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Year 2 > endocrine treatments > Flashcards

endocrine treatments Flashcards

1
Q

treatment for Graves (include oregnancy)
Include length if treatment

A

(antithyroid drugs)
1st line: carbimazole (TPO inhibitor), once daily, for 12-18 months!!
SE: aplasia cutis in early preg, agranalocytosis

for 1st tri (up until 12 weeks) of pregnancy only : 1st line- propylthiouracil (PTU), twice daily

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2
Q

1st line treatment for relapse of graves and side effects
(4 points)

A

radioiodine
use w/ steorid in active thyroid eye disease

contraindicted in pregnancy
risk of hypothyroidism

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3
Q

when to carry out thyroidectomy for hyperthyroidism

and side effects

A

useful when radioiodine contraindicted
SE’s:
recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism

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4
Q

Treatment for hypothyroidism

A

Levothyroxine daily

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5
Q

Post op care if thyroidectomy

A

Ca++ checked within 24 hrs
Ca++ replaced
If below 1.8mmol then IV ca++
Patient discharged on t3/t4

3-6months later for whole body Idoine scanning, give them thyrogine (rhTSH) prior to stimulate tsh - this shows metastasis

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6
Q

Management if MEN2
High risk

A

Total thyroidectomy in the beginning of life

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7
Q

addisons management
in an emergency situation and non emergency

what needs to be monitored

A

do not delay treatment to confirm diagnosis

1st line) If unwell: hydrocortisone 100-200mg IV + IV 0.9NaCl fluids (no fludocortsione in emergency)

otherwise: 15-30mg daily oral corticosteroid + fludocortisone daily

monitor bp & potassium

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8
Q

addisons patient education (details about sick day rules)

4 points

A

sick day rules:
1) double daily glucorticoid (hydrocortisone NOT fludocortisone) for moderate illness, surgery

2) severe illness etc, 100mg bolus IM of hydrocortisone

cannot stop suddenly
need to wear identification

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9
Q

Primary aldosteronism management (conns syndrome)

A

lifelong MR receptor antagonists for those who cant get surgery/bilateraly hyperaldosteronism:
-spironolactone (treats the hypokalaemia)
-amlodine (for Na reabsorption via ENAC)

unilateral laprascopic adrenelctomy 1st line.

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10
Q

treatment for prolactinoma

give drug names

A

1st line: dopamine agonist eg cabergoline
2nd: trans-spehnoidal surgery

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11
Q

endogenous cushings syndrome treatment
ACTH independant/dependant

A

mostly surgical to remove adenoma (either from pituitary or adrenals)
ACTH dependant- remove pituitary tumour (most common)
ACTH independant- remove adrenals, or could be ectopic (pancoast tumour)

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12
Q

what drug is first line to reduce cortisol excess (b4 surgery for eg)

A

metyrapone

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13
Q

treatment for acromegaly
give drug names as well

A

1st line) surgery (to remove pituitary adenoma)
2nd) somatostatin analogues (directly inhibits GH): octreotide
3rd line) gh antagonist- pegvisomant

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14
Q

definitive management of primary hyperparathyroidism

A

total parathyroidectomy

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15
Q

Phaeochromocytoma management-
most appropriate inital management & definitive management

give name of drugs

A

1st line: alpha blocker (eg. phenoxybenzamine)

2nd line: combination of a blocker + beta blocker (labetolol)

then surgery to remove phaecromocytoma

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16
Q

DKA initial mamagement and definitive management

(

A

initial: 1L 0.9% sodium chloride IV over one hour

fixed rate insulin infusion of 0.1 units/kg/hour & continue long acting insulin and stop short acting

once glucose is <14mmol start 10% dextrose (in addition to saline regime)

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17
Q

Woman with angina first diagnosed with diabetes initial management

A

Start metformin 1st then titrate upwards and add an SGLT-2 inhibitor regardless of glycemic control

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18
Q

Sick euthyroid treatment

A

Treat underlying cause
No treatment is required for the deranged thyroid function

19
Q

Beta blockers, polyurathicil, corticosteroids

this is the treatment for what

A

throtoxic storm treatment

20
Q

HHS treatment

3 points

A

Iv fluids 0.9% sodium chloride at 0.5-1L/hr

Possibly give potassium depending on their levels

Do not give insulin unless blood glucose stops falling with treatment of IV fluids

21
Q

when is a GLP-1 agonist (eg. liargulitide) considered in diabetic treatment

A

when a triple therapy (so metformin and 2 other frugs) has already been trialled and not worked. remember GLP1s also cause weight loss

22
Q

diabetic neuropathy treatment

A

1st line: amitryptiline (contraindicted in those with risk of urinary retention)
2nd: gabapentine, duloxetine, pregabalin

refer to pain clinic for resistant cases

23
Q

Myxoedemic come treatment

A

IV thyroxine and hydrocortisone

-a potentially fatal complication of undiagnosed hypothyroidism or poor adherence to levothyroxine therapy

24
Q

inital management for unilateral nasal polyps

A

Refer!! unilateral nasal polyps is a red flag

25
Q

ramsay hunt syndrome treatment

A

oral aciclovir for 7 days and oral prednisolone for 5 days

(shingles affecting the ear- this should be in the ENT deck)

26
Q

hypoglycaemia treatment: when should you give IM/ IV glucose

A

if patient is unconscious or unable to swallow

27
Q

treatment for toxic multinodular goitre

A

radioiodine therapy

28
Q

newly diagnosed adults with type 1 diabetes insulin regime

A

1st line: basal bolus using twice daily insulin detemir

29
Q

treatment for gastroparesis caused by metformin

A

metoclopramide

30
Q

de quervains thyroiditis (aka subacute) treatment

A

usually self limiting

1st: NSAID
2nd: steroids: (prescribe if hypothyoidism occurs)

31
Q

type 1 diabetes sick day rules

(4)

A

increase glucose monitoring,
drink 3l of water at least,
inc checking of ketone (every 4 hrs eg)
substitute meals for sugary drinks if struggling to eat

32
Q

what is a side effect of overuse of levothyroxine

A

osteoporosis

33
Q

max dose of metformin is…

A

1g (not mg!)

34
Q

Metformin sick day rules

A

Stop metformin until well (24-48hrs) risk of acidosis

35
Q

when should another drug be added onto metformin treatment for t2 diabetes

A

if hba1c remains 58mmol or above
unless
they are at risk of hf in which case u give metformin, then titrate up to max dose then give sglt2

36
Q

t1 diabetes is managed with insulin but metformin can sometimes be added on.
under what circumstances can metformin be added

A

bmi >25

37
Q

when is glucogel given over glucose tablets

A

only if not alert enough to swallow is glucogel given

38
Q

T2DM management non HF/CVD

A

1st: metformin

2nd: add dpp4/pioglitazone/sulfonyurea

3rd: add another drug from option above^
or
start insulin based treatment

4th: switch one fo the drugs for GLP-1mimetic if BMI>/= 35 or insulin

(therefore GLP-1 only started if patient is already on triple therapy and bmi>35 and hba1c isnt controlled yet)

39
Q

T2DM management for someone with HF/CVD risk

A

1st: metformin then titrate it up and add SGLT2

if metformin contraindicted do SGLT2 monotherapy

if hba1c is still >58mmol then follow normal guideline (so add more diabetes drugs )

40
Q

hypercalcaemia tx

A

1st: IV 0.9& saline
then give bisphsphonates

41
Q

endometrial polyps tx

A

myectomy

42
Q

toxic adenoma tx

A

1st line: radioiodine therapy

2nd: thyroidectomy

43
Q

acutely unewell in hospital and become hyperglycaemic first line management

A

fast acting insulin subcutaneously

Year 2 (50 decks)

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