Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
43 Cards in this Set
- Front
- Back
|
What is diabetes Insipidus? |
Large amounts of dilute urine produced, causing extreme thirst |
|
|
What are the two types of diabetes Insipidus? |
Cranial and nephrogenic |
|
|
What is cranial diabetes Insipidus? |
The hypothalamus of the brain not making enough and secreting enough vasopressin (anti-diuretic Hormone) |
|
|
What is nephrogenic diabetes Insipidus? |
Kidneys don't respond to anti-diuretic Hormone |
|
|
What is given in diabetes Insipidus? |
Desmopressin (more potent analogue of vasopressin with a longer duration of action and no vasoconstrictor effects) |
|
|
What is a side effect of desmopressin? (The drug that restricts urine)? |
Hyponatremic convulsions |
|
|
What happens when there is more ADH secreted? |
More fluid retention due to increased aquaporins at the distal convolated tubule and collecting duct |
|
|
What happens when there is less ADH secreted? |
More diluted urine due to decreased aquaporins expressed, so less water is reabsorbed into blood circulation |
|
|
What is syndrome of inappropriate anti-diuretic Hormone secretion? |
Hyponatremia due to inappropriate ADH secretion. When the blood is too diluted due to drinking a lot of water, sodium is diluted and aldosterone is reduced which further reduces sodium. Sodium is then expelled out of urine which causes water to follow, causing the plasma osmolarity of water in blood to go back to normal. But the sodium plasma osmolarity is much lower causing hyponatremia |
|
|
Symptoms of syndrome of inappropriate anti-diuretic Hormone secretion |
Same symptoms of dehydration. Headache, nausea, vomiting, confusion, coma, death, muscle ache, tremors |
|
|
How to correct hyponatremia |
Fluid restriction. Demeclocycline (blocks renal tubular effect of ADH). Tolvaptan (vasopressin antagonist) |
|
|
Corticosteroids are used for.... |
Inflammatory diseases and immunosuppression |
|
|
What is an example of a mineralocorticoid? |
Aldosterone |
|
|
When there is high mineralocorticoid activity.... |
...fluid retention occurs. Remember how when there is low aldosterone, there is low sodium, water moves from low solute concentration to high solute concentration, so it is secreted. The opposite happens |
|
|
What is the most potent mineralocorticoid? Begins with an Fl- |
Fludrocortisone. Used for neuropathic postural hypotension in diabetes or adrenal insufficiency due to septic shock (low blood pressure to retain fluid) |
|
|
What is an IV (significant) mineralocorticoid? Begins with hy- |
Hydrocortisone. For disease suppression on short term basis via surgery or emergency e.g. life threatening Asthma or thyrotoxicosis |
|
|
Side effects of mineralocorticoid |
Hypertension and hypernatremia (the sodium ions follow the water during reabsorption, causing excessive thirst). Hypokalaemia and loss of calcium ions (twitching, cramps) also occur |
|
|
High glucocorticoid activity means... |
Anti-inflammatory activity. Glucocorticoids also mimic cortisol |
|
|
What are examples of glucocorticoid drugs? |
Betamethasone/Dexamethasone (used for patients with heart failure where fluid retention isn't the goal). Prednisolone/Prednisone (most common steroid used by mouth for asthma, COPD, IBD). Deflazort |
|
|
Side effects of glucocorticoid (ACHING BOSOM) |
Adrenal suppression, (larger) Appetite, Abrupt withdrawal reactions
Cushing's syndrome, Cataracts
Hyperglycaemia, hyperlipidemia
Infections, insomnia
Nervous system (psychiatric reactions)
Glaucoma, GI ulcers
Blood pressure increases
Osteoporosis
Skin thinning
Obesity
Muscle wasting |
|
|
What are the symptoms of Adrenal suppression side effect? |
Fatigue, anorexia, nausea, vomiting, hyponatremia, hypotension, hyperkalemia, hypoglycemia (all about a year after stopping). Avoid abrupt withdrawal (if used for more than 3 weeks). Must mention if they've taken steroids in the last year, and may need a reintroduction |
|
|
How do glucocorticoids affect glucose levels? |
Increases it, risk of hyperglycaemia (diabetes) |
|
|
How do long term glucocorticoids affect bones? |
They inhibit osteoblasts activity (preventing bone build up) and promote osteoclast activity (promoting bone break down). This leads to osteoporosis. If treatment is more than 3 months, can use bisphosphonate prophylaxis (e.g. alendronic acid or risodrenate) |
|
|
How do glucocorticoids affect muscles? |
Cause muscle wastage leading to proximal myopathy |
|
|
How do glucocorticoids affect GI tract? |
GI ulcers, dyspepsia, irritation. (Counseling: take with or after food) |
|
|
How do glucocorticoids affect nervous system? |
Serious paranoid state and depression with suicide thoughts. Can cause other mood disorders e.g. insomnia and Euphoria |
|
|
How do glucocorticoids affect immune system? |
Increases susceptibility, severity and atypical symptoms. Diseases don't show until advanced stage. Avoid people with chicken pox (exposed non-immune patients need passive immunization with varicella-zoster immunoglobulin) and measles |
|
|
How do glucocorticoids affect eyes? |
Cataracts and glaucoma. Advise patient about visual disturbances and blurred vision. Would need referral to specialist (ophthalmologist) |
|
|
How do glucocorticoids affect skin? |
Skin thinning, purple-red striae, bruising |
|
|
How do glucocorticoids affect growth? |
Retardation in children. And can cause obesity due to fluid retention (Cushing's syndrome) |
|
|
Don't give Solu-Medrone 30mg (methylprednisolone injectable medicine containing lactose) to those with cow's milk allergy because... |
..they contain lactose. Allergic reactions include bronchospasm and Anaphylaxis |
|
|
How to manage glucocorticoids side effects? |
Lowest effective dose for minimum period, local treatment rather than systemic, single dose in the morning (suppressive action on cortisol secretion is least in the morning), alternate day administration (2 days worth as a single dose to reduce suppression), intermittently with short courses |
|
|
Avoid abrupt withdrawal of glucocorticoid in patients who have: |
Long term use is over 3 weeks. More than 40mg daily or equivalent for more than a week. Repeat doses taken in the evening. Recent repeated courses. Short course within 1 year of stopping long term steroids. Have other causes of adrenal suppression |
|
|
Steroid treatment cards should be given to those... |
Taking long term corticosteroids for more than 3 weeks |
|
|
In pregnant and breastfeeding women, corticosteroids are ... |
Generally safe. Monitor fluid retention in pregnant women |
|
|
What is Addison's disease? |
Adrenal insufficiency due to adrenal glands producing too little cortisol and aldosterone |
|
|
What is adrenalectomy? |
Removal of one or both adrenal glands resulting in less cortisol (glucocorticoid) and aldosterone (mineralocorticoid) |
|
|
Treatment of Addison's disease and adrenalectomy: |
Hydrocortisone (glucocorticoid) and fludrocortisone (mineralocorticoid) |
|
|
What is hypopituitarism? |
Pituitary gland doesn't stimulate hormone secretion by target glands. Use hydrocortisone |
|
|
What is Cushing's syndrome? |
Hypercortisolism |
|
|
Symptoms of Cushing's syndrome? |
Skin thinning, striae, fat deposits in face, Moon face, acne, hirsutism, amenorrhea |
|
|
Treatment of Cushing's syndrome |
Ketoconazole (warning: hepatotoxicity. Signs: anorexia, abdominal pain, dark urine, jaundice, itching, pale stools, nausea and vomiting).
Mytrapone: Cortisol inhibiting drugs (adrenal insufficiency. Patients should report: fatigue, anorexia, nausea, vomiting, hypotension. Adrenal suppression causes hyponatremia, hypoglycemia, hyperkalemia) |
|
|
What is tetracosactide used for? |
Analogue of corticotropin. And is used to test adrenocortical function. Where failure of the plasma cortisol concentration to rise after administration of tetracosactide indicates adrenal insufficiency |
