Endocrine 2

Question 1

Thyroid

Answer 1

involves in hypothalamus
Anterior pituatory

Question 2

Hypothyroidism

Answer 2

Goitre, weight gain, cold intolerance, myxedema

Could be a problem with thyroid or hypotholamus

TSH (Important diagnostic feature)
primary high and secondary Low

Question 3

Thyroid drugs

Answer 3

Levothyroxine - T4
Liothyronine - T3

Question 4

Levothyroxine ( cost effective )

Answer 4

Oral 50- 100u/day
Half life by binding into TBG
It is a prodrug
T4 converted to T3 in the cell to act on a nuclear receptor

Question 5

Liothyronine

Answer 5

Intravenous injection
It is an emergency

Question 6

Thyroid hormone receptor, how does thyroxine work?

Answer 6

thyroxine does not work on cytoplasm or in cell membrane but it works only in nucleus.

Question 7

Levothyroxine ( Pharmacological effects)

Answer 7

Increased O2 consumption and heat production

inc cardiac muscle contracitility

Question 8

Adverse effects of hypo drugs are

Answer 8

diarrhoea, sweating, nervousness, tachycardia, increased appettite, loss of weight

also leads to hyperthyroidism

Question 9

Hyperthyroidism

Answer 9

Exoptholamus
Weight loss
Heat intolerance
CVS ?

TSH

Primary
Secondary

Question 10

Thyroid hormone : Synthesis

Answer 10

Thyroperoxise

Question 11

Inhibitors of thyroperoxidase

Answer 11

Mechanism : Competitive inhibitors for substrate binding site on thyroperoxide

Question 12

Carbimazole

Answer 12

oral prodrug , rapid inhibition of enzyme (12hr).

Effect takes between 2-4 weeks ( depletion of thyroid and plasma stores of T4 required.

Question 13

Propylthiouracil

Answer 13

Reduces the deiodination of t4 and t3 in the peripheral tissues that may work more quickly.

AD effects are Neutropenia and agranulocytosis

symptoms are sore throat, blood count , rash, headache, joint pain

Question 14

Important point to remember

Answer 14

hyper and hypo both can be treated by throxine

Question 15

Permissive Hormone Action

Answer 15

T3 and the heart ( B adrenoreceptor)

Question 16

Hypothalamic pituatory axis

Answer 16

Adrenals (CRH AND ACTH) ADRENAL CORTEX

Question 17

Adrenaline Medulla

Answer 17

blood vessels, heart, bronchial smooth muscle

Epinephrine
Cardiac arrest
anaphylaxis - angioedema- acute hypersensitivity(epipen)

Question 18

Glucocorticoid - cortisol
Mineralocorticoid - aldosterone

Answer 18

5 major steroids

Question 19

Replacement therapy

Answer 19

Adrenal Cortex

Cortisol (glucocorticoid + weak mineralocoticoid)

Aldosterone (mineralocotticoid)

Question 20

Addison’s Disease

Question 21

Glucocorticoids : Anti-inflammatory effect

Answer 21

Immunosuppression

Mediator effect - decreased expression , COX-2, IL-1 to IL-8, TNF alpha, complement, NO and histamine, IgG.

Question 22

Glucocoticoid Drugs

Answer 22

Hydrocortisone is cortisol

Cortisone is a prodrug which is converted to hydrocortisone.

Therefore, hydrocortisone preffered to cotisone.

The ration is 1/1

Question 23

Glucocorticoids in Asthma

Answer 23

Step 2 Inhaler (fluticasolone)
Step 5 Oral (prednisolone)

Question 24

Glucocorticoids therapeutic use

Answer 24

Skin
Lung
GI
Musculoskeletal
Eye
CNS
Renal
Infectious Diseases
Haematology
Malignant

Question 25

Glucocorticoids adverse effects

Answer 25

diabetes osteoporosis muscle wasting peptic ulcer cushing syndrome moon face straie acne

Question 26

Adrenal suppression - withdrawal

Answer 26

Abrupt withdrawal Acute adrenal insufficiency leads to hypotention, death possible. Fever, weight loss, inflammation . If corticosteroid is given for more than 3 weeks, treatment should not be stopped abruptly. Magnitude or speed withdrawal It is slower when down to physiological dose ( prednisolone 7.5mg daily)

Question 27

Corticosteriods and covid

Answer 27

DEXAMETHASONE reduced all the causes of mortillity at 28days compared with usual care alone offer dexamethasone or hydrocortisone to people with severe

Question 28

Gonadotrophins and Posterior pituatory

Question 29

Gonads

Answer 29

Combined oral contraceptives inhibit ovulation - the combination of an oestrogen and a progestin is the most potent method known to supress GnRH, FSH and LH to release inhibiting follicular development and thereby preventing ovulation

Question 30

HPA - Posterior pituatory

Answer 30

oxytocin ADH

Question 31

Anti-diuretic hormone (ADH)

Answer 31

Diabetes insipidus Vasopressin (Water retention ) 1. Desmopressin (V2) ORAL AND NASAL spray 2. Carbamizole (Anti-epileptic) 3. Thiazides (diuretic) Vasoconstriction (V1) terlipressin - variceal bleeding secondary to portal hypertention felypressin - added to local anaesthetic injection

Question 32

Syndrome of Inappriate ADH secretion

Answer 32

Hyponatremia (more than 134mEq) headache vomiting confusion

Question 33

Summary

Answer 33

1. thyroid hormones 2. Adrenal Steroids (Glucocorticoids) 3. Hypothalamic/pituatory axis (HPA) 4. Posterior Pituatory (Oxytocin, ADH)

Question 34

Kahoot quiz followed by

Question 35

A patient with supraventricular tachycardia is prescribed a dose of verapamil 120mg to be taken 3 times a day . How many tablets should be taken at each dose ?

Answer 35

120/3 = 40

Question 36

Anterior pituItory hormone ?

Answer 36

ACTH

Question 37

Posterior pituitory hormone?

Answer 37

antidieuretic hormone

Question 38

Which drug would be the most effective in the maintanence therapy of hypothyroidism?

Answer 38

Levothyroxine

Question 39

why does it take 1-2 weeks for carbamizole to reduce thyroxine levels in hyperthyroid disease?

Answer 39

Depletion of thyroxine stores

Question 40

which drug would be the most effective at treating cardiac arrythmias due to hyperthyroidism?

Answer 40

proponolol

Question 41

Most likely drug to contributing to these symptoms? 26 yrs old woman presents to her GP with tachycardia, weight loss and night time walking in a stressful state. Her medication list is shown bleow?

Answer 41

Levothyroxine

Question 42

First test to check for patients with a sore throat on carbimazole? A 44 year old female patient is prescribed carbimazole by her GP as a part of a block and replacement regimen for the treatment of thyrotoxicosis. Gp advised her to report any sore throat immediately.

Answer 42

Neutrophil count

Question 43

Select the most appropriate treatment option, 29 years old with hasimotos thyroiditis has increasing anxiety, difficulty in sleeping and loose stools culture negative. Together with levothyroxine 200mcg daily. She is prescribed lopermide and lorazepem. Her next thyroid function test gives a TSH

Answer 43

Decrease the dose of thyroxine to 150 mcg daily

Question 44

Which drug is an oral steroid used to treat severe forms of asthma and exacerbations of COPD?

Answer 44

Prednisolone

Question 45

Select the most appropriate peice of information to communicate to the patient

Answer 45

An 80 year old woman presents to her GP with general lethargy and pain around her shpoulders and pelvis. Her ESR is elevated at 70mm/hr and she struggle to lift her arms over head. A diagnosis of polymyalgia

Question 46

Select the most appropriate piece of information to communicate to the patient

Answer 46

Bisphosphonate should be added to reduce osteoporosis risk

Question 47

select the most appropriate information to communicate to the patient A 25 years old male is seen for follow up of his ulcerative collitis for which he takes mesalazine. He has now complained of increasing stool frequency with occasional blood and mucus. It is felt he is having a midl flare of his colitis and is commenced on oral prednisolone 30mg once daily

Answer 47

never stop prolonged courses of steroids suddenly

Question 48

What is the major target site of action for the combined oral contraceptive?

Answer 48

hypothalamus

Question 49

which drug mechanism might be useful in the prevention of premature labour ?

Answer 49

oxytocin antagonist

Question 50

what volume of midazolam solution should be administered answer in millilitres? An 8 month old boy weighing 9kg requires a dose of midazolam 2.5mg to be administered bucally for febrile convulsions. Buccal midazolam liquid is available

Answer 50

25ml