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PRE-REG-Thuri > ENDOCRINE- HYPOTHALAMUS + PITUITARY HORMONES > Flashcards

ENDOCRINE- HYPOTHALAMUS + PITUITARY HORMONES Flashcards

1
Q

what is menopause?

A

Oestrogen levels decline in women between 45-55 years

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2
Q

What is treatment for vaginal atrophy?

A

Topical oestrogens- cream, tablet, rings

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3
Q

What is treatment of vasomotor instability?

A

Systemic oestrogen or Tibolone (tablet, patch)

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4
Q

What is patient counselling for systemic oestrogen or tibolone?

A

Apply below waistline

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5
Q

What is MOA of HRT?

A

Replaces reduced oestrogen levels to alleviate menopausal symptoms

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6
Q

What are 3 natural oestrogens?

A

Estrone

estradiol

estriol

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7
Q

What are 2 synthetic oestrogens?

A

Ethinylestradiol

mestanol

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8
Q

What are 3 tibolones?

A

Oestrogenic

Progestogenic

weak androgenic

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9
Q

What extra drug is needed for HRT if uterus is INTACT?

A

Progesterone

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10
Q

What is cyclical progesterone?

A

Use for 12-14 days of cycle
then have bleeding

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11
Q

What is continuous progesterone?

A

Avoids withdrawal bleeding

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12
Q

Who is continuous progesterone not suitable for?

A

Not for peri-menopause or if it has been less than 12 months since last period

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13
Q

What do we need to rule out if women bleed during continuous progresterone?

A

Rule out endometrial cancer

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14
Q

What are 3 SEs of HRT? (CVS)

A

Potential cancer- breast, cervical, ovarian (endometrial cancer- important to give progesterone)

VTE

CVD

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15
Q

What are some contraindications of HRT?

A

Untreated endometrial hyperplasia, vaginal bleeding, oestrogen dependent cancer, hx of breast cancer

VTE

Angina , MI

liver disease

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16
Q

What are 4 reasons to stop HRT?

A

VTE- unexplained

Liver dysfunction- jaundice, hepatitis, severe abd pain, liver enlargenment

Stroke- serious neurological effects

BP- above 160/95 mmhg

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17
Q

What to do with HRT if patient is undergoing major surgery?

A

Stop HRT 4-6 weeks before

Major VTE risk factor so restart when fully mobile

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18
Q

MOA of testosterone?

A

Role in masculine development

Spermatogenesis

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19
Q

What is a SE of testosterone?

A

Masculinisation

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20
Q

What are 3 symptoms of Masculinisation?

A

Acne

Anxiety

Male pattern baldness

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21
Q

What is MHRA warning regarding topical testosterone?

A

Risk of harm to children after accidental exposure

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22
Q

What is one caution of topical testosterone?

A

Not to be applied on genital area.

ONLY SHOULDER + ARMS

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23
Q

What is moa of clomifene?

A

Causes ovulation
anti- oestrogen

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24
Q

What is indication of clomifene?

A

Infertility

PCOS, oligomeorrhoea (infrequent perioids

25
Q

What are 2 SEs of Clomifene?

A

Risk of cancer (above 6 cycles)

Multiple pregnancies

26
Q

What is hyperthyroidism?

A

High level of thyroid hormones

(T3/4 + low TSH)

27
Q

What does high t3/4 do to the TSH?

A

Low TSH

28
Q

What is treatment for hyperthyroidism?

A

anti-thyroid drugs

28
Q

What are 8 symptoms of hyperthyroidism?

A

Heat intolerance

weight loss

tachycardia

diarrhoea

anxiety

tremors

sweating

bulging eyes

29
Q

What 5 things is the thyroid gland important in?

A

Muscle control

Metabolic rate

HR

brain development

digestive system

30
Q

What is MOA of Carbimazole + Propylthiouracil?

A

Interferes with synthesis of thyroid hormones T3 +T4

31
Q

What is indication of carbimazole?

A

Hyperthyroidism

32
Q

What are 3 Main SEs of Carbimazole? (BAR-T)

A

Blood dyscrasias

Acute pancreatitis

Rashes/ itching

33
Q

What monitoring is needed for carbimazole?

A

FBCs

34
Q

Can carbimazole be used in pregnanacy?

A

Not in 1st trimester- congential effects

but can be used 2nd + 3rd trimester - risk benefit

35
Q

What to do if patient has acute pancreatitis when taking carbimazole?

A

STOP

36
Q

What is patient counselling for carbimazole?

A

Report signs of infection or blood disorders.

e.g. sore throat, fever, mouth ulcer, bruising, bleeding

37
Q

What is a SE of propylthiouracil?

A

Hepatotoxicity

report signs of liver disorder

38
Q

What is propylthiouracil monitoring?

A

LFTs - stop if 3x ALT or AST

39
Q

What is hypothyroidism?

A

Low level of T3/T4 + high TSH

40
Q

What happens if low T3 + T4 ?

A

High TSH

41
Q

What are 9 symptoms of hypothyroidism?

A

Cold intolerance

weight gain

bradycardia

constipation

depression

muscle cramps

Fatigue

Loss of eyebrow/ hair loss

Dry skin

42
Q

What is hypothyroidism treatment?

A

Thyroid hormones

43
Q

MOA of levothyroxine + liothyronine?

A

Fake thyroid hormones, replacement therapy.

44
Q

What is indication of levothyroxine + liothyronine?

A

Hypothyroidism - choice drug (levo)

45
Q

When is liothyronine used?

A

In emergencies - rapid metabolism

46
Q

Wha is a SE of levothyroxine/liothyronine?

A

Thyrotoxic symptoms

e.g. diarrhoea, rapid pulse, insomnia, anxiety, tremors, anginal pain where latent ischaemia

47
Q

What is a caution of levothyroxine/liothyronine?

A

CVD, DM

48
Q

What is 20-25 mcg of liothyronine equal to?

A

100mcg levothyroxine

49
Q

How to take levothyroxine?

A

Take in morning at least 30 mins before breakfast, caffeine or any other medication.

50
Q

What is an MHRA warning regarding levothyroxine?

A

New advice if symptoms arise when switching brands

If you get symptoms= check TFTS + use specific tolerated brand

If still symptoms or poor control of thyroid level = use oral solution

51
Q

How long gap to leave between levothyroxine and antacids, calcium or iron?

A

4 HRS

52
Q

What is used for hyperthyroidism (graves) in 1st trimester of pregnancy?

A

Propylthiouracil (as carbimazole congenital effects)

53
Q

What is 1st line for grave’s disease?

A

Radioactive iodine

Then if above not suitable, can use carbimazole.

54
Q

What is carbimazole given with for grave’s disease?

A

Levothyroxine (to find perfect balance)

55
Q

What monitoring is done for levothyroxine?

A

TSH every 3 months, then yearly

56
Q

What should patients be cautious of when taking propylthiouracil?

A

Liver disorder

57
Q

What are 3 MHRA warnings for carbimazole?

A

Neutropenia + agranulocyrosis

Congenital malformations

acute pancreatitis

PRE-REG-Thuri (44 decks)

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