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Clin Med > Endocrine Treatments > Flashcards

Endocrine Treatments Flashcards

1
Q

Tx for Grave’s disease

A
  1. Thioamides: Methimazole and PTU (less common)
  2. Radioiodine
  3. BBs–propranolol
  4. Procedural tx–thyroidectomy, ablation of gland
  5. Opthalmology: glucocorticoids
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2
Q

TX for thyroid storm

A 
Propylthiouracil (PTU) is the antithyroid DOC 
\+
IV fluids 
\+
Propranolol 1-2 Mg IV 
\+
Iodine SSKI potassium iodide drops 
\+
Glucocorticoids--hydrocortisone 100mg IV 
\+
anti-pyretics for fever-- avoid ASA
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3
Q

Tx for toxic adenoma of thyroid

A
  1. radioactive iodine ablation

2. Surgery

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4
Q

TX for Transien Hypothyroidism or Subacute Thyroidits

A

Supportive

  • NSAIDs or ASA for pain and inflammation
  • **most cases self limiting—95% return to euthyroid state
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5
Q

TX for TSH secreting Pituitary Adenoma

**test of choice for this??

A

TOC=pituitary MRI

TX:

  • Radioactive iodine albation
  • PTU or methimazole

definitive tx* transsphenoidal resection

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6
Q

Tx for Suppurative Thyroiditis

A

ABX

*if fluctunat– I/D

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7
Q

Tx for Hashimoto

Contraindications? /

A

Levothyroxine–synthroid–synthetic T4

CONTRA: acute MI, tx for obesity and uncontrolled HTN

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8
Q

what do you always do before starting tx for hypothyroidism?
-monitoring schedule?

A

-obtain a baseline of free T4, TSH, LFT, CBC

Monitoring: repeat labs after 4-6 wks of tx and 4-6 wks after any adjustmnets in dosing

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9
Q

tx for cretinism

A

life long levothyroxine

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10
Q

Tx for subclinical hypothyroidism

A

no tx

just monitor TSH levels

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11
Q

If Patients TSH levels are low—how do you manage their levothyroxine dose?

*same question for if the TSH was high

A

Low tsh—lower the dose (indicating hyperT)

high TSH—increase dose of levothyroxine (indicating hypoT is still present)

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12
Q

Tx for hypopituitarism

A
  1. hormone replacement

2. fix underlying cause of the hypopituitarism

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13
Q

tx for euthyroid sick syndrome

A

none— consult endocrine

**management is focused on treating the systemic illness

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14
Q

tx for myxedema coma

A

IV levothyroxine

Supp. care–ICU admission, IV fluids, passive warming, IV glucocorticoids,

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15
Q

adv effects from levothyroxine tx

A

Mi
osteopenia
HA

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16
Q

Tx for silent thyroiditis aka post partum thyroiditis

A 
nothing 
*self limiting 
*euthyroid w/in 8-12 MOs
*symptomatic--like BBs 
NOO anti-thyroid meds
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17
Q

Tx for primary hyperaldosteronism

A

A: if caused by bilateral adrenal hyperplasia

  • Na+ restricted diet
  • spironolocatone or eplerenone
  • ACEI and/or BBs

B: if caused by aldosterone secreting adrenaoadenoma

  • spironolactone
  • surgical removal of the tumor
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18
Q

Tx for Addison’s disease

A

GLucocorticoid replacement with Hydrocortisone

Mineralcorticoid replacement with Fludrocortisone

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19
Q

TX for Acute Adrenal Insuff aka Addisonians Crisis

A
  1. IV isotonic (crystaloid) fluids (NSS or D5N5)
    AND
  2. IV hydrocortisone—- for known addisonian PT
    or
  3. IV dexamethasone–for unknown diagnosed addisonian PT
  4. fix any electrolyte abnormalities
  5. fludrocortisone if necessary
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20
Q

TX for Cushing’s Syndrome

A

If due to exogenous—gradual taper of corticoidsteroids–GRADUAL in order to prevent Addisonians Crisis

  1. If due to Cushing’s DZ: Transphenoidal resection to remove pituitary tumor
    * if cannot opperate administer*:
    - Mifepristone: glucocorticoid rec antagonist
    - Radiation therapy or Pasireotide–somatostatin analogue
  2. Adrenal tumor: tumor excision
  3. Ectopic Tumor: Resection if possible–If UNresectable… administer
    -Ketoconazole–antifungal
    or
    -Metyrapone–Adrenal Steroid Synthesis Inhibitor.
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21
Q

Tx for pheochromocytoma

A

*need to initiate pharmacotherapy before surgery

  1. Nonselective alpha blockade is best initial tx
    - PHEnoxybenzamine or PHEntolamine
    * administer 1-2 wks before surgery
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22
Q

what medical therapy do we not want to initiate for a pheochromocytoma patient?

A

BETA blockade—– it can cause severe HTN crisis due to inititating alpha constriction during catecholamine release triggers by surgery or spontaneously.

Then: definitie management is complete adrenalectomy

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23
Q

why do we never give BB alone to tx pheochromocytoma

A

the BB will block the vasodilation affect of the beta blockers—but the alpha receptors will still be stimulated by pheochromocytoma’s epinephrine—- leading to HTN crisis
***why ALPHA antagonists are given

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24
Q

Tx for TSh secreting pituitary adenoma

A

transphenoidal surgery–definitive management

*somatostatin analogs may be used prior to surgery to restore euthyrodism

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25
Q

TX for Papillary Thyroid Carcinoma

A

Thyroidectomy–subtotal or total
-post-op Levothyroxine given–to replace and supress tumor regrowth

  • post surgery radioiodine in some PTs
  • post-tx: may monitor thyroglobulin levels, TSH, and US of neck
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26
Q

Tx for Follicular thyroid carcinoma

A

Thyroidectomy–subtotal or total
-post-op Levothyroxine given–to replace and supress tumor regrowth

  • post surgery radioiodine in some PTs
  • post-tx: may monitor thyroglobulin levels, TSH, and US of neck
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27
Q

Tx of medullary thyroid carcinoma

A

TOTAL thyroidectomy

  • very poor prognosis
  • calcitonin levels are used to monitor for recurrence or residual disease
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28
Q

Tx for anaplastic thyroid carcinoma

A

Most cases cannot be surgically resected

  • tx is PALLIATIVE:
  • tracheostomy may be needed to maintain airway
  • PEG feeding tube

*Can try chemo or external beam radiation

29
Q

Tx for Men Type 1

A

Tumor specific (according to PPP)

30
Q

Tx for MEN type 2

A

surgical resection of ALL tumors

31
Q

best initial test for papillary thyroid CA?

A

US

32
Q

best definitive test for papillary thyroid CA?

A

FNA

33
Q

what is the second MC type of thyroid CA

A

follicular thyroid carcinoma

34
Q

which is slower growing— papillary or follicular

A

follicular

35
Q

where does foliclar like to met?

A

bones
CNS
lungs

36
Q

MC age of onset for follicular thyroid CA

A

40-60

diagnosis at 50+——>pooer prognosis

37
Q

which CA is derived from calictonin synthesiznig parafollicular cells

A

medullary thyroid CA

38
Q

10% of all cases of medulary thyroid CA are aossic with

A

MENIIa or MEN IIb

39
Q

what drug is medullary thyroid CA associated with

A

GLP antagonists

40
Q

what thyroid CA does not take up radioactive iodine?

A

medullary thyroid CA

41
Q

rock hard thyroid mass?

A

anaplastic thyroid CA

42
Q

tx for DKA

A 
S----saline 
I---insulin--regular 
P---potassium replacement 
S---search for underlying cause
*bicarb too
43
Q

why do we give K+ replacement for DKA?

A

because insulin naturally drives K+ into the cell…. so when we give exogenous insulin the K+ levels will FALL– so we need to avoid that by giving exogenous K+ replacement

*and bc the PT is super dehydrated

44
Q

In determining the severtiy of DKA– monitoring what levels is imp?

A

bicarb levels More IMP than monitoring glucose levels

**closing the anion gap determines complete management*

45
Q

first hour of DKA management, what kind of saline solution do we give

A

1 L of 0.9% NSS to re-expand contracted vascular tone
AND
rehydrate

46
Q

when BGL falls to around ____ mg/Dl.. we use ______ solutions to maintain blood glucose

A

250

D5 glucose solutions

47
Q

when do we administer bicarb to the DKA patient

lab value

A

when pH is below 7.0 or less

*keep giving until arterial PH reaches 7.1

48
Q

which saline solution do we NOT want to mix bicarb with?

A

NSS 0.9% bc that makse a hypertonic soln

49
Q

what solution of saline do we mix bicarb with

A

1L of 0.45% saline

50
Q

who do we NOT give K+ replacement to

A

Pts on dialysis or with CKD

51
Q

when K+ levels fall below______ K+ replacement recc

A

> 5.3

52
Q

initial TX for DM2

A

diet
exercise
Life style mod

53
Q

when do you incorporate antihyperglycemic PO meds in DM2

-what is the initial PO drug to use

A

if PT unable to control glucose with Life style mod

metformin

54
Q

how does metformin work

A

decreases hepatic glucose production and increases peripheral glucose uptake

55
Q

what are the glucose goals and managment for DM2

  1. A1C
  2. Preprandial glucose b/w?
  3. postprandial glucose under?
  4. BP?
A
  1. under 7.0%–check evry 3 months
  2. 80-110
  3. <140
  4. target is <130/80
56
Q

who should be taking statins?

A

DM patients who are b/w 40-75 YO with LDL levels of 70-189 but without clinical ASCVD

57
Q

who is contradinicated for metformin and WHY

A

DM with chronic renal failure
metforming MOA *inhibits gluconeogenesis in liver–>making the body use fat as fuel–wt loss! But we make ketones–which affect kidneys-so we cannot give to somene with weak kidneys

58
Q

TX for HHS

A

S— saline solution– rehydrate
I—insulin (regular)
P—K+ supplementation
S—search for underlying cause

59
Q

tx for acromegaly or gigantism

tx for refractory?

A

THREE PRONG APPROACH

  1. stop the hypersecretion
    - transsphenoidal surgery
  2. Preserve pituitary function
    - FIRSST LINE: Octreotide or Lanreortide–they are synthethic hormones mimicking/same as somatostatin (which inhibits GH)
    - SECOND: Cabergoline or Bromocriptine–dopamine agonists— BC dopaine also inhibs GH**
    - third line: Pegvisomant–GH receptor antagonist that inhibits IGF-1 release
  3. ameliorate comorbidities

**radiation tx is reserved for refractory cases

60
Q

tx for cortiocotroph adenoma aka cushings disease

A

transsphenoidal resection TOC

61
Q

TX for hyperprolactinemia

A

Bromocriptine or Cabergoline (bc dopamine inhibs prolactin)

surgical removal of the tumor

62
Q

Tx for central DI
1st?
2dn?

A

Desmopressin–is a synthetic ADH (DDAVP) first line–intranasal injection or PO

second line: carbamazepine second line

63
Q

Tx for SIADH

mild:

moderate-severe:

severe w/ obtundation (severe hyponatremia):

chronic:

A
  • treat underlying cause*
    mild: fluid restriction po (ex: under 800 mg-1L daily)

moderate-severe: ADH receptor antagonists–Convipatan or Tolvaptan

severe w/ obtundation (severe hyponatremia): IV HYPERtonic saline + furosemide
***do not give too fast bc can cause central pontine myelinolysis

chronic: Demeclocycline—inhibits ADH

64
Q

–vaptans in tx for?

A

SIADH

*ADH receptor antagonists

65
Q

TX for hyPOcalcemia
mild
severe or sympto

A

mild: oral CA + Vit D supplements
* may need K+ and Mag too

Severe or symptomatic: IV calcium gluconate or IV calcium carobonate

66
Q

TX for Hypercalcemia

  • mild
  • moderate-severe
A

mild:
- no immedaite tx needed— treat underlying cuase and increase water intake (bc this will promote CA excretion)

Mod-severe:
-IV fluids is INITIAL management–this promotes excretion

  • IV loop diuretics–Furosemide to further promote excretion
  • Calcitonin can be helpful adjunct in malignancy *fast onset of action than Bisphosphonates
  • Bisphosphonates–>Zoledronic acid or Pamidronate can be given with calcitonin in malignancy
  • Denosumab–>helpful adjunct in malignancy
  • Glucocorticoids–>for granulomatous disease
67
Q

tx for hyerparathyroidism

A

Parathyroidectomy definitive managment

vit d and Ca supplements post surgery

Cinacalcet inhibits release of PTH in PTs that are not candidates for surgery

Mild cases can just be observed

if severe CA develops–IV fluids and fureosemide

68
Q

Tx for hypoparathyroidism

A

Calcium supplementation + activated Vit D (calcitriol)

acute symptomatic–>IV calcium gluconate

Clin Med (52 decks)

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