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Victor BNF Notes > Endocrine System Part 2 > Flashcards

Endocrine System Part 2 Flashcards

1
Q

What is Hormone replacement therapy

A

replaces oestrogen with or without progesterone to relieve symptoms of menopause associated with low hormone levels

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2
Q

Examples of natural oestrogens

A
  • Estrone
  • Estradiol
  • Estriol
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3
Q

Examples of synthetic oestrogens

A
  • ethinylestradiol
  • mestranol
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4
Q

What is tibolone

A

medication to treat menopausal symptoms
- oestrogenic
- progesterogenic
- weak androgenic

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5
Q

What is vaginal atrophy

A

vaginal dryness

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6
Q

Treatment of vaginal atrophy

A

topical/oral oestrogens

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7
Q

What are vasomotor symptoms

A
  • Hot flushes
  • night sweat
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8
Q

Vasomotor symptom treatment

A

systemic oestrogens
- tablet
- patch (apply below waist line)

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9
Q

If systemic oestrogens are contraindicated in vasomotor symptoms, what do you give instead

A

Clonidine (vasodilator antihypertensive)

… but has bad side effects

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10
Q

What HRT do women without a uterus take

A

Oestrogen alone continuously

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11
Q

What HRT do women with a uterus take

A

Combined HRT
- oestrogen
- progesterone

either…
cyclically
or
continuously

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12
Q

When is continuously combined HRT unsuitable

A
  • per-menopausal (before)
  • <12 months after last period
  • irregular bleeding
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13
Q

How to check for endometrial cancer

A
  • symptoms of it is irregular bleeding
  • stop continuous combined HRT
  • is irregular bleeding stays, then refer
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14
Q

HRT and surgery

A

stop HRT 4 to 6 weeks before elective surgery

  • restart after surgery mobility as risk of VTE
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15
Q

Does HRT provide contraception

A

No

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16
Q

HRT and Contraception: Under 50

A

fertile 2 years after last period

  • use low oestrogen combined contraceptive if free from VTE risk factors
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17
Q

HRT and Contraception: Under 60

A

fertile 1 after last period

  • use condoms (barrier protection)
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18
Q

Side effects of HRT

A
  • Cancer
  • Coronary heart disease
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19
Q

Side effects of HRT: Cancer

A
  • ovarian
  • breast
  • cervical
  • endometrial cancer
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20
Q

Side effects of HRT: when is there a risk of coronary heart disease

A
  • combined HRT started 10 years after menopause
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21
Q

How to reduce the risk of endometrial cancer?

A

use progesterone HRT as well

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22
Q

What are the reasons to stop HRT

A
  • venous thromboembolism
  • stroke
  • liver disfunciton
  • High blood pressure
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23
Q

Reasons to stop HRT: VTE

A
  • sudden severe chest pain
  • sudden breathlessness
  • bloody cough
  • unexplained swelling
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24
Q

Reasons to stop HRT: Stroke

A
  • serious neurological effects
  • all stroke symptoms
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25
Q

Reasons to stop HRT: Liver Dysfunction

A
  • jaundice
  • hepatitis
  • liver enlargement
  • severe stomach pain
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26
Q

Reasons to stop HRT: High blood pressure

A
  • if BP is >160/95
27
Q

Risk factors that contra-indicate HRT

A
  • prolonged immobility
  • thrombophlebitis (inflamed blood vessels)
  • Angina
  • MI
  • VTE
  • Oestrogen dependant cancer
28
Q

What are Anti-oestrogens

A

oestrogen antagonists

29
Q

Example of an Anti-oestrogens

A

Clomifene (ovulation stimulator)

30
Q

Clomifene (anti-oestrogen) indications

A
  • infertility in women due to oligomenorrhoea (irregular bleeding)
  • secondary amenorrhoea (no menstruation)
31
Q

How many cycles should you use Clomifene for

A

6 cycles only

(increased risk of ovarian cancer)

32
Q

Main side effect of Clomifene

A

multiple pregnancies

33
Q

What is testosterone

A

replacement therapy in androgen deficiency

34
Q

Side effects of testosterone

A
  • masculinisation
  • male pattern boldness
  • acne
  • anxiety
  • sexual development
35
Q

Example of an anti-male androgen drug

A

Cyproterone (it is hepatotoxic)

36
Q

What do thyroid hormones regulate

A
  • metabolic rate
  • heart rate
  • digestive function
  • muscle control
  • brain development
37
Q

What hormones are in high concentration in Hyperthyroidism

A

T4 (thyroxine)

T3 (triiodothyronine)

38
Q

What hormones are in low concentration in Hyperthyroidism

A

TSH (Thyroid stimulating hormone)

39
Q

What hormones are in high concentration in Hypothyroidism

A

TSH (Thyroid stimulating hormone)

40
Q

What hormones are in low concentration in Hypothyroidism

A

T4 (thyroxine)

T3 (triiodothyronine)

41
Q

Symptoms of hyperthyroidism

A
  • heat intolerance
  • weight loss
  • diarrhoea
  • tachycardia
  • excitability
  • Tremors
  • Angina pain
  • sweating
  • arrhythmia
42
Q

Treatment of Hyperthyroidism

A
  • Carbimazole
  • Propylthiouracil
43
Q

Carbimazole/ Propylthiouracil mode of action

A
  • Anti-thyroid drug that interferes with synthesis of thyroid hormones
44
Q

Side effects of carbimazole

A
  • bone marrow suppression
  • rashes and itching
45
Q

Carbimazole patient counselling

A
  • report any signs of infection
  • if experiencing rashes/itching switch to Propylthiouracil or use antihistamine
46
Q

Side effects of Propylthiouracil (alternative)

A
  • hepatotoxicity

(stop and report sings of liver failure)

47
Q

What is thyrotoxicosis

A
  • increased heart rate (>140bpm)
  • arrhythmias
  • heat intolerance (>41c)
  • diarrhoea, nausea, vomiting
  • seizures, confusion
48
Q

How to treat thyrotoxicosis

A
  • anti-thyroid drugs
  • a lot of fluids
  • hydrocortisone
  • propranolol for rapid symptom relief
49
Q

What is the most common cause of thyrotoxicosis

A

Graves Disease

50
Q

What is Graves Disease

A

an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism)

51
Q

What is thyroidectomy

A

removal of thyroid gland

52
Q

How to prepare for thyroidectomy

A
  • iodine
  • 10-14 days before partial thyroidectomy
  • while using anti-thyroid drugs
53
Q

Hyperthyroidism in Pregnancy treatment

A

1st trimester
- Propylthiouracil

2nd trimester
- carmimazole

54
Q

Hyperthyroidism in Pregnancy: what treatments are contra-indicated

A
  • blocking-replacement regimen
  • radioactive iodine
55
Q

Symptoms of Hypothyroidism

A
  • cold intolerance
  • weight gain
  • constipation
  • bradycardia
  • lethargy
  • muscle cramps
  • hair thinning
  • slow thoughts
56
Q

Levothyroxine/ Liothyronine

A

Synthetic thyroid hormone as replacement therapy

57
Q

What is the drug for choice for hypothyroidism maintenance

A

Levothyroxine

58
Q

Levothyroxine dose

A

question any dose above 200mg at any one time

59
Q

How to take Levothyroxine

A
  • in morning
  • at least 30 mins before breakfast, caffeine or other medication
60
Q

Which of the two hypothyroidism drugs is best used for rapid effects and is more potent

A

Liothyronin

61
Q

When to use Liothyronin

A

severe hypothyroidism emergencies

62
Q

Liothyronin brands caution

A

brands may not be bio-equivalent

63
Q

What happens if initial dose of Liothyronin or Levothyroxine is too high

A
  • can cause hyperthyroidism
  • should stop for 1 to 2 days and restart at lower dose

Victor BNF Notes (25 decks)

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