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Endocrine Type 2 DM november 23 > Endocrine Part 3 > Flashcards

Endocrine Part 3 Flashcards

Steroids| Thyroid | Osteoporosis|Gout| DMARD|

1
Q

Q143: What is adrenal suppression?

A

Condition where adrenal glands DO NOT produce enough amounts of corticosteroids (cortisol)

mineralocorticoid (aldosterone) which helps regulate Na+, K+ and water retention.

80% due to Addison’s disease.

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2
Q

Q144: Examples of 2 hormones released by adrenal cortex for water and electrolyte regulation?

A

Aldosterone (mineralocorticoid), Cortisol (Glucocorticoid)

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3
Q

Q145: Difference between Cushing’s and Addison’s disease?

A

Addisons:
Body has little cortisol,
Get thinner,
Hypoglycemia,
Hyperkalemia,
Hyponatremia,
Postural hypotension.
**Cushing’s: Bodyhas too much cortisol,
Get fat,
Hyperglycemia,
Hypokalemia,
Hypernatremia,
Hypertension.

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4
Q

Q146: Signs of adrenal suppression?

A

Fatigue,
gastrointestinal upset,
anorexia, weight loss,
musculoskeletal symptoms,
hypoglycemia,
hyperkalemia,
hyponatremia,
dizziness, syncope.

Life-threatening: severe dehydration, hypotension, shock, seizures, stroke, cardiac arrest.

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5
Q

Q147: How to minimize corticosteroid side effects?

A

Lowest dose,
single morning dose,
local vs. systemic,
short course,
use spacer devices.

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6
Q

Q148: Two corticosteroids that should never be given together and why?

A

Betamethasone—-or ———–dexamethasone

with fludrocortisone

due to severe side effects.

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7
Q

Q149: Beneficial use of drug with high mineralocorticoid activity?

A

If drug also has lower glucocorticoid activity, avoiding side effects.

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8
Q

Q150: Combo of corticosteroids for replacement physiological states?

A

Hydrocortisone + fludrocortisone.

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9
Q

Q151: Beneficial use of drug with high glucocorticoid activity?

A

When accompanied by low mineralocorticoid activity.

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10
Q

Q152: Drug with highest glucocorticoid activity?

A

Betamethasone and dexamethasone.

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11
Q

Q153: Side effects of systemic corticosteroids?

A

Chorioretinopathy,
adrenal suppression,
infections,
neuropsychiatric effects,
osteoporosis.

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12
Q

Q154: Are corticosteroids safe in pregnancy?

A

Yes, benefit > risk.

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13
Q

Q155: Gradual vs. abrupt corticosteroid dose reduction?

A

Gradual withdrawal for certain conditions, abrupt for short-term use.

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14
Q

Q156: What is hyperthyroidism?

A

Excessive production of thyroid hormones leading to thyrotoxicosis.

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15
Q

Q157: Blood test results for hyperthyroidism?

A

TSH (Low), T4 (High).

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16
Q

Q158: Signs and symptoms of hyperthyroidism?

A
  1. Goitre,
  2. hyperactivity,
  3. disturbed sleep,
  4. fatigue,
  5. palpitations,
  6. anxiety,
  7. weight loss,
  8. heat intolerance,
  9. diarrhea, complications.
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17
Q

Q159: Drugs for HYPERthyroidism?

A

Carbimazole, Propylthiouracil.

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18
Q

Q160: How do carbimazole and propylthiouracil work?

A
  • Carbimazole reduces iodine and diiodotyrosine,
  • propylthiouracil inhibits new thyroid hormone production.
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19
Q

BLANK

A

BLANK

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20
Q

Q161: What is blocking replacement therapy, and when should it be avoided?

A
  1. Using thyroid and antithyroid drugs together to bring thyroid activity back to normal.
  2. Avoid in pregnancy due to potential fetal goitre.
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21
Q

Q162: Name 3 less commonly used antithyroid drugs and their uses.

A
  1. Iodine (adjunct to antithyroid drugs),
  2. radioactive sodium iodide (treatment of thyrotoxicosis),
  3. Propranolol (relieve thyrotoxic symptoms).
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22
Q

Q163: What is a thyroid storm/thyrotoxic crisis, and how is it treated?

A
  1. Life-threatening OVERACTIVE thyroid.

Treatment: IV fluids,
1. propranolol,
2. hydrocortisone,
3. oral iodine solution,
4. carbimazole
5. Propylthiouracil.

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23
Q

Q164: Which antithyroid drugs are safe in pregnancy, and when can they be given?

A
  • **Propylthiouracil is safe in the 1st trimester;
  • carbimazole should be avoided due to potential congenital effects.

Switch to carbimazole in the 2nd trimester if necessary.

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24
Q

Q165: What is hypothyroidism?

A

When the thyroid gland doesn’t produce enough thyroid hormone (T4). TSH is high.

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25
Q166: Blood test results for hypothyroidism?
LOW fT4, HIGH TSH.
26
Q167: Signs and symptoms of hypothyroidism?
1. Fatigue, 2. weight gain, 3. constipation, 4. menstrual irregularities, 5. depression, 6. dry skin, 7. intolerance to cold, complications.
27
Q168: Make a table comparing the signs and symptoms of thyroid disorders.
See table in previous response.
28
Q169: Causes of hypothyroidism?
1. Autoimmune disorders (Hashimoto’s), 2. iodine deficiency, 3. thyroid surgery, 4. pregnancy (sometimes), 5. drugs (lithium & amiodarone).
29
Q170: Uses of thyroid hormones?
Hypothyroidism, diffuse non-toxic goitre, thyroid carcinoma.
30
Q171: Drugs for HYPOthyroidism?
Levothyroxine, Liothyronine.
31
Q172: Contraindications for levothyroxine and liothyronine?
Thyrotoxicosis in both.
32
Q173: When is liothyronine indicated over levothyroxine?
When rapid reversal of severe hypothyroidism is needed; liothyronine works faster.
33
Q174: Why isn't liothyronine recommended over levothyroxine by the NHS?
Uncertainty about long-term adverse effects and insufficient evidence of benefit.
34
Q175: Side effects of levothyroxine and liothyronine?
1. Weight decreased, 2. edema, 3. vomiting, 4. flushing, 5. diarrhea, 6. headache, 7. anxiety, muscle weakness.
35
Q176: Safety information regarding levothyroxine?
Patients stabilized on a specific brand should continue with that brand; liquid formulation may be considered if symptoms persist after brand change.
36
Q177: Are levothyroxine and liothyronine safe in pregnancy and breastfeeding?
Levothyroxine: crosses the placenta, dosage may increase during pregnancy; liothyronine doesn't cross the placenta as much.
37
Q178: What is osteoporosis?
Progressive bone disease with low bone mass, microarchitectural deterioration, and increased risk of fragility fractures.
38
Q179: Risk factors for osteoporosis?
1. Age, 2. low BMI, 3. smoking, ----- alcohol, 4. inactivity 5. Vit D deficiency, 6. low calcium intake, 7. family history of hip fractures, 8. early menopause, certain diseases.
39
Q180: Main goal in managing osteoporosis?
To prevent fragility fractures in patients.
40
Q181: Lifestyle modifications for managing osteoporosis?
1. Weight loss, 2. avoid injury-prone activities, 3. quit smoking, 4. exercise (especially weight-bearing), 5. reduce alcohol, 6. increase calcium and vitamin D intake.
41
Q182: Drugs for postmenopausal osteoporosis?
1. Alendronic acid, 2. risedronate sodium, 3. ibandronic acid, 4. denosumab, 5. raloxifene hydrochloride, 6. hormone replacement therapy (HRT), 7. tibolone.
42
Q183: Why is HRT restricted to younger postmenopausal women?
Due to increased risks of cardiovascular disease and cancer in older postmenopausal women on long-term HRT.
43
Q184: Drugs for glucocorticoid-induced osteoporosis and osteoporosis in men?
1st line: Alendronic acid, risedronate sodium; 2nd line: zoledronic acid, denosumab, teriparatide.
44
Q185: How do bisphosphonates work?
Bind to bone crystals, reduce bone turnover.
45
Q186: MHRA warning on bisphosphonates?
Femoral fracture, osteonecrosis of jaw, osteonecrosis of external auditory canal.
46
Q187: Side effects of oral bisphosphonates?
Esophageal reactions, dysphagia, heartburn, retrosternal pain.
47
Q188: Dosage of bisphosphonates for men and women?
Women: 10mg daily or 70mg once weekly (postmenopausal). Men: 10mg daily.
48
Q189: Counseling points for patients taking bisphosphonates?
Swallow whole with plenty of water, take while standing/sitting, stay upright for 30 minutes, take on an empty stomach.
49
Q190: Drugs for treating osteoporosis?
Calcium and vitamin D.
50
Q191: Contraindications of bisphosphonates?
Abnormalities of esophagus, hypocalcemia, delayed stomach emptying.
51
Q192: Important safety advice regarding levothyroxine?
Patients stabilized on a specific brand should continue with that brand; consider liquid formulation if symptoms persist after brand change.
52
Q193: What should be done if a patient is going to have surgery while on HRT?
Stop HRT 4-6 weeks before surgery and restart after full patient mobilization; provide prophylaxis if unable to stop HRT.
53
Q194: Symptoms warranting immediate discontinuation of HRT?
Chest pain, breathlessness/cough with blood-stained sputum, calf swelling/severe pain, severe stomach pain, neurological effects, hepatitis/jaundice, prolonged immobility, memory trick: think heart attacks, strokes, VTE, PE.
54
Q195: What is ethinyl estradiol used for?
Short-term relief of estrogen deficiency symptoms, osteoporosis prophylaxis, female hypogonadism, menstrual disorders.
55
Q196: What are the symptoms of menopause?
Loss of breast tissue, bone and muscle loss, sexual dysfunction, hot flushes, mood swings, vaginal dryness, variations among women.
56
Q197: Why are different HRT regimens used?
To balance symptom relief with long-term risks; continuous estrogen plus cyclical progestogen for women with intact uterus, continuous estrogen alone for those with no uterus.
57
Q198: Risks of HRT?
Increased risk of breast cancer, endometrial cancer, ovarian cancer, VTE, stroke, and CAD.
58
Q199: When should HRT be initiated in menopausal women?
Before 60 or within 10 years of menopause onset for symptom relief; NOT for prevention of heart disease or osteoporosis.
59
Q200: What is VTE, and how can it be prevented in HRT users?
Venous thromboembolism. Use the lowest effective dose for the shortest duration, consider risk factors, advise patients to report leg swelling and pain.
60
Flashcard
Answer
61
Q201: What is osteoarthritis (OA)?
The most common type of arthritis characterized by the breakdown of joint cartilage and underlying bone.
62
Q202: Common sites of osteoarthritis?
Knees, hips, hands, spine.
63
Q203: Symptoms of osteoarthritis?
Joint pain, stiffness, swelling, reduced range of motion.
64
Q204: Non-pharmacological management of osteoarthritis?
Weight management, exercise, physical therapy, joint protection techniques, assistive devices.
65
Q205: Pharmacological management of osteoarthritis?
Acetaminophen, NSAIDs (topical and oral), opioids (for severe pain), corticosteroid injections, hyaluronic acid injections.
66
Q206: Potential side effects of long-term NSAID use?
GI bleeding, ulcers, renal impairment, cardiovascular events.
67
Q207: How does acetaminophen work, and why is it preferred over NSAIDs in some cases?
Acetaminophen reduces pain and fever but doesn't have anti-inflammatory effects. It may be preferred due to a lower risk of GI and cardiovascular side effects compared to NSAIDs.
68
Q208: What is gout?
A form of inflammatory arthritis caused by the deposition of urate crystals in the joints, leading to sudden and severe pain and swelling.
69
Q209: Factors that increase the risk of developing gout?
Genetics, diet (high purine intake), obesity, alcohol consumption, certain medications (e.g., diuretics).
70
Q210: How is gout managed acutely?
NSAIDs, colchicine, corticosteroids, and lifestyle modifications like dietary changes.
71
Q211: What is colchicine, and how does it work in gout?
Colchicine is an anti-inflammatory medication that reduces the inflammatory response to urate crystals in gout.
72
Q212: Long-term management of gout?
Lifestyle modifications (diet, alcohol), urate-lowering therapy (allopurinol, febuxostat), prophylaxis during initiation of urate-lowering therapy (colchicine or NSAIDs).
73
Q213: What is allopurinol, and how does it work in gout?
Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid, helping to lower urate levels in the blood.
74
Q214: What is fibromyalgia?
A chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.
75
Q215: Common symptoms of fibromyalgia?
Widespread pain, fatigue, sleep disturbances, cognitive difficulties (fibro fog), and mood disorders (anxiety, depression).
76
Q216: Non-pharmacological management of fibromyalgia?
Exercise, sleep hygiene, stress management, physical therapy, and cognitive-behavioral therapy.
77
Q217: Pharmacological management of fibromyalgia?
Antidepressants (duloxetine, milnacipran), anticonvulsants (pregabalin), muscle relaxants (cyclobenzaprine), and pain relievers (acetaminophen, NSAIDs).
78
Q218: What is sciatica?
A painful condition caused by irritation or compression of the sciatic nerve, often resulting in pain that radiates down the back of the leg.
79
Q219: Common causes of sciatica?
Herniated discs, spinal stenosis, degenerative disc disease, piriformis syndrome.
80
Q220: Non-pharmacological management of sciatica?
Rest, physical therapy, heat/ice, and exercises to improve flexibility and strength.
81
Q221: Pharmacological management of sciatica?
Pain relievers (NSAIDs, acetaminophen), muscle relaxants, and in some cases, corticosteroid injections.
82
Q222: What is rheumatoid arthritis (RA)?
A chronic autoimmune disease that causes inflammation and deformity of the joints.
83
Q223: Common symptoms of rheumatoid arthritis?
Joint pain, stiffness, swelling, fatigue, and potentially joint deformities.
84
Q224: Pharmacological management of rheumatoid arthritis?
Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, and biologics like etanercept and adalimumab.
85
Q225: How do DMARDs work in rheumatoid arthritis?
They suppress the immune system's inflammatory response, slowing the progression of joint damage.

Endocrine Type 2 DM november 23 (4 decks)

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