part 2 endocrine

Question 1

what is the mhra warning with systemic administration of corticosteroids?

what should patients report?

Answer 1

chorioretinopathy [retinal disorder]

report signs of blurred vision/vision disturbances

Question 2

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

Answer 2

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

Question 3

list some examples of glucocorticoid hormones and explain what they do

Answer 3

dexamethasone, methylprednisolone and prednisolone

help reduce inflammation

Question 4

what are the 5 side effects of glucocorticoids?

Answer 4

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

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

Question 5

what are the 5 side effects of mineralocorticoids?

Answer 5

- water retention
potassium loss
calcium loss
hypertension
sodium retention

Question 6

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

Answer 6

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

cause is mainly addisons disease

Question 7

what are the 9 signs and symptoms of adrenal suppression?

Answer 7

fatigue
anorexia
hypotension
hyponatraemia
hyperkalaemia
hypoglycaemia
salt craving
nausea and vomiting

Question 8

in what ways can you manage the side effects of corticosteroids

Answer 8

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

Question 9

what is the corticosteroid replacement therapy given in adrenal suppression?

Answer 9

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

Question 10

what are the 5 major side effects with systemic corticosteroids?

Answer 10

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

Question 11

are corticosteroids suitable for pregnancy?

Answer 11

the benefits must outweigh the risks

Question 12

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

Answer 12

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

Question 13

what is HYPERthyroidism

Answer 13

high levels of thyroid hormones in body causing thyrotoxicosis

Question 14

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

Answer 14

hyperthyroidism = low TSH and high T4
hypothyroidism = high TSH and low T4

Question 15

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

Answer 15

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

Question 16

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

Answer 16

carbimazole [most common]

propylthiouracil

Question 17

what is blocking replacement therapy and why is it done?

Answer 17

a combination of levothyroxine and carbimazole

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

Question 18

can pregnant women have the blocking regimen regime?

Answer 18

no

Question 19

what is a thyrotoxic crisis [a thyroid storm]?

Answer 19

oversecretion of thyroid hormones producing deadly levels - medical emergency

Question 20

what are the signs and symptoms of a thyroid storm?

Answer 20

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

Question 21

what is the emergency treatment for a thyroid storm?

Answer 21

• IV fluids
• hydrocortisone
• propanolol
• oral iodine, carbimazole, propylthiouracil

Question 22

which hyperthyroid drugs are suitable for pregnancy?

why are small doses recommended during pregnancy?

Answer 22

carbimazole and propylthiouracil

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

Question 23

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

Answer 23

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]

Question 24

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

Answer 24

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

Question 25

what are the 2 MHRA warnings related to carbimazole?

Answer 25

congenital defects in 1st trimester [wear contraception] acute pancreatitis

Question 26

what should you monitor for whilst taking propylthiouracil?

Answer 26

hepatotoxicity

Question 27

patient and carer advice for propylthiouracil?

Answer 27

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

Question 28

what is HYPOthyoridism?

Answer 28

under production of thyroid hormones

Question 29

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

Answer 29

``` weight gain fatigue depression intolerance to the cold constipation menstrual irregularities ```

Question 30

what are the primary and secondary causes of hypothyroidism?

Answer 30

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

Question 31

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

Answer 31

levothyroxine - most commonly used for maintenance therapy liothyronine

Question 32

who does osteoporosis normally affect?

Answer 32

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

Question 33

what are the risk factors for osteoporosis?

Answer 33

``` low vit D and calcium low bmi smoking age alcohol lack of exercise ```

Question 34

what is the aims of treatment for osteoporosis?

Answer 34

to prevent fractures thru medication and lifestyle changes

Question 35

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

Answer 35

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

Question 36

what is the 1st line drug treatment for osteoporosis?

Answer 36

oral bisphosphonates: alendronic acid and risedronate sodium

Question 37

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

Answer 37

ibrandronic acid denosumab raloxifene [also bisphosphonates]

Question 38

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

Answer 38

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

Question 39

what is the drug treatment for glucocorticoid induced osteoporosis?

Answer 39

oral bisphosphonates: alendronic acid and risedronate sodium

Question 40

drug treatment for osteoporosis in men?

Answer 40

alendronic acid / risedronate sodium

Question 41

what is the drug action for bisphosphonates?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

what are some side effects of alendronic acid?

Answer 43

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

Question 44

what is the dose of alendronic acid for: 1. postmenopausal women 2. men

Answer 44

1. 10mg a day or 70 mg weekly | 2. 10mg a day

Question 45

what are the counselling associated with alendronic acid?

Answer 45

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

Question 46

what is HRT?

Answer 46

oestrogen and progestogen that can reduce menopause symptoms

Question 47

what are the symptoms of menopause? [6]

Answer 47

``` hot flushes vaginal dryness sexual dysfunction skin ageing bone loss decreased muscle mass ```

Question 48

what is early menopause and natural menopause?

Answer 48

early: women under 45 years natural: women over 50

Question 49

``` estradiol estriol ethinylestradiol mestranol estrone ``` which of these are synthetic oestrogen and which are natural oestrogens?

Answer 49

estradiol, estriol, estrone - natural ethinylestradiol, mestranol - synthetic

Question 50

can oestrogen cause thromboembolism?

Answer 50

yes

Question 51

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

Answer 51

because it reduces risk of cancer

Question 52

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

Answer 52

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

Question 53

what are the risks of HRT

Answer 53

``` breast cancer endometrial cancer [risk reduced with progesterone] stroke chd thromboembolism ovarian cancer ```

Question 54

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

Answer 54

risk of coronary heart disease

Question 55

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

Answer 55

breast cancer risk

Question 56

which risk.. - depends on dose and duration of oestrogen only HRT - is reduced when progestogen is added [to women with intact uterus]

Answer 56

risk of endometrial cancer

Question 57

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

Answer 57

tibolone

Question 58

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

Answer 58

combined HRT [oestrogen and progesterone] - with uterus continuous oestrogen - without uterus

Question 59

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

Answer 59

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

Question 60

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

Answer 60

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

Question 61

what is the sex hormone raloxifene licensed for?

Answer 61

licensed for postmenopausal osteoporosis

Question 62

what are the 2 classes of progesterone?

Answer 62

progesterone and its analogues: eg dydrogesterone testosterone analogues : norethisterone

Question 63

what are desogestrel, levonorgestrel and norethisterone?

Answer 63

oral contraceptions

Question 64

what are the 2 indications for ulipristal acetate?

Answer 64

fibroids | hormonal emergency contraception

Question 65

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

Answer 65

ellaONE - 30mg emergency contraception | esmya - 5mg fibroids

Question 66

what is the MHRA warning associated with esmya 5mg?

Answer 66

risk of liver injury and hepatic impairment | report signs of liver disease

Question 67

what are cyproterone acetate, dutasteride and finasteride?

Answer 67

male sex hormone antagonism [anti-androgens]

Question 68

what is the indication of cyproterone?

Answer 68

treats severe hypersexuality and sexual deviation in men

Question 69

what is low strength finasteride used to treat?

Answer 69

male baldness

Question 70

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

Answer 70

- women should be careful to handle crushed tablets - wear contraception as excreted in sperm - decreases prostate cancer markers

Question 71

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

Answer 71

ejaculation disorders impotence decreased libido breast enlargement/tenderness

Question 72

what is the drug action of finasteride

Answer 72

metabolises testosterone to dihydrotestosterone [more potent androgen]

Question 73

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

Answer 73

1mg - male baldness | 5mg - benign prostatic hyperplasia