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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
Drugs that induce prolactin excess states
Phenothiazines & other dopamine blockers
26
In female: typical hyperprolactinemia cases
amenorrhea | galactorrhea
27
in adult male: typical hyperprolactinemia cases
``` reduced libido muscle mass decrease reduced facial hair growth erectile dysfunction gynecomastia is possible ```
28
Treating Hyperprolactinemia
dopamine agonists Ergot type: Bromocriptine (parlodel) Cabergoline (Dostinex) Non-Ergot type: Parkinson's treatment agents
29
Most common ause of druge induced hyperprolactinemia
antiphychotic agents
30
what is contraindicated in psychotic patients?
Dopamine agonists
31
Dopamine agonists in contraindicated in what?
Psychotic patients
32
Lowest effective dose (meds) for prescribing dopamine agonists
Cabergoline (Dostinex) (o.5 mg tabs (1/2 tab PER WEEK)) Bromocriptine (Parlodel) 2.5 mg tablets (1/2 tab at bedtime (qhs)
33
Common side effects of prescribing dopamine agonists
nausea & orthostatic hypotension SLIGHT risk of hypertension/CVA
34
TRF
thyrotropin releasing hormone
35
TRF regulates what?
In hypothalamus TSH and prolactin
36
T3
Triiodotyronine (T3)
37
T4
Tetraiodothyronine (T4, thyroxine, levothyroxine)
38
Special T3/T4 function
Increase sensitivity to catecholamines THEREFORE EXCELL T3/T4 PRODUCES SYMPTOMS 7 SIGNS OF SYMPATHETIC AGONIST EXCESS
39
Thyroid hormone products
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
Levothyroxine doses
from .025 to .3 mg (tablets) Full replacement dose usually .1-.2 mg Toxicity dose related to dose and T4 effects
41
Levothyroxine caution?
ADVANCE DOSE CAUTIOUSLY IN PATIENT >65 increases metabolism and cardiac oxygen requirements
42
Plummer's disease
Toxic Nodular Goiter causes Hyperthyroidism
43
two diseases of hyperthroidism
Grave's disease | Toxic Nodular Goiter (Plummer's disease)
44
Causes pf hypothyroidism (Primary (gland failure))
Hashimoto's thyroiditis Absence/Destruction Low Iodine Intake
45
Hypothyroid symptoms
``` Poor memory Inability to concentrate Hair loss Weight gain Cold intolerance Weakness Fatigue Dry skin Menstrual irregularities Cognitive decline ```
46
Hypothyroidism treatment
First choice: Thyroxine (T4) daily
47
Lag time for Thyroid-Pituitary Axis
Long lag time 6-8 weeks
48
where is T4 metabolized
liver (CYP450)
49
Age factor in Hypothyroidism treatment
Low & slow for > 65 y/o | dose typically 75% of young adults
50
Adverse effects of thyroxine
similar symptoms of hyperthyroidism
51
Symptoms of hyperthyroidism
``` Restlessness Insomnia Tremor Weight loss Heat intolerance Weakness Fatigue Muscle cramps Menstrual irregularities anxious HTN ``` Increase in sympathetic receptor sensitivity
52
Hyperthyroidism treatment
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
BetaBlockers in hyperthyroidism
``` Control cardiovascular syptoms: Tachycardia Anginga Tremors Agitation ``` Non-selective agent best: Propranolo (Inderal) CAUTIONS in asthmatics, acute CHF
54
Anti-thyroid agents
``` Thioamides Anion Inhibitors Iodides Iodinated contrast media Radioactive iodine ```
55
Thioamides
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
How long does it take for thioamides to deplete T3/T4 stores?
3-4 weeks does not block iodide uptake
57
Two examples of thioamides
Propylthiouracil (PTU) Q6-8 hrs BEST CHOICE FOR PREG PATIENTS Methimazole (Tapazole) single daily dose
58
Thioamine Adverse effects
Rash Edema Agranulocytosis
59
anion inhibitors
Prevent REUPTAKE OF IODINE limited usefulness (drug induced hyperthyroidism Main choice: POTASSIUM PERCHLORATE Can cause aplastic anemia
60
Iodides
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
Iodinated contrast media
bock T4 to T3 CONVERSION Onset of action within a few days ``` Choices: Iopanpoic acid (Telepaque) Diatrizoate sodium (Hypaque) Ipodate sodium (oragrafin) ```
62
Radioactive Iodine (I131)
Oral prep, rapidly absorbed destroys thyroid gland within a few weeks > 30 years of safe use CONTRAINDICATED IN PREGNANCY!!!
63
Thyroid storm
uncommon form of hyperthyroidism AKA thyrotoxic crisis Cause: Stress, coexisting illness, idiopathic ``` Symptoms: High fever Tachycardia/arrhythmia Diarrhea/vomiting/dehydration Coma ```
64
Thyroid storm treatment
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
Androgen
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
Available Androgens
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
Androgen Adversities
Liver damage/hepatoma risk (mainly oral preparations) INCREASED HEMATOCRIT: = VASCULAR THROMBOSIS INCREASED LIBIDO: = INCREASED AGGRESSIVENESS Oily skin/acne
68
Best approach to decreased levels of adrogens
``` use symptoms and lab values (total T <200 ng/dl) ```
69
aromatase
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
aromatase inhibitors
reduce production of estrogens choices: Anastozole (Arimidex) Letrozole (Femara) Exemestane (Aromasin) Side effects (hypoestrogenism)
71
Indications for aromatase inhibitors
Breast Ca treatment reduces risk of recurrence gradually replacing tamoxifen (Nolvadex) Breast CA prevention Ovulation induction
72
Anti-Androgen strategies
Block steridogenesis Ketoconazole (Nizoral) Drug interaction issues (CYP450 inhibitor) Block T to DHT conversion Finasteride (Propecia) Inhibit androgen receptors
73
Androgen Receptor Blockers
Cyrpoterone acetate Also blocks progesterone receptors Flutamide (Eulexin) Bicalutamide (Casodex) Nilutamide (Nilandron)
74
Antiandrogen Ultilization
Women: Hirsutism, masculinization PCO most common indication Men Male pattern baldness Prostatic hypertrophy Prostate Ca treatment
75
Androgenic alopecia
Male Pattern Baldness
76
Important Endocrine Event (testosterone conversion)
Testosteron (T) is converted to > Dihydrotestosterone (DHT) by the action of ... 5-Alpha reductase
77
BPH Medical treatment
Alpha sympathetic receptor blocking drugs | 5-Alpha reductase inhibitors
78
Male pattern baldness medical treatment
5-alpha reuctase inhibitors | Minoxidil (Rogaine)
79
5-Alpha reductase inhibitor (drugs)
Finasteride (Propecia) | Dutasteride (Avodart)
80
Anti-Androgen Side effects
Women: diminished libido ``` Men: Diminishe libido Erectile dysfunction Decline in muscle mass/strength diminished sense of well-being gynecomastia ```
81
Androgen Cause with Pregnancy
MASCULIZATION OF THE FEMALE FETUS
82
Anti-androgen caution with pregnancy
INCOMPLETE MASCULINIZATION OF A MALE FETUS
83
Ambiguous genitalia
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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