Chapter 26: Hypothalamus & Pituitary Gland

Question 1

Somatropin or Somatrem MOA

Answer 1

Replaces or stimulates release of GH or ILF-1

*SOMA helps you GROW!

Question 2

What would you use to treat growth failure in kids with GH deficiency, Turner’s Syndrome, Prader-Willi syndrome, and chronic kidney disease?

Answer 2

Somatropin or Somatrem

Question 3

What is a major contraindication for the use of somatrem / somatropin?

Answer 3

Epiphyses already closed. Adults requires CONFIRMED GH deficiency or panhypopituitarism

Question 4

Sermorelin / Tesamorelin MOA

Answer 4

GHRH …but no longer available in the US so don’t worry about it too much

Question 5

What drug would you use to treat a patient with Laron dwarfism? What is this drug’s MOA? Risks?

Answer 5

Mecasermin - IGF-1 promotes growth in patients with closed epiphyses

Risks include elevated intracranial pressure

meCASErMIN - use in special CASES of MINimal height

Question 6

Octreotide MOA?

Answer 6

Inhibits GH release because it is a somatostatin analogue

Long acting

Question 7

When would you prescribe octreotide?

Answer 7

Acromegaly, gigantism
Diarrhea from peptide-secreting tumors
Control GI bleeding

Question 8

Pegvisomant

Answer 8

Competitive inhibitor of GH

Most effective at lowering IGF-1 but can also have rebound effects of increasing GH

$$$$$$

Question 9

What does bromocriptine do?

Answer 9

it is a synthetic dopamine receptor agonist –> dopamine inhibits lactotrophs –> lactotrophs usually make prolactin = inhibit pituitary prolactin release

twice a day dose

Question 10

Why is vomiting/nausea a common side effect of bromocriptine?

Answer 10

The area postrema has significant numbers of dopamine receptors (and it is a dopamine agonist)

Question 11

What dopamine receptor agonist also causes alcohol intolerance and should NOT be used to suppress postpartum lactation?

Answer 11

Bromocriptine

Bros have alcohol intolerance

Question 12

What are the clinical applications of bromocriptine?

Answer 12

Acromegaly, amenorrhea/galatorhea due to HYPERPROLACTINEMIA

Prolactinomas

Question 13

What is the advantage of cabergoline over bromocriptine?

Answer 13

Cabergoline results in less nausea

Question 14

Cabergoline is used to treat hyperprolactinemia, but should not be used in what types of patients?

Answer 14

Pregnant patients

Patients with heart disease

Question 15

Protirelin MOA?

Answer 15

TRH - test thyroid fxn

Question 16

Thyrotropin MOA?

Answer 16

TSH - test thyroid fxn

Question 17

Cosyntropin MOA?

Answer 17

ACTH 1-24 - test adrenal fxn

Question 18

GnRH analogues can be given continuously or in a pulsatile fashion. What is the difference?

Answer 18

Continuous GnRH: suppressed LF and FSH release by desensitizing the pituitary gland

Pulsatile: stimulates LH and FSH release by anterior pituitary

Question 19

What GnRH analogue could you use to both diagnose hypogonadism and stimulate ovulation? What is the stipulation with stimulating ovulation?

Answer 19

Gonadorelin

Must be pulsatile form to stimulate ovulation

“-relins” are GnRH analogues

Question 20

Goserelin, histrelin, leuprolide, and nafarelin are used for gonadotropin suppression or stimulation?

Answer 20

These drugs (GnRH analogues) are given via DEPOT formulations so they work to suppress gonadal steroid production

-RELINS

Question 21

What drugs (2) could you use to inhibit premature LH surges in women undergoing controlled ovarian hyperstimulation? What is the MOA?

Answer 21

Ganirelix
Cetrorelix

X - is for GnRH receptor ANTAGONIST

-relins are analogues, -reliX are antagonists

Question 22

Which drug is purified from the urine of post-menopausal women?

Answer 22

Urofollitropin

Uro = urine

Question 23

Urofollitropin and follitropin MOA?

Answer 23

FSH - stimulate gonadal maturation and steroid production

uroFollitropin , Follitropin - F is for FSH

Question 24

What is the ONLY clinical application for follitropin or urofollitropin?

Answer 24

Treat anovulation –> induce that shit, help ppl get pregnant

Question 25

Follitropin has an adverse risk for what serious syndrome?

Answer 25

Ovarian hyperstimulation syndrome (important to know that FSH is leading cause of OHSS)

(FYI mild form can be just bloating, nausea, vomiting, but can progress to the serious or moderate forms which include serious weight gain, pleural effusion, lower abdominal pain, etc)

Question 26

Conivaptan

Answer 26

Vi V2 vasopressin antagonist used to treat HYPONATREMIA (like in SIADH)

Question 27

Tolvaptan

Answer 27

V2 vasopressin antagonist used for either hyponatremia OR heart failure

Question 28

Leuprolide clinical application?

Answer 28

depot formulations of GnRH

breast cancer, prostate cancer, endometriosis, porphyria, precocious puberty