Endocrineywiney Flashcards
What HRT should be given to ladies without a uterous
don’t need progesterone- only women with uterus need
why is HRT used in early menopause
because women are at increased risk of oesteoperosis
Why are we giving progesterone cyclically with the oestrogen
to prevent cancer of the uterous (or the missing but in a hyderectomy) from developping
Is tibolone given cyclically
no - continuous
when is early menopause and how long do we treat it for
before 45
treat until usualy menopause - 50
under what age do the benifits of HRT probably outweigh the risks
under 60
how many days of the cycle is progesterone given
at least 10 of 28
when is the risk of DVT with HRT highest
first year
how long before surgery should we stop hrt
4-6 weeks
What are the rules for when pred should NOT be abruptly withdrawn
- dose over 40mg for over 1 week
- repeated doses in the evening
- more than 3 weeks treatment
- short course within 1 year of stopping long term therapy
- received repeated short courses (particularly if taken for longer than 3 weeks)
why is hydrocortisone not suitable long term (use pred instead)
high mineralocorticoid activity resulting in fluid retention)
what vaccines should be avoided in people receiving systemic corticosteroids
live
diseases someone on long term steroids should be councelled about
avoid chicken pox, measales, shingles
what is the purpose of the dexamthasone suppression test
diagnose cushing syndrome
5 mineralocorticoid side-effects
hypertension sodium retension water retention potassium loss calclium loss
what suprise drug is used to TREAT cushing syndrome
What is the caution with this
ketoconazole
liver toxicity- no longer recommended for antifungal effect
when is BM monitoring suitable in T2DM
insulin treated
using drugs causing hypos
to monitor effects of lifestyle changes or illness
to ensure safe levels when driving
how much glucose is used to treat a hypo initially….
and then
10-20g
repeat if needed after 10-15 mins
then have a long acting carb snack
what is used to treat an unconcious hypo
glucagon - when possible carbs by mouth
what % glucose is idea for treating hypo by IV
20%
50% increased risk of extravisation
what is an option for treating post menopausal arthritis if bisphosphoantes are not an option
(3)
HRT - but bone loss continues once stopped
calcitrol
strontium
why is calcitonin salmon no longer recommended for oesteoperosis?
risk of malignancy outweighs benifits
when in steroid therapy does the most bone loss occur
first 6-12 months
consider prophylaxic treament for oesteoperotic fractures for people likely to be taking steroids for how long
over 3 months
strotium ranelate has what warning associated with it
CV risk
what oesteoperosis fracture preventing drug must be stopped for temporary or prolonged immobilisation
strontium
Which is longer acting desmopressin or vasopressin?
Which is used for maintinance of diabetes insipudus
Desmonpressin - longer acting maintaince
which has vasocontrictor effect, desmopressin or vasopressin?
Vasopressin - so used for variceal bleeding in portal hypertension
what drug is used to correct hyponautremia caused by inapprpriate secretion of antidiuretic hormone
demeclocycline
electrolyte imbalance caused by demopressin
hyponautraemic convulsion
dopamine receptor agonists, including quinagolide for hyperlactinemia, pretty much all carry what warning?
What other warning is quinagolide associated with?
Sudden onset of sleep
Hypotensive reactions
ways to reduce breast pain (2)
reduction in dietary fat
not using OC/HRT
what warning is associated with prostate cancer drugs such as goserelin (anything ending in -elin)
tumour flare - initial increase in tumour progression due to higher levels of circulating testosterone
May cause spinal cord compression. Consider different treatments if this is likely.
why should iodine not be used for the long term treatment of hyperthyroidism
action tends to diminish over time
betablockers are somtimes used to treat thyrotoxicosis. But do they affect thyroid funciton tests?
no
what is the hyperthyroid treatment of choice in each stage of preg
1st trimester - propylthiuricil (carbimazole associated with defects)
2nd onwards - carbimazole (less hepatotoxicty)
Carbimazole BNF safety warning box?
neutropenia and agranualocytosis
