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Pharmacology > ERS L11 - Treatment of Pituitary Disorders > Flashcards

ERS L11 - Treatment of Pituitary Disorders Flashcards

1
Q

Somatotropin replacement

A

For pituitary dwarfism.

Direct stimulation to increase protein synthesis and amino acid uptake. Increase lipolysis (after a few hours). Increase glucose level (after a few hours).

Indirectly stimulate bone growth by stimulation of IGF-1 production from liver.
Increase sulphate uptake into cartilage.
Promote bone growth by stimulating thymidine and uracil incorporation into DNA and RNA respectively.

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2
Q

Follitropin

A

Recombinant human FSH

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3
Q

Lutropin alpha

A

Recombinant human LH

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4
Q

Human chorionic gonadotropin

A

As LH replacement

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5
Q

Human menopausal gonadotropin

A

For FSH replacement

Mixture of FSH and LH

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6
Q

Choriogonadotropin alpha

A

Recombinant HCG

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7
Q

FSH replacement

A

*must add LH replacement for treating hypogonadism

Follitropin
Human menopausal gonadotropin

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8
Q

LH replacement

A

*add FSH replacement

Lutropin alpha
HCG
Choriogonadotropin alpha

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9
Q

For primary hypoadrenalism, eg Addison’s disease

A

Hydrocortisone/cortisone + fludrocortisone

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10
Q

Hydrocortisone

A

Corticosteroid, mainly with glucocorticoid function

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11
Q

Cortisone

A

Converted to hydrocortisone in liver

Corticosteroid, mainly glucocorticoid function

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12
Q

Fludrocortisone

A

Mineralosteroid

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13
Q

Secondary hypoadrenalism

A

Corticosteroid with glucocorticoid function only

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14
Q

Somatotropin: side effects

A 
Hypothyroidism
Glucose intolerance
Peripheral edema
Papilledema, visual changes
Increased intracranial pressure, headache
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15
Q

FSH replacement: side effects (X8)

A

Ovarian hyper simulation syndrome (ovarian enlargement, hydrothorax, ascites, hypovolemia)

Haemoperitoneum
Dyspnea
Electrolyte imbalance
Arterial thromboembolism
Fever 
Multiple births 
Gynecomastia
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16
Q

LH replacement: side effects

A 
Headache
Depression
Edema 
Precocious puberty
Gynecomastia
17
Q

Treatment for hyperprolactinemia

A

Dopamine D2 receptor agonist

  • Bromocriptine
  • Cabergoline
  • Inhibit prolactin secretion
  • Reduction in size of prolactin-producing adenoma
18
Q

Cabergoline

A

Dopamine D2 agonist

For hyperprolactinemia, hypersecretion of growth hormone

19
Q

Bromocriptine

A

Dopamine D2 agonist

For hyperprolactinemia, hypersecretion of growth hormone

20
Q

Side effects of bromocriptine / cabergoline

A 
1. Postural hypotension 
(D1 receptor, vasodilation)
2. Constipation (decrease gut motility)
3. Nausea and vomiting 
(D2 receptors, chemoreceptor trigger zone --> vomiting centre in medulla)
4. Dizziness
21
Q

Octreotide

A

Somatostatin analogue for hypersecretion of GH

  1. Inhibit release of GH from anterior pituitary
  2. (minority) Reduce tumour size (reduce blood loss during surgery)
22
Q

Lanreotide

A

Somatostatin analogue for hypersecretion of GH

  1. Inhibit release of GH from anterior pituitary
  2. (minority) Reduce tumour size (reduce blood loss during surgery)
23
Q

Octreotide vs Lanreotide

A

Both somatostatin analogue

Octreotide:

  • longer acting
  • less hyperglycemic effect
24
Q

Side effects of octreotide

A
  1. GI disturbance: Nausea and vomiting, Abdominal cramps, Flatulence, Steatorrhoea
  2. Gall stone: ↓ gall bladder motility
  3. Glucose intolerance: inhibit secretion of insulin from pancreas
25
Q

Side effects of Lanreotide

A
  1. GI disturbance: Nausea and vomiting, Abdominal cramps, Flatulence, Steatorrhoea
  2. Gall stone: ↓ gall bladder motility
  3. Glucose intolerance: inhibit secretion of insulin from pancreas
26
Q

Pegvisomant

A

GH receptor antagonist

  1. Block GH signaling
  2. Inhibit hepatic production of IGF-1
27
Q

Side effects of Pegvisomant

A
  1. Elevated liver enzyme
  2. Nausea
  3. Diarrhoea
28
Q

Treat acromegaly / gigantism

A
  1. Somatostatin analogue
    Octreotide
    Lanreotide
  2. GH receptor antagonist
    Pegvisomant
  3. Dopamine receptor agonist
    Bromocriptine
    Cabergoline
29
Q

Metyrapone

A

Treat Cushing’s Syndrome

Inhibit 11-beta-hydroxylase

30
Q

Trilostane

A

For Cushing’s Syndrome

Inhibit 3-beta-drhydrogenase (3-beta-HSD)

31
Q

Side effects of metyrapone

A
  1. Hypotension
  2. Nausea, vomiting
  3. Headache, dizziness
  4. Rash
32
Q

Side effects of trilostane

A
  1. Hypotension
  2. Nausea, vomiting
  3. Headache, dizziness
  4. Rash
33
Q

Treat Cushing’s Syndrome

A

Metyropone

Trilostane

34
Q

Treat diabetes insipidus

A

Vasopressin

Desmopressin

35
Q

MoA of desmopressin

A

Agonist of V2R at distal tubule and collecting ducts in kidneys

  • Increase aquaporin-2 transcription
  • Increase AQP-2 translocation to cell surface
36
Q

Side effects of desmopressin

A
  1. Fluid retention
  2. Dilutional hyponatremia
  3. Headache
  4. Nausea
  5. Allergy
37
Q

Side effects of vasopressin

A
  1. Fluid retention
  2. Dilutional hyponatremia
  3. Headache
  4. Nausea
  5. Allergy

Only to vasopressin (less sensitive, bind to V1R…)

  1. Coronary artery spasm –> angina
  2. Abdominal and uterine cramps
38
Q

Treat pituitary dwarfism

A

Somatotropin

39
Q

Treat gonadotropin deficiency

A

FSH + LH replacement

FSH:

  • Follitropin
  • Human menopausal gonadotropin

LH:

  • Lutropin alpha
  • Choriogondadotropin alpha
  • HCG

Pharmacology (10 decks)

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