Endocrine System Part 2 Flashcards
What is Hormone replacement therapy
replaces oestrogen with or without progesterone to relieve symptoms of menopause associated with low hormone levels
Examples of natural oestrogens
- Estrone
- Estradiol
- Estriol
Examples of synthetic oestrogens
- ethinylestradiol
- mestranol
What is tibolone
medication to treat menopausal symptoms
- oestrogenic
- progesterogenic
- weak androgenic
What is vaginal atrophy
vaginal dryness
Treatment of vaginal atrophy
topical/oral oestrogens
What are vasomotor symptoms
- Hot flushes
- night sweat
Vasomotor symptom treatment
systemic oestrogens
- tablet
- patch (apply below waist line)
If systemic oestrogens are contraindicated in vasomotor symptoms, what do you give instead
Clonidine (vasodilator antihypertensive)
… but has bad side effects
What HRT do women without a uterus take
Oestrogen alone continuously
What HRT do women with a uterus take
Combined HRT
- oestrogen
- progesterone
either…
cyclically
or
continuously
When is continuously combined HRT unsuitable
- per-menopausal (before)
- <12 months after last period
- irregular bleeding
How to check for endometrial cancer
- symptoms of it is irregular bleeding
- stop continuous combined HRT
- is irregular bleeding stays, then refer
HRT and surgery
stop HRT 4 to 6 weeks before elective surgery
- restart after surgery mobility as risk of VTE
Does HRT provide contraception
No
HRT and Contraception: Under 50
fertile 2 years after last period
- use low oestrogen combined contraceptive if free from VTE risk factors
HRT and Contraception: Under 60
fertile 1 after last period
- use condoms (barrier protection)
Side effects of HRT
- Cancer
- Coronary heart disease
Side effects of HRT: Cancer
- ovarian
- breast
- cervical
- endometrial cancer
Side effects of HRT: when is there a risk of coronary heart disease
- combined HRT started 10 years after menopause
How to reduce the risk of endometrial cancer?
use progesterone HRT as well
What are the reasons to stop HRT
- venous thromboembolism
- stroke
- liver disfunciton
- High blood pressure
Reasons to stop HRT: VTE
- sudden severe chest pain
- sudden breathlessness
- bloody cough
- unexplained swelling
Reasons to stop HRT: Stroke
- serious neurological effects
- all stroke symptoms
Reasons to stop HRT: Liver Dysfunction
- jaundice
- hepatitis
- liver enlargement
- severe stomach pain
Reasons to stop HRT: High blood pressure
- if BP is >160/95
Risk factors that contra-indicate HRT
- prolonged immobility
- thrombophlebitis (inflamed blood vessels)
- Angina
- MI
- VTE
- Oestrogen dependant cancer
What are Anti-oestrogens
oestrogen antagonists
Example of an Anti-oestrogens
Clomifene (ovulation stimulator)
Clomifene (anti-oestrogen) indications
- infertility in women due to oligomenorrhoea (irregular bleeding)
- secondary amenorrhoea (no menstruation)
How many cycles should you use Clomifene for
6 cycles only
(increased risk of ovarian cancer)
Main side effect of Clomifene
multiple pregnancies
What is testosterone
replacement therapy in androgen deficiency
Side effects of testosterone
- masculinisation
- male pattern boldness
- acne
- anxiety
- sexual development
Example of an anti-male androgen drug
Cyproterone (it is hepatotoxic)
What do thyroid hormones regulate
- metabolic rate
- heart rate
- digestive function
- muscle control
- brain development
What hormones are in high concentration in Hyperthyroidism
T4 (thyroxine)
T3 (triiodothyronine)
What hormones are in low concentration in Hyperthyroidism
TSH (Thyroid stimulating hormone)
What hormones are in high concentration in Hypothyroidism
TSH (Thyroid stimulating hormone)
What hormones are in low concentration in Hypothyroidism
T4 (thyroxine)
T3 (triiodothyronine)
Symptoms of hyperthyroidism
- heat intolerance
- weight loss
- diarrhoea
- tachycardia
- excitability
- Tremors
- Angina pain
- sweating
- arrhythmia
Treatment of Hyperthyroidism
- Carbimazole
- Propylthiouracil
Carbimazole/ Propylthiouracil mode of action
- Anti-thyroid drug that interferes with synthesis of thyroid hormones
Side effects of carbimazole
- bone marrow suppression
- rashes and itching
Carbimazole patient counselling
- report any signs of infection
- if experiencing rashes/itching switch to Propylthiouracil or use antihistamine
Side effects of Propylthiouracil (alternative)
- hepatotoxicity
(stop and report sings of liver failure)
What is thyrotoxicosis
- increased heart rate (>140bpm)
- arrhythmias
- heat intolerance (>41c)
- diarrhoea, nausea, vomiting
- seizures, confusion
How to treat thyrotoxicosis
- anti-thyroid drugs
- a lot of fluids
- hydrocortisone
- propranolol for rapid symptom relief
What is the most common cause of thyrotoxicosis
Graves Disease
What is Graves Disease
an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism)
What is thyroidectomy
removal of thyroid gland
How to prepare for thyroidectomy
- iodine
- 10-14 days before partial thyroidectomy
- while using anti-thyroid drugs
Hyperthyroidism in Pregnancy treatment
1st trimester
- Propylthiouracil
2nd trimester
- carmimazole
Hyperthyroidism in Pregnancy: what treatments are contra-indicated
- blocking-replacement regimen
- radioactive iodine
Symptoms of Hypothyroidism
- cold intolerance
- weight gain
- constipation
- bradycardia
- lethargy
- muscle cramps
- hair thinning
- slow thoughts
Levothyroxine/ Liothyronine
Synthetic thyroid hormone as replacement therapy
What is the drug for choice for hypothyroidism maintenance
Levothyroxine
Levothyroxine dose
question any dose above 200mg at any one time
How to take Levothyroxine
- in morning
- at least 30 mins before breakfast, caffeine or other medication
Which of the two hypothyroidism drugs is best used for rapid effects and is more potent
Liothyronin
When to use Liothyronin
severe hypothyroidism emergencies
Liothyronin brands caution
brands may not be bio-equivalent
What happens if initial dose of Liothyronin or Levothyroxine is too high
- can cause hyperthyroidism
- should stop for 1 to 2 days and restart at lower dose
