pain
- dark urine
- jaundice
- nausea/vomiting

52
Q

What can cortisol inhibiting drugs cause

A

adrenal insufficiency

53
Q

Signs of Adrenal insufficiency

A
  • fatigue
  • anorexia
  • nausea
  • abdominal pain
  • hypokalaemia
  • hypoglycaemia
54
Q

What is Osteoporosis

A

a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes

55
Q

What are risk factors for osteoporosis

A
  • low body weight
  • elderly (65+)
  • smoking
  • lack of exercise
  • excess alcohol
  • history
  • menopause
  • long term oral corticosteroids
56
Q

What should at risk patients do to prevent osteoporosis

A

maintain adequate calcium levels and vitamin D levels

57
Q

How long does someone need to take corticosteroids to be at risk of osteoporosis

A

> = 3 months

58
Q

Treatment of corticosteroid induced osteoporosis

A

Bisphosphonates

Other options:
- Vitamin D3
- HRT in women
- Testosterone in men (unlicensed)

59
Q

Treatment of post-menopausal osteoporosis

A

1st Line: Bisphosphonates
(Alendrotnic Acid)

2nd Line:
Strontium Renelate

3rd Line:
Teriparatide (parathyroid hormone)

60
Q

Bisphosphonates mode of action

A

Slows the rate of bone growth and dissolution by adsorbing onton the hydroxyapatite crystals in the bone

61
Q

Examples of Bisphosphonates

A
  • Alendronic Acid
  • Risedronate sodium
  • ibandronic acid
  • Zolendronic Acid
  • Pamidronate
62
Q

Which Bisphosphonates are given as IV

A
  • Zolendronic Acid
  • Pamidronate
63
Q

Patient counselling: Alendronic Acid

A

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
64
Q

Patient counselling: Risedronate

A

35mg Weekly

  • anytime of day
  • leave 2 hour gap between it and food/drink
  • upright for 30 mins
65
Q

Which medications and foods do you need to leave a2 hour gap when taking risedronate

A
  • Antacids
  • Calcium containing products
    (milk, iron/mineral supplements)
66
Q

Side effects of Bisphosphonates

A
  • Oesophageal reactions
  • Atypical femoral fractures
  • Osteonecrosis of Jaw
  • Osteonecrosis of external auditory canal
67
Q

Side effects of Bisphosphonates: Oesophageal reactions

A
  • oesophagitis (inflammation of oesophagus)
  • Strictures (abnormal restriction of blood vessels)
  • Ulcers
68
Q

Side effects of Bisphosphonates:
Atypical femoral fractures

A
  • greater risk with long term therapy
  • review after 5 or more years use
69
Q

Side effects of Bisphosphonates: Osteonecrosis of Jaw

A
  • 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
70
Q

Side effects of Bisphosphonates: Osteonecrosis of external auditory canal

A
  • mainly in patients with long term therapy >2 years

risk factors include:
- ear operation
- chemotherapy
- steroid use
- cotton bud use

71
Q

Patient counselling for Bisphosphonates

A
  • 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
72
Q

Strontium Ranelate mode of action

A

bone formation stimulant and reduces bone resorption

73
Q

Side Effects of Strontium Ranelate: Serious cardiovascular disease

A
  • myocardial infarction
  • VTE
  • do cardiovascular risk assessment, every 6-12 months
74
Q

Side Effects of Strontium Ranelate: Severe allergic reaction

A

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)

75
Q

Other drugs used in osteoporosis

A
  • HRT
  • Raloxifene (HRT)
  • Calcitonin (salmon)
  • Denosumab (human monoclonal antibody)

Victor BNF Notes (25 decks)

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