endocrine treatments Flashcards
treatment for Graves (include oregnancy)
Include length if treatment
(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
1st line treatment for relapse of graves and side effects
(4 points)
radioiodine
use w/ steorid in active thyroid eye disease
contraindicted in pregnancy
risk of hypothyroidism
when to carry out thyroidectomy for hyperthyroidism
and side effects
useful when radioiodine contraindicted
SE’s:
recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism
Treatment for hypothyroidism
Levothyroxine daily
Post op care if thyroidectomy
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
Management if MEN2
High risk
Total thyroidectomy in the beginning of life
addisons management
in an emergency situation and non emergency
what needs to be monitored
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
addisons patient education (details about sick day rules)
4 points
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
Primary aldosteronism management (conns syndrome)
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.
treatment for prolactinoma
give drug names
1st line: dopamine agonist eg cabergoline
2nd: trans-spehnoidal surgery
endogenous cushings syndrome treatment
ACTH independant/dependant
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)
what drug is first line to reduce cortisol excess (b4 surgery for eg)
metyrapone
treatment for acromegaly
give drug names as well
1st line) surgery (to remove pituitary adenoma)
2nd) somatostatin analogues (directly inhibits GH): octreotide
3rd line) gh antagonist- pegvisomant
definitive management of primary hyperparathyroidism
total parathyroidectomy
Phaeochromocytoma management-
most appropriate inital management & definitive management
give name of drugs
1st line: alpha blocker (eg. phenoxybenzamine)
2nd line: combination of a blocker + beta blocker (labetolol)
then surgery to remove phaecromocytoma
DKA initial mamagement and definitive management
(
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)
Woman with angina first diagnosed with diabetes initial management
Start metformin 1st then titrate upwards and add an SGLT-2 inhibitor regardless of glycemic control
Sick euthyroid treatment
Treat underlying cause
No treatment is required for the deranged thyroid function
Beta blockers, polyurathicil, corticosteroids
this is the treatment for what
throtoxic storm treatment
HHS treatment
3 points
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
when is a GLP-1 agonist (eg. liargulitide) considered in diabetic treatment
when a triple therapy (so metformin and 2 other frugs) has already been trialled and not worked. remember GLP1s also cause weight loss
diabetic neuropathy treatment
1st line: amitryptiline (contraindicted in those with risk of urinary retention)
2nd: gabapentine, duloxetine, pregabalin
refer to pain clinic for resistant cases
Myxoedemic come treatment
IV thyroxine and hydrocortisone
-a potentially fatal complication of undiagnosed hypothyroidism or poor adherence to levothyroxine therapy
inital management for unilateral nasal polyps
Refer!! unilateral nasal polyps is a red flag
ramsay hunt syndrome treatment
oral aciclovir for 7 days and oral prednisolone for 5 days
(shingles affecting the ear- this should be in the ENT deck)
hypoglycaemia treatment: when should you give IM/ IV glucose
if patient is unconscious or unable to swallow
treatment for toxic multinodular goitre
radioiodine therapy
newly diagnosed adults with type 1 diabetes insulin regime
1st line: basal bolus using twice daily insulin detemir
treatment for gastroparesis caused by metformin
metoclopramide
de quervains thyroiditis (aka subacute) treatment
usually self limiting
1st: NSAID
2nd: steroids: (prescribe if hypothyoidism occurs)
type 1 diabetes sick day rules
(4)
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
what is a side effect of overuse of levothyroxine
osteoporosis
max dose of metformin is…
1g (not mg!)
Metformin sick day rules
Stop metformin until well (24-48hrs) risk of acidosis
when should another drug be added onto metformin treatment for t2 diabetes
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
t1 diabetes is managed with insulin but metformin can sometimes be added on.
under what circumstances can metformin be added
bmi >25
when is glucogel given over glucose tablets
only if not alert enough to swallow is glucogel given
T2DM management non HF/CVD
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)
T2DM management for someone with HF/CVD risk
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 )
hypercalcaemia tx
1st: IV 0.9& saline
then give bisphsphonates
endometrial polyps tx
myectomy
toxic adenoma tx
1st line: radioiodine therapy
2nd: thyroidectomy
acutely unewell in hospital and become hyperglycaemic first line management
fast acting insulin subcutaneously
