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SMUPASPG19-PHARM 1 > Endocrine-Hypo, pituitary, thyroid > Flashcards

Endocrine-Hypo, pituitary, thyroid Flashcards

1
Q

What is special regarding Pituitary gland? Consider in all dysfunction of life

A

PITUITARY HORMONES
Short half-life
NO PO-Rapidly digested by peptidase enzymes
Regulate by Hypothalmus release/inhibitory
Growth, BP, pregnancy childbirth, milk, sex organs, thyroid, conversion to energy/metabolism, water balance kidneys, temp.

RX
SQ, IM, IV
Regulatory negative feedback loops

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2
Q

WHat drugs affect the Endocrine Diseases?

A

Types of drugs:
Hormone replacement
Stimulate hormone release
Inhibit hormone release- DOPAMIN AND SOMATROPIN RELEASE INHIB/SOMATOSTATIN***

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3
Q

How do Gonadotropin Releasing Hormones work? What are mainstay in Gonadtrophin RX?

A

Regulates sex hormone synthesis- LH, FSH
GnRH- hypothalamus in pulses- via hypothalamic-pituitary portal system to AP

Stimulates ovary/testes to produce hormones
AXIS- regulating sex hormone synthesis

GnRH will bind to the GnRH receptor in AP- GPCR
activate secondary messenger system signaling leads to the production of LH an FSH

MAINSTAY in vitro fertilization
Control ovarian stimulation
follicle development
sperm production

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4
Q

How are Gonadotropins produced and what is MOA?

A

Produced by gonadotroph cells in AP
FSH - Stimulate ovarian follicle development
FSH + LH - Needed for ovarian steroidogenesis

Human chorionic gonadotropin (hCG)-Produced by the placenta, Regulate reproductive functions

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5
Q

What are the target cells for LH and FSH?

A

Target cells in males:
Leydig cells
Sertoli cells

Target cells in females:
Thecal cells
Granulosa cells

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6
Q

What are the Clinical use of Gonadotropins Replacement

Menotropins?

A

from PMP urine has unused hormones, high FSH, LH

MOA-Induce FSH LH, thus ovulation, ovary development in patients with functional oligo or anovulation.

Males off label- LH- spermatogenesis in primary or secondary hypogonadotropic hypogonadism

ADE- multiple pregnancy, GDM, preclampsia, preterm, ovarian-enlarged, hypovolemia, fever

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7
Q

What are the differences btwn FSH Replacement

Urofollitropin and Follitropin alfa Lutropin?

A

Urofollitropin (Bravelle)- FSH ONLY urine

MOA: stimulates ovarian follicular growth who DO NOT have primary ovarian failure. (dfx in ovaries b4 40y, no estrogen and no release of eggs)

Follitropin-Recombinant FSH-FAKE, identical to human FSH. Shorter half-life

MOA: stimulate ovarian follicular growth in growth who DO NOT have primary ovarian failure.
M-stimulate spermatogenesis in men with hypogonadotrophic hypogonadism

Lutropin alfa- (luveris) LH ONLY Added
w/ Follitropin for infertile women w/ LH deficiency.

MOA- inc. follicular estradiol secretion, need for FSH induced follicular development/maturation.

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8
Q

What are Gonadotropins ADRs?

A 
HA,
depression, 
edema, 
precocious puberty, 
hCG antibody production (rare)
Reversible, 
Gynecomastia 
Serious
Multiple pregnancies
15-20% in ovulation induction (1% general population)
GDM
preeclampsia, preterm labor

Ovarian hyperstimulation syndrome (OHS)
Ovarian enlargement, ascites, hydrothorax, hypovolemia, fever, arterial thromboembolism, shock

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9
Q 
What are GnRH Agonists Uses for?
gonadorelin
goserelin
histrelin
**leuprolide (Lupron)
naferelin
triptorelin
A

Uterine benign fibroids
Central precocious puberty- early secondary sex characteristics
Advanced ovarian and breast cancer
thinning of endometrial lining,
PCOS-amenorrhea infertility
Prostate cancer- testosterone suppression, NON pulsitile
Blocks LH surge in IVF protocols
Endometriosis-block cyclic changes
Estrogen-sensitive endometrium-like tissue outside the uterus, < 6 months, d/t bond density

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10
Q

What are MOA of GnRH Agonists

A 
Reg. FSH, LH from pituitary
Pulsatile INC promots ovulation
Continusous- inhibits FSH, LH, treat hormone sensitive cancers
Synthetic
IM, SC, nasal spray IV
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11
Q

What do the GnRH Antagonists do and clinical use?

A

inhib FSH and LH release
Prevent LH surge
Reduces testosterone prostate cancer

-RELIX

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12
Q

What drugs are avail. for HYPOprolactinemia?

A

NONE**

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13
Q

What hormone released form hypothalamus inhibits prolactin release in pituitary?

A

Dopamine
Any RX for treatment of Psychosis will have MOTOR effect
Any RX for treatment of Parkinson will have psychos effect

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14
Q

How is prolactin regulated?

A

Not by NEGATIVE feedback

PRL NO stimulate hormone release on its target organ

Ex. produces milk, milk does not feedback to hypothalamus

Made by lactotrophs in the AP

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15
Q

What drug will release PRL?

A

***Phenothiazine

ANY Dopamine antagonist will INC prolactin release

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16
Q

What is the only formulation for treating HYPERprolactemia?

A

Bromocriptine- PO
Cabergoline-PO, VAG

MOA-DA agonists- promotes DA to inhibit PRL

DEC GH in acromegaly- extra bone after epiphyseal plates fuse
Parkinson- risk psychosis
Shrink tumors

ADR:
Psychosis
Pulmonary infiltrates and fibrosis, ORTHO HTN

17
Q

MC for HYPERprolactemia?

A

1-PRL-secreting adenomas

PRL MOA: supress HYPO-PIT- AXIS
inhibits GnRH-DEC LH FSH- body saying no more eggs we already prego.

HYPOgandism, infertility

  1. ANY Dopamine antagonist
18
Q

What is produced by hypothalmus and releasded by post pituitary and involves lactation? the LOVE HORMONE

A 
Oxytocin (Pictocin)
similar to ADH (vasopressin)
milk ejection
stimulate uterine contractions
High dose can effect vasopressin receptors

MOA- labour induction, STOP postpartum bleeding

ADRs-Rare
excessive contractions
vasopressin activation- water retention/water toxic, hyponatremia, CV, seize, death

AVOID-Fetal distress, uterine rupture

19
Q

What is released due to plasma concentration DEC, dec. blood pressure?

A

ADH- ANTI (retention) diruetic hormone

Drug Vasopressin

20
Q

What is 4000x great than natural ADH?

A

desmopressin vaspressin Analog
IV, SC, INH

MOA- specificity for V2 receptors stimulates water retention.
cause urinary retention

DOC- poly-uria, dipsia, DI, , hyernatremia, bedwetting
IV- bleeding, coagulpathies- Hemophilia A, Willebrand- platelet adhesion dfx

21
Q

1:10000 Pt has a h/o CAD, HA, nausea, HYPOnatremia, vascocontstriction? What are these ADR associate with?

A

Vasopressin

22
Q

What is used for treatment of CHF and Acute heart failure?

A

Vasopressin Antagonists

MOA- opposite of water retention. Releases fluid overload, thus dec pressure

23
Q

What have a NEG log linear relationship?

A

FREE T4 and TSH

small change in T4= Large change in TSH

24
Q

Which is best for assessment of thyroid?

Which is best to rule out Pituitary (secondardy) vs Hypothalmaic (tertiary) dz

A

TSH- somthing is off

T4- HPO

TSH- normal- NO further test
HIGH TSH= HYPOthyrodism (LOW T4 degree of HPO)
LOW TSH= HYPERthryodisim (HIGH T3/T4 degree) (Thyroid overstimulating, so TSH shuts down dramatically bc neg feedback, thinks enough)

25
Q

PT c/o fatigue, slow speech, weight gain, COLD, constipation, hair coarse, tongue swollen, HA

Vitals- bradycardia, slow metabolic

PE- delayed DTR

TSH levels- HIGH TSH

What is DDX?

A

HYPOthyroidsim

26
Q

PT c/o hyperpigmented spots, thinning hair, pruitius and hives, weight loss, lid lag-sclera seen,
Vitals- tachycardia

LOW TSH
LOW HDL

A

HYPERthyroidism

27
Q

What is the treatment for HYPOthyroidism?

A

LEVOthyroxine- pig thyroid (allergy alert)
lifelong for most pt

MOA-thyroid hormone inc. Take 6 weeks to reach steady state. Check by 3 wks w/T4/TSH. Don’t adjust dose til after 3wk prn.
EMPTY STOMACH 1HR B4 BKFST.

ADRs-DEC dose elderly, CAD- tachycardia.
FOOD alters dose
Rare-CV,CNS, DERM, wt loss (similar to HYPERTHY)

28
Q

Regarding dose of Levothryoxine what is important?

A

Variable PO bioavailability- when switching to IV, HALF the original dose.

INC DOSE

29
Q

What are the overlaps of HYPOthyroid?

A 
MIMIC pregnancy
Always get a UPT
Use trimester specific for TSH levels
****IF pregnant and LEVO- adjust by 30%, goal 150%
Check TSH q4 wks
Reduce after pregnancy
REcheck 4-6wk postpartum
30
Q

What is the hCG replacement RX?

A

Choriogonadotropin alfa- urine

MOA- stimulates gonadal steriods by causing production of androgen testes, as a substitute of LH stimulatin ovulation

31
Q

How do GnRH agonist work with prostate cancer and others?

A

Continuous suppression- negative feed back
GnRh + androgen receptor antagonist- dec testoserone w/in 2 wks.

Block LH surge prn

Endometriois- blocks cycle sx ONLY FOR 6MO LIMIT-NOT IDEAL D/T reduced bone density

Uterine fibroids-estrogen sensitive inc bleeding anemia and pelvic pain

Other- ovarian ca, thins endometrial, Brest cancer, PCOS

SMUPASPG19-PHARM 1 (17 decks)

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