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part 2 endocrine Flashcards

1
Q

what is the mhra warning with systemic administration of corticosteroids?

what should patients report?

A

chorioretinopathy [retinal disorder]

report signs of blurred vision/vision disturbances

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2
Q

what 2 hormones are classed as mineral corticosteroids and what is their role?
which can hold the most water?

A

hydrocortisone and fludrocortisone

water. help with fluid retention. where sodium goes water flows. they retain water in the body and that allows sodium to be retained in the body, thus increasing blood pressure.

fludrocortisone

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3
Q

list some examples of glucocorticoid hormones and explain what they do

A

dexamethasone, methylprednisolone and prednisolone

help reduce inflammation

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4
Q

what are the 5 side effects of glucocorticoids?

A

diabetic bodybuildes are psychos and get stomach ulcers from eating broken bones

  • peptic ulcers
  • diabetes
  • psychiatric reactions
  • osteoporosis
  • muscle wastage
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5
Q

what are the 5 side effects of mineralocorticoids?

A 
- water retention
potassium loss
calcium loss
hypertension
sodium retention
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6
Q

what is adrenal suppression and what is the cause most of the time?

A

adrenal glands not producing enough corticosteroids which regulate sodium potassium and water retention

cause is mainly addisons disease

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7
Q

what are the 9 signs and symptoms of adrenal suppression?

A 
fatigue
anorexia
hypotension
hyponatraemia
hyperkalaemia
hypoglycaemia
salt craving
nausea and vomiting
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8
Q

in what ways can you manage the side effects of corticosteroids

A

use lowest dose for shortest time
short course of steroids
using spacer device for high doses to allow for airway deposition and reduce oropharyngeal deposition

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9
Q

what is the corticosteroid replacement therapy given in adrenal suppression?

A

a combination treatment of fludrocortisone and hydrocortisone because hydrocortisone on its own does not give enough mineral corticosteroid activity

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10
Q

what are the 5 major side effects with systemic corticosteroids?

A
  1. adrenal suppression with long term use. do not abruptly stop
  2. infection risk increases
  3. measles risk increases
  4. chicken pox risk increases unless already had it
  5. psychiatric reactions eg mood swings, depression etc
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11
Q

are corticosteroids suitable for pregnancy?

A

the benefits must outweigh the risks

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12
Q

which patients is gradual withdrawal of corticosteroids considered for? [6 things]

A
  1. had another short course of steroids after a year of long term use
  2. had more than 40mg daily for more than 1 week
  3. have had any other cause of adrenal suppression
  4. have had repeat courses of more than 3 weeks
  5. have had repeat doses in the evening
  6. have had more than 3 weeks treatment
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13
Q

what is HYPERthyroidism

A

high levels of thyroid hormones in body causing thyrotoxicosis

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14
Q

what do the levels of TSH [thyroid stimulating hormones] and T4 [thyroxine] look like in hypothyroidism and hyperthyroidism?

A 
hyperthyroidism = low TSH and high T4
hypothyroidism = high TSH and low T4
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15
Q

what are the signs and symptoms of hyperthyroidism? [5]

A
  • swollen neck [goitre]
  • weight loss
  • disturbed sleep
  • hyperactivity
  • heat intolerance
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16
Q

which 2 drugs are used for hyperthyroidism and which one is the most commonly used one?

A

carbimazole [most common]

propylthiouracil

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17
Q

what is blocking replacement therapy and why is it done?

A

a combination of levothyroxine and carbimazole

done because overtreatment with carbimazole can cause hypothyroidism so use levothyroxine as well to create balanced thyroid levels

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18
Q

can pregnant women have the blocking regimen regime?

A

no

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19
Q

what is a thyrotoxic crisis [a thyroid storm]?

A

oversecretion of thyroid hormones producing deadly levels - medical emergency

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20
Q

what are the signs and symptoms of a thyroid storm?

A

rapid heart beat, unconsciousness, jaundice, N&V, diarrhoea, high temp

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21
Q

what is the emergency treatment for a thyroid storm?

A
  • IV fluids
  • hydrocortisone
  • propanolol
  • oral iodine, carbimazole, propylthiouracil
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22
Q

which hyperthyroid drugs are suitable for pregnancy?

why are small doses recommended during pregnancy?

A

carbimazole and propylthiouracil

because they can cross the placenta and cause fetal goitre and hypothyroidism

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23
Q

which antithyroid drugs are the drug of choice in the 1st trimester and then the 2nd trimester and why?

A

propylthiouracil for 1st trimester because carbimazole causes congenital effects

switch to carbimazole for 2nd trimester because propylthiouracil may cause hepatoxicity [watch out for dark urine, N&V, jaundice symptoms]

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24
Q

what is the important safety information related to carbimazole? what is the pt and carer advice

A

warn pt to tell doctors if they get any non specific illness eg sore throat, bruising, mouth ulcers

carbimazole can cause neutropenia so bone marrow suppression, infections esp sore throat, infections

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25
Q

what are the 2 MHRA warnings related to carbimazole?

A

congenital defects in 1st trimester [wear contraception]

acute pancreatitis

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26
Q

what should you monitor for whilst taking propylthiouracil?

A

hepatotoxicity

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27
Q

patient and carer advice for propylthiouracil?

A

hepatoxicity signs and symptoms [N&V, jaundice, fatigue, anorexia, dark pee]

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28
Q

what is HYPOthyoridism?

A

under production of thyroid hormones

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29
Q

what are the signs and symptoms of hypothryoidism? [6]

A 
weight gain
fatigue
depression
intolerance to the cold
constipation
menstrual irregularities
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30
Q

what are the primary and secondary causes of hypothyroidism?

A

primary: iodine deficiency, surgery, radiotherapy, drugs, disease
secondary: pituitary/hypothalamic disorder

31
Q

what are the 2 drugs used in hypothyroidism and which one is the most commonly used?

A

levothyroxine - most commonly used for maintenance therapy

liothyronine

32
Q

who does osteoporosis normally affect?

A

post menopausal women
men over 50
ppl taking long term ORAL corticosteroids

33
Q

what are the risk factors for osteoporosis?

A 
low vit D and calcium
low bmi
smoking
age
alcohol
lack of exercise
34
Q

what is the aims of treatment for osteoporosis?

A

to prevent fractures thru medication and lifestyle changes

35
Q

what lifestyle changes can one do to reduce risk of osteoporosis?

A

exercise
less smoking and alcohol
more vit D and calcium in diet
normal BMI

36
Q

what is the 1st line drug treatment for osteoporosis?

A

oral bisphosphonates: alendronic acid and risedronate sodium

37
Q

what is the drug treatment for osteoporosis if alendronic acid and risedronate sodium is contraindicated?

A

ibrandronic acid
denosumab
raloxifene
[also bisphosphonates]

38
Q

can HRT be given for osteoporosis and if so who is its use restricted to?

A

yes

for younger postmenopausal women as can cause cancer in older postmenopausal women

39
Q

what is the drug treatment for glucocorticoid induced osteoporosis?

A

oral bisphosphonates: alendronic acid and risedronate sodium

40
Q

drug treatment for osteoporosis in men?

A

alendronic acid / risedronate sodium

41
Q

what is the drug action for bisphosphonates?

A

gets absorbed onto bone crystals slowing bone growth and dissolution and slows bone turnover thus preventing fractures

42
Q

What is the MHRA advice for bisphosphonates and the related pt and carer advice? [3]

A
  1. femoral fracture - pt must seek medical attention at any hip thigh or groin pain
  2. osteonecrosis of jaw - keep good dental hygiene and report any oral issues
  3. osteonecrosis of external auditory canal - report ear pain, discharge from ear etc
43
Q

what are some side effects of alendronic acid?

A

oral/oesophageal side effects eg heart burn, dysphagia, difficulty swallowing

44
Q

what is the dose of alendronic acid for:

  1. postmenopausal women
  2. men
A
  1. 10mg a day or 70 mg weekly

2. 10mg a day

45
Q

what are the counselling associated with alendronic acid?

A

take dose whole/plenty of water
sit or stand upright for 30 mins after taking
take 30 mins before food on empty stomach

46
Q

what is HRT?

A

oestrogen and progestogen that can reduce menopause symptoms

47
Q

what are the symptoms of menopause? [6]

A 
hot flushes
vaginal dryness
sexual dysfunction
skin ageing
bone loss
decreased muscle mass
48
Q

what is early menopause and natural menopause?

A

early: women under 45 years
natural: women over 50

49
Q 
estradiol
estriol
ethinylestradiol
mestranol
estrone

which of these are synthetic oestrogen and which are natural oestrogens?

A

estradiol, estriol, estrone - natural

ethinylestradiol, mestranol - synthetic

50
Q

can oestrogen cause thromboembolism?

A

yes

51
Q

why should progesterone be added to oestrogen and given to women with uteruses?

A

because it reduces risk of cancer

52
Q

what properties does tibolone possess and is it given continuously or cyclically?

A

tibolone possesses oestrogenic, progestogenic and weak androgenic [male] activity

given continuously

53
Q

what are the risks of HRT

A 
breast cancer
endometrial cancer [risk reduced with progesterone]
stroke
chd
thromboembolism 
ovarian cancer
54
Q

what risk is increased in women who start HRT more than 10 years after menopause?

A

risk of coronary heart disease

55
Q

what risk can be increased by all HRT, increases within 1-2 years of treatment and disappears within 5 years of stopping?

A

breast cancer risk

56
Q

which risk..

  • depends on dose and duration of oestrogen only HRT
  • is reduced when progestogen is added [to women with intact uterus]
A

risk of endometrial cancer

57
Q

which hormonal drug increases the risk of stroke 2.2 times from the 1st year of treatment?

A

tibolone

58
Q

what is the choice of HRT for women with a uterus and for women without one?

A

combined HRT [oestrogen and progesterone] - with uterus

continuous oestrogen - without uterus

59
Q

what are the 2 types of preparations of combined HRT with progestogen and which is better?

A
  1. continuous hrt given everyday
  2. cyclic where progestogen given for the last 12-14 days of cycle. this is better because less side effects bc not given daily
60
Q

a woman who is on HRT is due for surgery in 16 weeks time. what must be done in preparation of her surgery?

A

stop HRT 4-6 weeks before surgery because of risk of thromboembolism. restart after surgery after full mobilisation

if HRT cannot be stopped then give unfractionated heparin or LMWH

61
Q

what is the sex hormone raloxifene licensed for?

A

licensed for postmenopausal osteoporosis

62
Q

what are the 2 classes of progesterone?

A

progesterone and its analogues: eg dydrogesterone

testosterone analogues : norethisterone

63
Q

what are desogestrel, levonorgestrel and norethisterone?

A

oral contraceptions

64
Q

what are the 2 indications for ulipristal acetate?

A

fibroids

hormonal emergency contraception

65
Q

what are the doses of these 2 brands of ulipristal and what are their indications?
esmya
ellaONE

A

ellaONE - 30mg emergency contraception

esmya - 5mg fibroids

66
Q

what is the MHRA warning associated with esmya 5mg?

A

risk of liver injury and hepatic impairment

report signs of liver disease

67
Q

what are cyproterone acetate, dutasteride and finasteride?

A

male sex hormone antagonism [anti-androgens]

68
Q

what is the indication of cyproterone?

A

treats severe hypersexuality and sexual deviation in men

69
Q

what is low strength finasteride used to treat?

A

male baldness

70
Q

what are the cautions of dutasteride and finasteride? [3]

A
  • women should be careful to handle crushed tablets
  • wear contraception as excreted in sperm
  • decreases prostate cancer markers
71
Q

what are the side effects of finasteride and dutasteride? [4]

A

ejaculation disorders
impotence
decreased libido
breast enlargement/tenderness

72
Q

what is the drug action of finasteride

A

metabolises testosterone to dihydrotestosterone [more potent androgen]

73
Q

what are the indications for these 2 strengths of finasteride:
1mg
5mg

A

1mg - male baldness

5mg - benign prostatic hyperplasia

endocrine (3 decks)

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