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Pharmacy Pre-Registration 20/21 > Endocrine > Flashcards

Flashcards in Endocrine Deck (30)
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1
Q

Which bisphosphonate needs to be discontinued if a skin rash develops?

A

Strontium ranelate

Severe allergic reaction:
Symptoms known as DRESS ‘Drug rash with eosinophilia and systemic symptoms’
Starts with: fever, rash, swollen glands, high WCC

2
Q

What is the side effect we need to be vigilant about with Bisphosphonate treatment?

A

Osteonecrosis of the Jaw

The risk is higher with IV therapy for cancer treatment than it is with oral.

Patients have a dental check up before starting and need to maintain good oral hygiene and attend regular check ups.

They should report any oral symptoms: Pain, inflammation, difficulty swallowing

3
Q

If patients taking Alendronic acid experience dysphagia, heartburn, pain on swallowing or retrosternal pain what should they do?

A

Stop taking and Report it- may be an oesophageal reaction: can be serious

4
Q

Desmopressin, used for diabetes insipidous and first line for nocturnal enuresis, can cause electrolyte disturbance: hyponatreamia. What can this lead to, and what can be done to stop this?

A

Hyponatreamic convulsions mentioned in the BNF.

This can be minimised by sticking to the recommended start dose and avoiding drugs that increase secretion of vasopressin such as TCA’s.

5
Q

Clomifene is a drug used to treat female infertility as it is anti-oestrogen. The CSM have advised that it should not be used for more than __ cycles, due to increased risk of _____ cancer.

A

Not for more than 6 cycles

Increased risk of ovarian cancer with clomifene use.

6
Q

Which drug used in thyroid therapy can cause agranulocytosis and neutropenia? what is this drug used for?

A

Carbimazole

Used for Hyperthyroidism
Used in the 18 month blocking-replacement regimen together with levothyroxine.

7
Q

What test is indicated prior to therapy with levothyroxine and Liothyronine?

A

Baseline ECG- this is because we want to check we haven’t mistaken hypothyroidism with ischaemia/ cardiovascular disease.

8
Q

Which antithyroid drug is used if carbimazole is contraindicated?
What do we need to monitor with this drug?

A

Propylthiouracil

Liver function- severe hepatic reactions have taken place.

9
Q

What drugs are used for management of thyrotoxic symptoms (when too much thyroid hormone has been given)?

A

Beta blockers- propranolol
IV fluids
hydrocortisone

10
Q

What side effect of carbimazole is common and can be treated with antihistamines without the need to discontinue?

A

Rashes and pruritis- don’t say ‘discontinue’ in exam cause you’ve mistaken it for neutropenia/agran

11
Q

Sick day rule for patients on a systemic steroid and fall mildly ill?

A

Double dose for 2 days

12
Q

Sick day rule for patients on a systemic steroid and severely ill?

A

Double dose until symptoms improve

13
Q

If a patients has severe diarrhoea or vomiting and can’t keep their steroid down?

A

Hydrocortisone emergency injection may be needed from GP

14
Q

Difference between Addisons and Cushings (hint: they are opposites)?

A

Addisons is a deficiency of ACTH- (adrenocorticotropic hormone) because the immune system has turned against the adrenal glands. Symptoms: anorexia, Nausea and vomiting, weightloss- treat with glucocorticoids

Cushings- too much ACTH, caused by long term glucocorticoid therapy or tumour. Moon face, buffalo hump, mood swings, weight gain. Treatment- withdraw the steroid

15
Q

Symptoms of DKA?(8)

A
Rapid weight loss
Abdominal pain
Nausea and vomiting
Rapid and deep breathing?
Sweet smelling breath
Sweet/metallic tasting breath
Altered odour of urine/sweat
Sleepiness
16
Q

In adults:
Gradual withdrawal of systematic corticosteroids is considered in those where the disease is unlikely to relapse and have….? (6)

A

Received more than 40mg of prednisolone (or equiv) daily in the last week

Given repeated doses in the evening

Received more than 3 weeks treatment

Recently received repeated courses (particularly for longer than 3 weeks)

Taken short-course within a 1 year of stopping long-term treatment

Other possible causes of adrenal suppression

17
Q

How to withdraw corticosteroids from adults and children?

A

Adult:
Dose may be reduced rapidly down to physiological dose (equivalent to 7.5mg prednisolone daily) and then reduced more slowly

Child:
Dose may be reduced rapidly down to physiological dose (equivalent to 2-2.5 mg/m2 prednisolone daily) and then reduced more slowly

18
Q

When can systemic steroids be stopped abruptly?

A

When disease is unlikely to relapse and those who have received less than 3-weeks treatment (and those not included in the patient groups described on page 659)

19
Q

How long can corticosteroid-induced adrenal suppression last for after stopping drug

A

1 year or more

20
Q

What is the duration of dexamethasone and betamethasone?

A

Long duration of action

Makes it good for suppression of corticotrophin secretion (e.g. congenital adrenal hyperplasia)

21
Q

Steroid with high mineralocorticoid activity

A

Fludrocortisone acetate

Can be used to treat postural hypotension

22
Q

Steroid with very high glucocorticoid activity and insignificant mineralocorticoid activity?

A

Betamethasone

and

Dexamethasone

23
Q

Corticosteroid with moderate glucocorticoid activity and high mineralocorticoid activity - good for topical use because side-effects are less marked?

A

HYDROCORTISONE

24
Q

What are prednisolone and prednisones predominant activity on?

A

Glucocorticoids

25
Q

Side effects of glucocorticoids? (6)

A

Diabetes
Osteoporosis (particularly in elderly)
At high doses - avascular necrosis of femoral head
Muscle wasting
Weekly linked with peptic ulcer/perforations
Psychiatric reactions

26
Q

Side effects of mineralocorticoids (5)

Think minerals

2 increase, 2 decrease

A

Hypertension (hence why it can tx postural hypo)

Sodium retention
Water retention

Potassium loss
Calcium loss

27
Q

What is Deflazacort?

A

Derived from prednisolone

Has high glucocorticoid activity

28
Q

What happens to prednisolone when it crosses the placenta in pregnancy?

A

88% is inactivated

29
Q

What is the advise with ketoconazole and hepatic inpairment?

In treating Cushing syndrome

A

Avoid in acute or chronic impairment

Do not initiate the drug if liver enzymes are greater than 2X the normal upper limit

30
Q

Symptoms suggestive of adrenal Insufficiency?

A
Fatigue
Anorexia
Nausea and vomiting
Hypotension
Hyponatraemia 
Hypoglycaemia
Hyperkalaemia

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