Endocrinology Flashcards
What are examples of mineralcorticoids?
Fludrocortisone and hydrocortisone
What are examples of glucocorticoids?
Dexamethasone, betamethasone, prednisolone
What are the side effects of mineralocorticoids?
hypertension due to retention of sodium and water
Loss of potassium and calcium ions
What are the side effects of glucocorticoids?
ACHINGBOSOM Adrenal suppression Cushing syndrome Hyperglycaemia/ Hyperlipidaemia Insomnia / Infections Nervous system/ Psychiatric reactions Gastrointestinal / Glaucoma
Blood pressure increase Osteoporosis Skin thinking Obesity Muscle wasting
When should abrupt withdrawal be avoided when taking steroids?
- Long term use >3 weeks
- > 40mg daily for one week
- Repeated doses taken in the evening
- Recent repeated courses
- Short course within 1 year of stopping long term steroids
- Have other causes of adrenal suppression
What are the symptoms of Cushing syndrome?
- Skin thinning
- Easy bruising
- Reddish- purple stretch marks
- Striae “stretch marks”
- Fat deposits in the face
- Moon face
- Acne
- Hirsutism “dark facial hair on woman”
- Amenorrhoea “ the absence of menstruation”
When taking risedronate what should be avoided?
Leave 2 hr gap between risedronate and food, drink, antacids, calcium-containing products such as milk, iron or mineral supplements
What are the common side effects of Bisphosphonates?
- Oesophageal reactions
- Atypical femoral fractures
- Osteonecrosis of the jaw - Report any oral symptoms: dental mobility, pain, swelling, non-healing sores or discharge– > this is most common with zolendronic acid
- Osteonecrosis of external auditory canal: Report ear pain, ear discharge or ear infection during treatment.
What is tibolone?
Its a combined HRT of oestrogenic, progestogenic and weak androgenic
What cancers are caused by HRT as a SE?
- Ovarian cancer
- Breast cancer
- Cervical Cancer
- Endometrial cancer- adding progesterone reduces this additional risk
What are the reasons to stop HRT?
VTE
Stoke
Liver dysfunction caused by oestrogen
Blood pressure about 160/95
What is used to stimulate ovulation in infertile women?
Clomiphene
“max use is 6 cycles”
What’s first line treatment of hypothyroidism?
Levothyroxine; max dose usually 200mcg
Take in the morning at least 30 minutes before breakfast, caffeine-containing liquids or other medication
What’s second line treatment of hypothyroidism?
Liothyronine 25mcg = 100mcg of levothyroxine
ideal in severe hypothyroid emergencies as it has a rapid effect and more potent
Switching brands without a UK licence may not be bioequivalent
What course of action is taken if hyperthyroidism occurs with levothyroxine or liothyronine?
Reduce dose or withhold 1-2 doses and start again at a lower dose
What are the symptoms of hypothyroidism?
Cold intolerances Weight gain Constipation Bradycardia Lethargy Muscle cramps Slow movements Slow thoughts Depression Hair thinning
What are the symptoms of hyperthyroidism?
Heat intolerance Weight loss Diarrhoea Tachycardia Excitability Tremors Angina pain Sweating Arrhythmias
What is first line treatment of hyperthyroidism and what reason would cause it to be changed to second line?
1st line is carbimazole
if a rash is developed give antihistamine or switch to propylthiouracil
What is second line treatment for hyperthyrodism?
Propylthiouracil
What is used in first trimester and second trimester of pregnancy with hyperthyrodism?
1st trimester use Propylthiouracil
2nd trimester use Carbimazole
What is the fasting blood-glucose concentration target on waking?
5-7 mmol/L
What is the fasting blood-glucose concentration target on before meals?
4-7mmol/L
What is the fasting blood-glucose concentration target 90 minutes after eating?
5-9 mmol/L
What is the fasting blood-glucose concentration target when driving?
5mmol/L
What is the HbA1C blood test recommended to be for initial diagnosis for T2D?
6.55 or 48 mmol/L
What is the target hypertension for a diabetic without complication and with complications?
Without complications= 140/80
With complications= 130/80
What drink/food can help in a hypoglycaemic event?
10-20g of glucose/ sucrose Coca-Cola 100-200ml Lucozade original 55-100ml sugar lumps 3-6 Sugar 2-4 tsp
What is diabetic ketoacidosis?
Occurs when blood glucose levels are extremely high which results in ketone build up
What are the symptoms of diabetic ketoacidosis?
Symptoms:
- Severe hyperglycaemia
- High blood Ketones
- Ketonuria
- Pear drop breath
- Dehydration or excessive thirst
- Polyuria
- Nausea and vomiting
- Anorexia
- Abdominal pain
- Difficulty breathing
- Electrolyte imbalance
- Mental confusion
- Drowsiness
- Diabetic coma
- Convulsion
How is diabetic ketoacidosis treated?
soluble insulin- as its fast acting
fluid to hydrate
potassium to correct hypo
What are the symptoms of hypoglycaemia ?
Symptoms:
- hunger
- pale skin
- tingling lips
- sweating, chills, clammy
- Dizziness
- Shakness
- Palpitations
- Blurred vision
- Confusion
- Irritability
- Irrational behaviour
- Slurred speech
- Difficulty concentrating
- Drowsiness and coma
What actions are required if hypoglycaemia occur during driving i.e. below 5mmol/L?
- Stop vehicle in safe place and switch engine off
- Eat or drink a fast-acting sugar and then long-acting carbohydrate e.g. sandwich to maintain levels
- Wait 45 minutes after blood glucose levels return to normal, before continuing journey
What antagonises the hypoglycaemic effect of insulin?
Corticosteroids
Oral contraceptives
Loop/Thiazide diuretics
What masks the symptoms of a hypoglycaemia with diabetes?
beta blockers
What enhances hypoglycaemic effect of insulin>
ACE inhibitors
Alcohol
What is olanzapine associated with in diabetes?
high blood sugar levels in new onset or pre-existing diabetes mellitus and ketoacidosis which may be reversible after discontinuation of olanzapine
