Victor BNF Notes > Endocrine System Part 2 > Flashcards

Endocrine System Part 2 Flashcards

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1
Q

What is Hormone replacement therapy

A

replaces oestrogen with or without progesterone to relieve symptoms of menopause associated with low hormone levels

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2
Q

Examples of natural oestrogens

A
  • Estrone
  • Estradiol
  • Estriol
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3
Q

Examples of synthetic oestrogens

A
  • ethinylestradiol
  • mestranol
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4
Q

What is tibolone

A

medication to treat menopausal symptoms
- oestrogenic
- progesterogenic
- weak androgenic

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5
Q

What is vaginal atrophy

A

vaginal dryness

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6
Q

Treatment of vaginal atrophy

A

topical/oral oestrogens

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7
Q

What are vasomotor symptoms

A
  • Hot flushes
  • night sweat
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8
Q

Vasomotor symptom treatment

A

systemic oestrogens
- tablet
- patch (apply below waist line)

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9
Q

If systemic oestrogens are contraindicated in vasomotor symptoms, what do you give instead

A

Clonidine (vasodilator antihypertensive)

… but has bad side effects

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10
Q

What HRT do women without a uterus take

A

Oestrogen alone continuously

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11
Q

What HRT do women with a uterus take

A

Combined HRT
- oestrogen
- progesterone

either…
cyclically
or
continuously

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12
Q

When is continuously combined HRT unsuitable

A
  • per-menopausal (before)
  • <12 months after last period
  • irregular bleeding
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13
Q

How to check for endometrial cancer

A
  • symptoms of it is irregular bleeding
  • stop continuous combined HRT
  • is irregular bleeding stays, then refer
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14
Q

HRT and surgery

A

stop HRT 4 to 6 weeks before elective surgery

  • restart after surgery mobility as risk of VTE
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15
Q

Does HRT provide contraception

A

No

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16
Q

HRT and Contraception: Under 50

A

fertile 2 years after last period

  • use low oestrogen combined contraceptive if free from VTE risk factors
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17
Q

HRT and Contraception: Under 60

A

fertile 1 after last period

  • use condoms (barrier protection)
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18
Q

Side effects of HRT

A
  • Cancer
  • Coronary heart disease
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19
Q

Side effects of HRT: Cancer

A
  • ovarian
  • breast
  • cervical
  • endometrial cancer
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20
Q

Side effects of HRT: when is there a risk of coronary heart disease

A
  • combined HRT started 10 years after menopause
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21
Q

How to reduce the risk of endometrial cancer?

A

use progesterone HRT as well

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22
Q

What are the reasons to stop HRT

A
  • venous thromboembolism
  • stroke
  • liver disfunciton
  • High blood pressure
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23
Q

Reasons to stop HRT: VTE

A
  • sudden severe chest pain
  • sudden breathlessness
  • bloody cough
  • unexplained swelling
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24
Q

Reasons to stop HRT: Stroke

A
  • serious neurological effects
  • all stroke symptoms
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25
Reasons to stop HRT: Liver Dysfunction
- jaundice - hepatitis - liver enlargement - severe stomach pain
26
Reasons to stop HRT: High blood pressure
- if BP is >160/95
27
Risk factors that contra-indicate HRT
- prolonged immobility - thrombophlebitis (inflamed blood vessels) - Angina - MI - VTE - Oestrogen dependant cancer
28
What are Anti-oestrogens
oestrogen antagonists
29
Example of an Anti-oestrogens
Clomifene (ovulation stimulator)
30
Clomifene (anti-oestrogen) indications
- infertility in women due to oligomenorrhoea (irregular bleeding) - secondary amenorrhoea (no menstruation)
31
How many cycles should you use Clomifene for
6 cycles only (increased risk of ovarian cancer)
32
Main side effect of Clomifene
multiple pregnancies
33
What is testosterone
replacement therapy in androgen deficiency
34
Side effects of testosterone
- masculinisation - male pattern boldness - acne - anxiety - sexual development
35
Example of an anti-male androgen drug
Cyproterone (it is hepatotoxic)
36
What do thyroid hormones regulate
- metabolic rate - heart rate - digestive function - muscle control - brain development
37
What hormones are in high concentration in Hyperthyroidism
T4 (thyroxine) T3 (triiodothyronine)
38
What hormones are in low concentration in Hyperthyroidism
TSH (Thyroid stimulating hormone)
39
What hormones are in high concentration in Hypothyroidism
TSH (Thyroid stimulating hormone)
40
What hormones are in low concentration in Hypothyroidism
T4 (thyroxine) T3 (triiodothyronine)
41
Symptoms of hyperthyroidism
- heat intolerance - weight loss - diarrhoea - tachycardia - excitability - Tremors - Angina pain - sweating - arrhythmia
42
Treatment of Hyperthyroidism
- Carbimazole - Propylthiouracil
43
Carbimazole/ Propylthiouracil mode of action
- Anti-thyroid drug that interferes with synthesis of thyroid hormones
44
Side effects of carbimazole
- bone marrow suppression - rashes and itching
45
Carbimazole patient counselling
- report any signs of infection - if experiencing rashes/itching switch to Propylthiouracil or use antihistamine
46
Side effects of Propylthiouracil (alternative)
- hepatotoxicity (stop and report sings of liver failure)
47
What is thyrotoxicosis
- increased heart rate (>140bpm) - arrhythmias - heat intolerance (>41c) - diarrhoea, nausea, vomiting - seizures, confusion
48
How to treat thyrotoxicosis
- anti-thyroid drugs - a lot of fluids - hydrocortisone - propranolol for rapid symptom relief
49
What is the most common cause of thyrotoxicosis
Graves Disease
50
What is Graves Disease
an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism)
51
What is thyroidectomy
removal of thyroid gland
52
How to prepare for thyroidectomy
- iodine - 10-14 days before partial thyroidectomy - while using anti-thyroid drugs
53
Hyperthyroidism in Pregnancy treatment
1st trimester - Propylthiouracil 2nd trimester - carmimazole
54
Hyperthyroidism in Pregnancy: what treatments are contra-indicated
- blocking-replacement regimen - radioactive iodine
55
Symptoms of Hypothyroidism
- cold intolerance - weight gain - constipation - bradycardia - lethargy - muscle cramps - hair thinning - slow thoughts
56
Levothyroxine/ Liothyronine
Synthetic thyroid hormone as replacement therapy
57
What is the drug for choice for hypothyroidism maintenance
Levothyroxine
58
Levothyroxine dose
question any dose above 200mg at any one time
59
How to take Levothyroxine
- in morning - at least 30 mins before breakfast, caffeine or other medication
60
Which of the two hypothyroidism drugs is best used for rapid effects and is more potent
Liothyronin
61
When to use Liothyronin
severe hypothyroidism emergencies
62
Liothyronin brands caution
brands may not be bio-equivalent
63
What happens if initial dose of Liothyronin or Levothyroxine is too high
- can cause hyperthyroidism - should stop for 1 to 2 days and restart at lower dose
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