F1 Hormone therapies Flashcards
1
Q
what are the 3 main types of hormones?
A
steroid (contain cholesterol)
peptide
amine
2
Q
state examples of steroid hormones
A
oestrogen
progesterone
testosterone
cortisol
3
Q
state examples of peptide hormones
A
insulin
glucagon
ADH
oxytocin
4
Q
state examples of amine hormones
A
adrenaline
thyroxin
triiodothyronine
Human Growth Hormone
5
Q
describe type 1 diabetes
A
- autoimmune (caused by virus or allergen exposure)
- progressive destruction and loss of function of islet beta cells
- onset usually under 40 years (early)
- rapid onset
- treatment with insulin, regular exercise and healthy diet
6
Q
how is insulin released?
A
positive signals go to pancreatic beta cells and they then release insulin
7
Q
various roles of insulin
A
- acts on insulin receptor (tyrosine kinase receptor)
- stimulates glucose uptake into skeletal muscle through increase in GLUT4 transporters
- stimulates conversion of glucose into glycogen in the liver
- prevents glycogen breakdown
- inhibits glucose synthesis (gluconeogenesis)
- stimulates lipogenesis (storage of fat)
- inhibits food intake
- stimulates cells to take up potassium
8
Q
describe the insulin receptor and what happens when insulin binds
A
- tyrosine kinase activity of enzyme leads to phosphorylation of each subunit and activation of downstream signalling cascade
- insulin binding to receptor will open up GLUT
9
Q
how are insulins classified?
A
- according to duration of action
- normally insulin forms into hexers which break into monomers to be absorbed into bloodstream (short-acting insulins will have more of a tendency to form monomers to be absorbed into the blood)
10
Q
what is detemir?
A
- 14 carbon fatty acid (myristic acid) bound which promotes binding to albumin
- dissociates slowly from albumin
- long-acting insulin
11
Q
how does insulin glargine work?
A
- structural changes to insulin molecule make it less soluble at physiological pH
- it precipitates on injection which leads to slow absorption from subcutaneous space
- long-acting insulin
12
Q
what are the 4 classifications of insulin?
A
- short-acting human insulin analogues
- intermediate
- long-acting
- biphasic (pre-mixed)
13
Q
describe short-acting human insulin analogues
A
- soluble and rapid acting
- typically taken after a meal
14
Q
describe long-acting insulins
A
- mix of insulin complexed other ingredients
- gradually absorbed into bloodstream
- eg. insulin glargine
- eg. insulin detemir
15
Q
describe biphasic (pre-mixed) insulins
A
mix of short and intermediate acting insulins
16
Q
describe the action profiles for the 4 types of insulins
A
17
Q
compare the action profiles for short and long acting insulins
A
18
Q
compare the action profiles for short vs intermediate acting insulins
A
19
Q
what is monitoring particularly important for?
A
- essential for good glycemic control
- good glycemic control = minimise acute and long-term complications of DM
20
Q
what are steroids?
A
steroids, also called corticosteroids, are anti-inflammatory medicines used to treat a range of conditions
21
Q
state some conditions that can be treated with steroids / corticosteroids
A
- asthma and COPD
- hayfever
- severe hives
- eczema
- painful joints or muscles (eg. arthritis, tennis elbow, frozen shoulder)
- pain caused by an irritated or trapped nerve eg. severe sciatica
- IBS
- lupus
- multiple sclerosis (MS)
22
Q
symptoms of anaphylaxis
A
- itching, hives, redness or swelling of the skin
- throat tightness or swelling
- swelling of the lips, tongue and throat
- coughing, wheezing, trouble breathing
- dizziness, disorientation or confusion
- low blood pressure / hypotension
- nausea, vomiting, diarrhoea, abdominal cramps, loss of bowel movements
- weakened pulse, increased heart rate or loss of consciousness
23
Q
draw a diagram to show the phases of an allergic response
A
24
Q
what causes a severe allergic reaction biologically?
A
- our immune system produces antibodies to defend against foreign substances
- some people’s bodies overreact to substances that shouldn’t be seen as a threat which triggers allergic reaction or anaphylactic shock
25
explain the differences in allergies in different people
- some people are born with certain allergies and others may present in later life
- other factors to consider may include asthma, eczema and family history of allergies
- for children, most common triggers are foods such as certain fruits, peanuts, fish, shellfish and milk
- for adults, triggers can extend to medications like antibiotics or aspirin or even insect stings or latex
26
describe beta 1 adrenoceptors, giving example and function
eg. sinoatrial node and ventricles in heart
rate and force of contraction
27
describe beta 2 adrenoceptors, giving example and function
eg. airway smooth muscle
relaxation
28
state examples of where beta 3 adrenoceptors are found
eg. skeletal muscle, adipose tissue
29
aim of treatment of anaphylaxis
- rapid relief of symptoms
- block early phase of allergic attack
30
what are the 2 routes for treatment of anaphylaxis?
intramuscular injection
- 500 micrograms using adrenaline 1 in 1000 injection
- repeat dose after 5 minutes if there is no response
- injected into anterolateral aspect of the middle third of the thigh
slow intravenous injection
- 1 mg every 3-5 minutes as required
- 1 in 10 000 solution is recommended
31
describe EpiPens
- patients must carry 2 devices with them at all times
- use the adrenaline autoinjector
- use if there are any signs affecting the ABC
32
what is ABC when it comes to anaphylaxis?
airways
- swelling of the tongue
- a feeling of constriction in the throat
breathing
- wheezing
- difficulty in breathing
circulation
- feeling faint
- dizzy
- cold clammy skin
33
describe hormonal changes around the menopause and how this can cause breast cancer
- before the menopause, the ovaries produce the hormones oestrogen and progesterone
- after the menopause, oestrogen is made in body fat and muscle
- these hormones can stimulate the growth of some breast cancer cells
34
describe Tamoxifen as a treatment for breast cancer
- selective oestrogen receptor modulator (SERM)
- most common chemo-preventative medicine (used after cancer therapy)
- only effective in ER positive breast cells (confirmed with biopsy)
- binds to the ER in competitive manner
- to prevent new cancer cells from growing
35
describe aromatase inhibtors as treatment for breast cancer
- disrupt the production of oestrogen via blockage of aromatase enzyme
- patients with secondary ER positive breast cancer not responded to TAM
- aromatase inhibtors work by stopping oestrogen being made in body fat after the menopause
36
state some types of aromatase inhibitors used as breast cancer treatment
anastrozole (Arimidex)
letrozole (Femara)
exemestane (Aromasin)
37
describe Fulvestrant (Faslodex) as a treatment for breast cancer
- oestrogen receptor antagonist
- similar mechanism to TAM
- can also modify oestrogen receptors in the cancer cells (down regulation)
- delivered as an injection
38
describe progesterone (Megace or Provera) as a treatment for breast cancer
- used in patients unable to take AIs or TAM or patients that are unresponsive to all other treatment attempts
- artificial progesterone can control the growth of breast cancer cells
- most common are: medroxyprogesterone acetate (Provera) and megestrol acetate (Megace)
39
common side effects of breast cancer treatment
- hot flushes and sweating
- changes to your periods if you still have them
- less interest in sex
- vaginal dryness or discharge
- feeling sick
- painful joints
- mood changes
- tiredness
- osteoporosis
- early menopause
40
state some treatments for breast cancer
- Tamoxifen (TAM)
- aromatase inhibitors (AIs)
- Fulvestrant (Faslodex)
- progesterone (Megace or Provera)
