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Pharm II > Endo Pharm (1) > Flashcards

Endo Pharm (1) Flashcards

1
Q

Another name for anterior pituitary

A

Adenohypophysis

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2
Q

ACTH

A

adrenocorticotropic hormone

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3
Q

What inhibits the process of Prolactin

A

Dopamine

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4
Q

Endocrine-secreting pituitary tumors

A

Growth Hormone (Giantism, acromegally)
ACTH (Cushing’s Disease)
Prolactin (prolactinoma) (MOST COMMON)

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5
Q

Pituitary tumors do not secrete these hormones

A

TSH, FSH, LH

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6
Q

Pituitary extracts (GH availability)

A

No longer used

Due to risk of Prion Disease: Creutzfeldt-Jakob Disease (CJD)

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7
Q

Recombinant GH

A

licensed for short stature associated with growth hormone deficiency (GHD)

Genotropin, Humatrop, Hutropin, et al
Injections (SQ or IM)

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8
Q

Treatment with GH

A 
GH deficient states
Some short stature children:
Normal GH but delayed growth
Turner syndrome (45,X)

Experimental:
Muscle augmentation in elderly
Intrauterine growth retardation

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9
Q

Adverse Effects with GH

A 
Usually well tolerated, esp children
Hypothyroidism possible
MYALGIA, ARTHRALGIA
GLUCOSE INTOLERANCE
Possible stimulation of tumor growth
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10
Q

Symptoms of acromegaly

A

Diabetes
Soft tissue swelling
Teeth gaping
Macroglosia (large tongue)

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11
Q

GH excess: Pituitary Adenoma before epiphyseal plate closure

A

Giantism

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12
Q

GH excess: Pituitary Ademona after epiphyseal Plate closure

A

Acromegaly

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13
Q

Most common cause of acromegaly

A

pituitary tumor

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14
Q

Excess GH in adults leads to:

A 
Glucose intolerance leading to DM
Cardiact enlargement leading to CHF
HTN
Renal failure
Soft tissue swelling including: head, shoe, nose, lips, ears, fingers.
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15
Q

Options for treating GH excess disorders

A

GH inhibity hormone (Somatostatin) (secretion)

GH receptor antagonist (receptors)

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16
Q

Somatostatin

A

Somatostatin from the hypothalamus inhibits the pituitary gland’s secretion of growth hormone and thyroid stimulating hormone. In addition, somatostatin is produced in the pancreas and inhibits the secretion of other pancreatic hormones such as insulin and glucagon.

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17
Q

Indications for Somatostatin (receptor) Agonists

A

Utility in acromegaly & carcinoid syndrome

for growth limitation: controversial

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18
Q

Somatostatin (receptor) Agonists choices

A

Octreotide (Sandostatin, Sandostating LAR)

Lanreotide (Somatuline LA, Autogel)

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19
Q

GH receptor Blockade indication

A

Acromegaly not responsive to surgery or somatostatin analogs

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20
Q

GH receptor blockade med?

A

Pegvisomant (Somavert)

also administered via SQ injections

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21
Q

Main function of prolactin

Other functions of prolactin:

A

Lactation (main)

Stress response
sexual response
fluid balance
Immunologic (?)
Other
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22
Q

Prolactin deficient symptoms

A

Probably none other than lactation failure

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23
Q

Pathophysiology of Prolactin excess states

A

Loss of prolactin inhibiting factor (dopamine)
excess of thyrotopin-releasing factor (TRF)
Results in galactorrhea & Hypogonadism (Low FSH & LH)

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24
Q

Causes of Prolactin Excess States

A

Pituitary adenoma
Primary hypothyroidism
Drug induces

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25
Q

Drugs that induce prolactin excess states

A

Phenothiazines & other dopamine blockers

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26
Q

In female: typical hyperprolactinemia cases

A

amenorrhea

galactorrhea

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27
Q

in adult male: typical hyperprolactinemia cases

A 
reduced libido
muscle mass decrease
reduced facial hair growth
erectile dysfunction
gynecomastia is possible
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28
Q

Treating Hyperprolactinemia

A

dopamine agonists
Ergot type:
Bromocriptine (parlodel)
Cabergoline (Dostinex)

Non-Ergot type:
Parkinson’s treatment agents

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29
Q

Most common ause of druge induced hyperprolactinemia

A

antiphychotic agents

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30
Q

what is contraindicated in psychotic patients?

A

Dopamine agonists

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31
Q

Dopamine agonists in contraindicated in what?

A

Psychotic patients

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32
Q

Lowest effective dose (meds) for prescribing dopamine agonists

A

Cabergoline (Dostinex) (o.5 mg tabs (1/2 tab PER WEEK))

Bromocriptine (Parlodel) 2.5 mg tablets (1/2 tab at bedtime (qhs)

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33
Q

Common side effects of prescribing dopamine agonists

A

nausea & orthostatic hypotension

SLIGHT risk of hypertension/CVA

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34
Q

TRF

A

thyrotropin releasing hormone

35
Q

TRF regulates what?

A

In hypothalamus

TSH and prolactin

36
Q

T3

A

Triiodotyronine (T3)

37
Q

T4

A

Tetraiodothyronine (T4, thyroxine, levothyroxine)

38
Q

Special T3/T4 function

A

Increase sensitivity to catecholamines

THEREFORE EXCELL T3/T4 PRODUCES SYMPTOMS 7 SIGNS OF SYMPATHETIC AGONIST EXCESS

39
Q

Thyroid hormone products

A

Preferred:
Levothyroxine (T4, syntroid, levoxyl, levo-t, unithyroid)

Use “never required”:
Liothyronine (T3, Cytomel, Triostat)
Liotrix (Thyrolar)-4:1 ratio of T4:T3
Desiccated Thyroid (Bovine Thyroid) Armour thyroid, thyroid strong, thyrar)

40
Q

Levothyroxine doses

A

from .025 to .3 mg (tablets)

Full replacement dose usually .1-.2 mg
Toxicity dose related to dose and T4 effects

41
Q

Levothyroxine caution?

A

ADVANCE DOSE CAUTIOUSLY IN PATIENT >65

increases metabolism and cardiac oxygen requirements

42
Q

Plummer’s disease

A

Toxic Nodular Goiter

causes Hyperthyroidism

43
Q

two diseases of hyperthroidism

A

Grave’s disease

Toxic Nodular Goiter (Plummer’s disease)

44
Q

Causes pf hypothyroidism (Primary (gland failure))

A

Hashimoto’s thyroiditis
Absence/Destruction
Low Iodine Intake

45
Q

Hypothyroid symptoms

A 
Poor memory
Inability to concentrate
Hair loss
Weight gain
Cold intolerance
Weakness
Fatigue
Dry skin
Menstrual irregularities
Cognitive decline
46
Q

Hypothyroidism treatment

A

First choice: Thyroxine (T4) daily

47
Q

Lag time for Thyroid-Pituitary Axis

A

Long lag time 6-8 weeks

48
Q

where is T4 metabolized

A

liver (CYP450)

49
Q

Age factor in Hypothyroidism treatment

A

Low & slow for > 65 y/o

dose typically 75% of young adults

50
Q

Adverse effects of thyroxine

A

similar symptoms of hyperthyroidism

51
Q

Symptoms of hyperthyroidism

A 
Restlessness
Insomnia
Tremor
Weight loss
Heat intolerance
Weakness
Fatigue
Muscle cramps
Menstrual irregularities
anxious
HTN

Increase in sympathetic receptor sensitivity

52
Q

Hyperthyroidism treatment

A

Quickly control symptoms
Beta adrenergic blokade (control sypathetic agonist type symptoms)

Utilize anti-thyroid agents
Prevent thyroid storm

Definitive treatment
Thyroid excision or destruction

53
Q

BetaBlockers in hyperthyroidism

A 
Control cardiovascular syptoms:
Tachycardia
Anginga
Tremors
Agitation

Non-selective agent best:
Propranolo (Inderal)
CAUTIONS in asthmatics, acute CHF

54
Q

Anti-thyroid agents

A 
Thioamides
Anion Inhibitors
Iodides
Iodinated contrast media
Radioactive iodine
55
Q

Thioamides

A

Blocks SYNTHESIS of T3/T4

anti-thyroid drugs are also a class of drugs that are used to control thyrotoxicosis.

act principally by blocking the synthesis of T4 by preventing iodination of tyrosine residues.

56
Q

How long does it take for thioamides to deplete T3/T4 stores?

A

3-4 weeks

does not block iodide uptake

57
Q

Two examples of thioamides

A

Propylthiouracil (PTU)
Q6-8 hrs
BEST CHOICE FOR PREG PATIENTS

Methimazole (Tapazole)
single daily dose

58
Q

Thioamine Adverse effects

A

Rash
Edema
Agranulocytosis

59
Q

anion inhibitors

A

Prevent REUPTAKE OF IODINE
limited usefulness (drug induced hyperthyroidism
Main choice: POTASSIUM PERCHLORATE
Can cause aplastic anemia

60
Q

Iodides

A

Suppress T3/T4 RELEASE
Quick onset of action
Escape from suppression occurs in 2-8 weeks

Interferes with thioamide action and radioactive iodine
start thioamides first
AVOID IF RADIOACTIVE IODINE USE IS LIKELY

61
Q

Iodinated contrast media

A

bock T4 to T3 CONVERSION
Onset of action within a few days

Choices:
Iopanpoic acid (Telepaque)
Diatrizoate sodium (Hypaque)
Ipodate sodium (oragrafin)
62
Q

Radioactive Iodine (I131)

A

Oral prep, rapidly absorbed
destroys thyroid gland within a few weeks
> 30 years of safe use
CONTRAINDICATED IN PREGNANCY!!!

63
Q

Thyroid storm

A

uncommon form of hyperthyroidism
AKA thyrotoxic crisis

Cause: Stress, coexisting illness, idiopathic

Symptoms:
High fever
Tachycardia/arrhythmia
Diarrhea/vomiting/dehydration
Coma
64
Q

Thyroid storm treatment

A

Hospitlization and:

Beta Blocker (propranolol)
Calcium channel blocker (diltiazem)
Potassium iodide: block T3/T4 release
Propylthiouracil (PTU)
Hydrocortison: CV stability, reduce T4 to T3 conversion
65
Q

Androgen

A

Male sex hormone:
For use in hypogonadal men and women

Enhance libido

Enhance general quality of life (?)
Maintain/enhance muscle mass & strength
reduce risk of falling in elderly
increase RBC production

66
Q

Available Androgens

A

Orally active:
ethyltestosterone
Fluoxymeterone (Halotestin)
Oxandrolone (Oxandrin, Anavar)

Testosterone:
Gel formation (Androgel)
Patch (testoderm, Androderm)
Pellets for IM injection (Testopel)

Other IM injection options: Testosterone cypionate, enanthate, proprionate

67
Q

Androgen Adversities

A

Liver damage/hepatoma risk (mainly oral preparations)

INCREASED HEMATOCRIT: = VASCULAR THROMBOSIS

INCREASED LIBIDO: = INCREASED AGGRESSIVENESS

Oily skin/acne

68
Q

Best approach to decreased levels of adrogens

A 
use symptoms and
lab values (total T <200 ng/dl)
69
Q

aromatase

A

Aromatase: An enzyme involved in the production of estrogen that acts by catalyzing the conversion of testosterone (an androgen) to estradiol (an estrogen). Aromatase is located in estrogen-producing cells in the adrenal glands, ovaries, placenta, testicles, adipose (fat) tissue, and brain.

70
Q

aromatase inhibitors

A

reduce production of estrogens

choices:
Anastozole (Arimidex)
Letrozole (Femara)
Exemestane (Aromasin)

Side effects (hypoestrogenism)

71
Q

Indications for aromatase inhibitors

A

Breast Ca treatment
reduces risk of recurrence
gradually replacing tamoxifen (Nolvadex)

Breast CA prevention

Ovulation induction

72
Q

Anti-Androgen strategies

A

Block steridogenesis
Ketoconazole (Nizoral)
Drug interaction issues (CYP450 inhibitor)

Block T to DHT conversion
Finasteride (Propecia)

Inhibit androgen receptors

73
Q

Androgen Receptor Blockers

A

Cyrpoterone acetate
Also blocks progesterone receptors

Flutamide (Eulexin)
Bicalutamide (Casodex)
Nilutamide (Nilandron)

74
Q

Antiandrogen Ultilization

A

Women:
Hirsutism, masculinization
PCO most common indication

Men
Male pattern baldness
Prostatic hypertrophy
Prostate Ca treatment

75
Q

Androgenic alopecia

A

Male Pattern Baldness

76
Q

Important Endocrine Event (testosterone conversion)

A

Testosteron (T) is converted to >

Dihydrotestosterone (DHT) by the action of …

5-Alpha reductase

77
Q

BPH Medical treatment

A

Alpha sympathetic receptor blocking drugs

5-Alpha reductase inhibitors

78
Q

Male pattern baldness medical treatment

A

5-alpha reuctase inhibitors

Minoxidil (Rogaine)

79
Q

5-Alpha reductase inhibitor (drugs)

A

Finasteride (Propecia)

Dutasteride (Avodart)

80
Q

Anti-Androgen Side effects

A

Women:
diminished libido

Men:
Diminishe libido
Erectile dysfunction
Decline in muscle mass/strength
diminished sense of well-being
gynecomastia
81
Q

Androgen Cause with Pregnancy

A

MASCULIZATION OF THE FEMALE FETUS

82
Q

Anti-androgen caution with pregnancy

A

INCOMPLETE MASCULINIZATION OF A MALE FETUS

83
Q

Ambiguous genitalia

A

intersex

Ambiguous genitalia is a rare condition in which an infant’s external genitals don’t appear to be clearly either male or female. In a baby with ambiguous genitalia, the genitals may be incompletely developed or the baby may have characteristics of both sexes.

Pharm II (10 decks)

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