endocrine treatments Flashcards
(43 cards)
treatment for Graves (include oregnancy)
Include length if treatment
(antithyroid drugs)
1st line: carbimazole (TPO inhibitor), once daily, for 12-18 months!!
SE: aplasia cutis in early preg, agranalocytosis
for 1st tri (up until 12 weeks) of pregnancy only : 1st line- propylthiouracil (PTU), twice daily
1st line treatment for relapse of graves and side effects
(4 points)
radioiodine
use w/ steorid in active thyroid eye disease
contraindicted in pregnancy
risk of hypothyroidism
when to carry out thyroidectomy for hyperthyroidism
and side effects
useful when radioiodine contraindicted
SE’s:
recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism
Treatment for hypothyroidism
Levothyroxine daily
Post op care if thyroidectomy
Ca++ checked within 24 hrs
Ca++ replaced
If below 1.8mmol then IV ca++
Patient discharged on t3/t4
3-6months later for whole body Idoine scanning, give them thyrogine (rhTSH) prior to stimulate tsh - this shows metastasis
Management if MEN2
High risk
Total thyroidectomy in the beginning of life
addisons management
in an emergency situation and non emergency
what needs to be monitored
do not delay treatment to confirm diagnosis
1st line) If unwell: hydrocortisone 100-200mg IV + IV 0.9NaCl fluids (no fludocortsione in emergency)
otherwise: 15-30mg daily oral corticosteroid + fludocortisone daily
monitor bp & potassium
addisons patient education (details about sick day rules)
4 points
sick day rules:
1) double daily glucorticoid (hydrocortisone NOT fludocortisone) for moderate illness, surgery
2) severe illness etc, 100mg bolus IM of hydrocortisone
cannot stop suddenly
need to wear identification
Primary aldosteronism management (conns syndrome)
lifelong MR receptor antagonists for those who cant get surgery/bilateraly hyperaldosteronism:
-spironolactone (treats the hypokalaemia)
-amlodine (for Na reabsorption via ENAC)
unilateral laprascopic adrenelctomy 1st line.
treatment for prolactinoma
give drug names
1st line: dopamine agonist eg cabergoline
2nd: trans-spehnoidal surgery
endogenous cushings syndrome treatment
ACTH independant/dependant
mostly surgical to remove adenoma (either from pituitary or adrenals)
ACTH dependant- remove pituitary tumour (most common)
ACTH independant- remove adrenals, or could be ectopic (pancoast tumour)
what drug is first line to reduce cortisol excess (b4 surgery for eg)
metyrapone
treatment for acromegaly
give drug names as well
1st line) surgery (to remove pituitary adenoma)
2nd) somatostatin analogues (directly inhibits GH): octreotide
3rd line) gh antagonist- pegvisomant
definitive management of primary hyperparathyroidism
total parathyroidectomy
Phaeochromocytoma management-
most appropriate inital management & definitive management
give name of drugs
1st line: alpha blocker (eg. phenoxybenzamine)
2nd line: combination of a blocker + beta blocker (labetolol)
then surgery to remove phaecromocytoma
DKA initial mamagement and definitive management
(
initial: 1L 0.9% sodium chloride IV over one hour
fixed rate insulin infusion of 0.1 units/kg/hour & continue long acting insulin and stop short acting
once glucose is <14mmol start 10% dextrose (in addition to saline regime)
Woman with angina first diagnosed with diabetes initial management
Start metformin 1st then titrate upwards and add an SGLT-2 inhibitor regardless of glycemic control
Sick euthyroid treatment
Treat underlying cause
No treatment is required for the deranged thyroid function
Beta blockers, polyurathicil, corticosteroids
this is the treatment for what
throtoxic storm treatment
HHS treatment
3 points
Iv fluids 0.9% sodium chloride at 0.5-1L/hr
Possibly give potassium depending on their levels
Do not give insulin unless blood glucose stops falling with treatment of IV fluids
when is a GLP-1 agonist (eg. liargulitide) considered in diabetic treatment
when a triple therapy (so metformin and 2 other frugs) has already been trialled and not worked. remember GLP1s also cause weight loss
diabetic neuropathy treatment
1st line: amitryptiline (contraindicted in those with risk of urinary retention)
2nd: gabapentine, duloxetine, pregabalin
refer to pain clinic for resistant cases
Myxoedemic come treatment
IV thyroxine and hydrocortisone
-a potentially fatal complication of undiagnosed hypothyroidism or poor adherence to levothyroxine therapy
inital management for unilateral nasal polyps
Refer!! unilateral nasal polyps is a red flag
