A.12- thyroid. pituitary hormones Flashcards by שני דוידפור

what is somatotropin?

recombinant form of human GH

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how are somatotropin and mecasermin given?

sabcutaneous injection

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list the SE of somatotropin

pseudotumor cerebri, edema, hyperglycemia, scoliosis, slipped capital femoral epiphysis

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what is mecasermin?

recombinant form of human IGF-1

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Indications for somatotropin

GH deficiency (dwarfism), increased height in Turner and Prader willi syndrome, malabsorption syndromes, AIDS- associated wasting

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SE of mecasermin

hyperglycemia, intracranial hypertension, ↑ liver enzymes

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indication of mecasermin

IGF-1 deficiency, Laron dwarfisim

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list GH antagonists

somatostatin analogues (e.g octreotide, lantreotide), pegvisomant

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how is octreotide given?

parenteral
(regular : inject 2-4 daily)
(slow release formulation: inject every 4 week)

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octreotide indications

acromegaly, endocrine tumors, control of bleeding from esophageal varices

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octreotide SE

GI disturbances, steatorrhea, gallstones, cardiac conduction abnormalities

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how is pegvisomant given?

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indication of pegvisomant

acromegaly

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SE of pegvisomant

↑ liver enzymes

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what is follitropin- alpha

a recombinant form of human FSH

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how are FSH and LH hormones given?

parenteral

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indication for FSH and LH

male infertility! controlled ovarian stimulation

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which hormone has both FSH and LH activity?

menotropin

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SE of follitropin-alpha and lutropin

ovarian hyperstimulation syndrome, gynecomastia (men) multiple pregnancies, headache, depression, edema

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a synthetic peptide with GnRH agonist activity

leuprolide (=leuprorelin), Buserelin

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what is important in the administration of leuprolide?

give by intermittent administration–> ↑ FSH and LH (GnRH is a Pulsatating hormone)
continuous administration will ↓ FSH and LH

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indications for leuprolide

ovarian suppression (endometriosis, leiomyoma, controlled ovulation induction) , central precocious puberty, prostate cancer, diagnostics, hypothalamic hypogonadism (Kallman syndrome) 
"leu is proud of his prostate"

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GnRH antagonists

Ganirelix, Degarelix

“Please relax! you are not ovulating..”

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how are GnRH’s given?

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SE of GnRH's

think hormonal symptoms "menopause" : nausea, headach

what is Degarelix used for?

prostate cancer

prolactin drugs

bromocriptine, cabergoline, quinagolide

what is the function of bromocriptine

it is a Dopamine (D₂) receptor agonist | suppresses the pituitary secretion of prolactin and GH

how is bromocriptine given?

oral

when to you give bromocriptine or cabergoline ?

prolactin secreting adenoma, acromegaly

SE of bromocriptine

GI , orthostatic and psychiatric disturbances

oxytocin receptor agonist

oxytocin

mechanism of oxytocin

Gq mechanism--> activation of oxytocin receptors (OXTR)--> unterine contraction

how is atosiban and oxytocin given?

oxytocin receptor antagonist

atosiban

indication for Oxytocin

induce labor, control uterine hemorrhage after delivery

SE of oxytocin

placental abruption, uterine rupture, hypotension, fetal distress

why do we use atosiban?

tocolytic agent- supress preterm labor

SE of atosiban

infant death

list ADH (Vasopressin) drugs

desmopressin, vasopressin, conivaptan

what is desmopressin?

selective V₂ agonist. a synthetic analog of ADH

how is desmopressin given?

IV, intransal (1-3% BA), oral (0.3% BA), SC

which drug has a prolonged half-life comparing to endogenous ADH

desmopressin

indications of desmopressin

Central diabetic insipidus (no ADH), Hemophilia A, von Willebrand disease

SE of desmopressin

"water poisoning", hyponatremia, headache

what is vasopressin?

V1, V2 agonist

indication of vasopressin

control bleeding in esophageal varices or colon diverticula (v1--> vasoconstriction) Central diabetic insipidus (V2)

what is conivaptan and how is it given?

V1, V2 antagonist, IV administration

indications of conivaptan

SIADH (too much ADH--> water retention-->hyponatremia) fluid retention (HF) "Coni likes to evaporate water"

important SE of conivaptan

osmotic demyelination syndrome due to rapid Na correction

what are synthetic thyroid hormones used for?

hypothyroidism

name thyroid drugs

levothyroxine (T4), liothyronine (T3), iodine

how is levothyroxine given?

oral, IV

SE of levothyroxine and liothyronine

hyperthyroidism symptoms

how is liothyronine given?

oral, IV (10X more potent than T4)

when is liothyronine preferred on levothyroxine?

deiodinase enzyme deficiency (T4 cannot convert to T3)

when is iodine given?

dietary iodine deficiency (endemic goiter), thyrotoxicosis crisis

SE of iodine

cutaneous irritation, allergic reaction, thyroiditis

what are antithyroid drugs? list classification

used in hyperthyroidism. | thioamides, iodide salts, radioactive iodine, anion inhibitors, B- blockers, corticosteroids

what do thioamides do? (e.g- propylthiouracil)

1. inhibit thyroid peroxidase activity | 2. inhibit peripheral conversion of T4 to T3 (methimazole no effect on this)

give 2 thioamides

propylthiouracil (PTU), methimazole

how are PTU and methimazole given?

oral

propylthiouracil and methimazole SE

skin rash, nausea, vasculitis, agranulocytosis, liver dysfunction, hypothyroidism, drug-induced lupus methimazole is teratogenic

what do iodide salts do?

1. inhibit tyrosine iodination 2. inhibit thyroid hormone release 3. reduce the size of a hyperplastic thyroid gland

what are Lugol's solution and Potassium iodide?

iodide salts

how are iodide salts given?

oral

when is iodide salts given?

thyroid storm, preparation for thyroidectomy

what is iodine radioisotope for (I¹³¹) ?

radiation-induced destruction of thyroid parenchyma

SE of radioactive iodine therapy?

pharyngitis, hypothyrodism

b blockers in thyroid storm

propranolol

what is the effect of propranolol in thyroid storm?

inhibit the conversion of T4 to T3 | Control the tachycardia caused by thyrotoxicosis

corticosteroids used for thyroid storm and thyroid ophthalmopathy

hydrocortisone, methyl-prednisolone

what effects do corticosteroids have on the thyroid

1. inhibit the conversion of T4 to T3 | 2. Control thyroid ophthalmopathy (seen in Graves disease). give IV

Anion inhibitors

thiocyanate, perchlorate

the function of anion inhibitors

reduce the uptake of iodide by the thyroid gland (rarely used clinically)

SE of anion inhibitors

aplastic anemia

management of thyrotoxic storm

1. PTU or methimazole (IV bolus) 2. potassium-iodide solution (IV) 3. b blockers (IV) 4. glucocorticoids (IV)