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Pharmacology II > Growth Hormones / Adrenocorticohormones > Flashcards

Growth Hormones / Adrenocorticohormones Flashcards

1
Q

IGF-1?

  • induced by what hormone?
  • binds to what receptor?
  • has what primary effect
A
  • GH
  • binds to tyrosine kinase receptor (like insulin)
  • primary effect: linear growth (bone muscle cartilage)
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2
Q

what is acromegaly?

cause, presentation?

A
  • GH oversecretion secondary to IGF-insensitivity (no long loop control of of GHRH, GH)
  • presentation: overgrowth - local, esp in skull & mandible
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3
Q

what is somatropin?

  • MOA?
  • clinical uses?
  • AEs?
A

somatropin = GH

  • MOA: is GH
  • clinical uses: for GH deficient children with short stature (dwarfism):
    • ​Prader-Willi / Turner
  • AEs:
    • glucose tolerance (hyperglycemia)*
    • intracanial pressure
    • fluid retention
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4
Q

mecasermin

  • what kind of drug?
  • MOA?
  • PK?
  • clinical uses?
  • AEs?
A
  • rhIGF-1 - a recominant human IGF
  • MOA: binds IFR-1 receptor (tyrosine kinase receptor)
    • stimulates linear growth –> skeletal/muscle/bone/cartilage
  • PK: must ingest carbohydates 20 min before tx
  • clinical use: short stature in IGF-deficient children that is not responsive to exogenous GH
  • AEs:
    • hypoglycemia*
    • intracranial hypertension
    • adenotonsillar hypertrophy
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5
Q

synthetic somatstatin analogs

  • include what drugs?
  • arewhat kind of drugs?
  • MOA?
  • clinical uses?
  • AEs?
A

= “eotide” - octreotide, lanreotide

  • type of GH antagonist
  • MOA: bind somatostatin receptors (SSTRs), inducing its effects
  • clinical uses:
    • via GH antagonism:
      • acromegaly (local bone overgrowth at mandible/skull d/t IGF long loop insensitivity)
      • hormone secreting tumors (uncontrolled growth)
      • diarrhea
      • esophageal varices
  • AEs:
    • sinus bradycardia
    • hypothyroidism (SST agonist - inhibiton of TSH,”pulse generator”)
      • sinus bradycardia
    • hyperglycemia (SST agonist - inhibition of insulin/glucagon)
    • chest pain)
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6
Q

what two drugs can be used to treat short stature in children?

how are they different?

A
  • somatotropin and mecasemin:
    • both:
      • increase linear growth
      • AE - intracranial HTN
    • somatropin - 1st choice
      • GH
      • AE - hyperglycemia
    • mecasemin - 2nd choice
      • rhIGF-1 (recombinant IGF-1)
      • AE - hypoglycemia
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7
Q

pegvisomant

  • what kind of drug?
  • MOA?
  • clinical uses?
  • AEs?
A
  • is a GH antagonist
  • MOA: is a polyethylene glycol (PEG) derivative of GH that binds & dimizes GH receptor –> inhibiting it
  • clinical uses: acromegaly (local overgrowth at skull/mandible d/t insensitivtiy to IGF long loop)
  • AEs: none
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8
Q

what drugs are used to treat acromegaly?

A
  • “-reotride”: octeotride, lanreatide (SST analogs)
  • pegvisomant
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9
Q

what are primary and secondary adrenal insufficiency?

A
  • both: characterized by insufficient cortisol (glucocorticoid) production
    • primary: @ adrenal glands: damaged adrenal glands are unresponsiveness to ACTH
    • secondary @pituitary: insufficient ACTH production by pituitary
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10
Q

what is Cushing’s Syndrome/Disease?

A

both characterized by prolonge excess cortisol

  • Cushing Syndrome: prolonged, elevated cortisol
  • Cushing’s Disease: excess cortiol due to an ACTH-secreting tumor on pituitary
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11
Q

what are the glucocorticoid hormones?

A

Systemic Use (Oral / IV/ IM / SQ)

Hydrocortisone

Prednisolone / Prednisone

Triamcinolone

Dexamethasone

Betamethasone

Topical Use

Fluticasone

Budesonide

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12
Q

what is fludrocortisone?

A

a mineralcorticoid with a little bit of glucocorticoid activity

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13
Q

which glucocorticoid has the higest anti-inflammatory potency?

A

dexamethasone

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14
Q
A
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15
Q

glucocorticoids -MOA

A
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16
Q

glucocorticoids - PK

A

slow onset of action: at least several hours

17
Q

what is the biggest limitation for long term use of corticosteroids?

A
  • decreased muscle mass (weakness)
  • thinning of skin
  • osteoporosis
18
Q

how is adrenal insufficiency treated?

A

= primary adrenal insufficiency

tx with glucocorticoid

  • hydrocortisone - start with since its s_hort-acting_ and can mimic circadian rhythm
    • dosing: multiple 20-30 mg doses throughout the day
    • prednisoned/dexamethasone are alternatives:
      • longer acting ones that be used for patients with difficult compliance
  • fludrocortisone (mineralcorticoid > glucorticoid) - most pts eventually require mineralcorticoids prevent sodium loss, volume depletion, hyperkalemia
19
Q

glucorticoids effects

A
  • fuid / electrolyte abnormality effects
    • hypertension
      • glaucoma/cataracts
  • catabolic effects:
    • hyperglycemia [inc blood glucose]
    • osteoporosis [inc bone resorption]
  • immunosuppression
    • inc reased of infection
    • inc risk of peptic ulcers
  • behavioral changes - psychoses
20
Q

common AEs of glucocorticoid use typically present after what duration of time?

A

after long term use (>2 weeks) of glucocorticoid use

21
Q

why might one reduce/stop dosage of corticosteroids?

how should this be done?

A
  • if AEs start to present (typically after 2 weeks + use)
  • corticosteroid discontinuation should be tapered:
    • ​endogenous cortisol levels may not not return for another 6-9 months
22
Q

C/Is of glucocorticosteroid use?

A

line up with AEs:

  • HTN w/ HF
  • diabetes
  • osteoporosis
  • peptic ulcer
  • glaucoma
  • aggresive infections: varicella/tuberculosis
23
Q

fludrocortisone

  • what type of drug
  • MOA
A
  • mineralcorticoid > glucocorticoid
  • MOA = binds mineralcorticoid receptor - a nuclear receptor (Subclass II) on the zona glomerulosa, increasing transcription of
    • N/K-ATPases & ENac channels (kidney)
      • this inc Na+ reabpsrotion at several tissues
24
Q

fludrocortisone

clinical uses

A

aldosterone insufficiency secondary to Addison’s diseases (primary adrenal insufficiency)

25
Q

fludricortisone - AEs

A
  • increased palsma volume –> HTN
  • hypokalemia
  • metabolic alkalosis
  • general steroid effects: myopathy / immunosupression / psychiatric distrurbanc
26
Q

adrenaocortical antagonists

include what classes / drugs?

A
  • glucocorticoid (cortisol) synthesis inhibitors
    • ketoconazole
    • metryapone
  • spironolactone
  • mitotane
27
Q

ketoconazole

  • is what kind of drug?
  • has what MOA?
  • what clinical uses?
  • AEs?
A
  • a glucocorticoid antagonist (adrenal antagonist)
  • MOA: enters adrenal cortex cells and inhibits both glucocorticoid (cortisol) AND androgen (testosterone)
    • lower circulating levels of cortisol , testosteorne
  • clinical uses:
    • Cushing’s Syndrome - lowers circulating cortisol
    • Prostate Cancer - lowers cirulating testosterone
    • Fungal infections - is also an anti0fungal
  • PK - strong CYP-3A4 & P-gp inhibitor
  • AE - hepatotoxicity
28
Q

metyrapone

  • what kind of drug?
  • MOA?
  • clinical uses?
  • AEs?
A
  • is a glucocorticoid synthesis inhibitor (adenocortical antagonist)
  • MOA: selective inhibitor of 11-hydoxylation of steroids, inhibiting cortisol synthesis
  • clinical uses:
    • Cushing’s Syndrome - lowers levels of circulating cortisol
      • can be used in pregnant women*
  • AEs:
    • water retention
    • hurisitsm
29
Q

mitotane

  • what kind of drug?
  • MOA?
  • clinical uses?
  • AEs?
A
  • adrenal antagonist
  • MOA: unknown
  • clinical uses: Cushing’s syndrome - lowers levels of circulating cortisol
  • AEs:
    • depression
    • somnolence
30
Q

spironolacatone

  • what kind of drug?
  • MOA
  • clinical uses
  • AEs
A
  • a mineralcorticoid inhibitor (adrenal antagonist)
  • MOA: binds to & inhibits aldosterone receptors in zona glomerulosa
  • clinical uses:
    • fluid retention - edema, HTN ( induces diuresis )
    • primary hyperaldosteroism - excess aldosterone secretion at the level of the adrenal gland (idiopathic /adrenocortical neoplasm / ect)
31
Q

which drug lowers both cortisol and testosterone levels? what does it treat?

A

ketoconazole

can treat:

  • cushing’s disease
  • prostate cancer
32
Q

which adrenocortical antagonists increases fuid retention ? which lowers fluid retention?

A
  • metyrapone - inc fluid retention
  • spironolactone - dec fluid retention: tx for edema / HTN
33
Q

which drug can be used to treat cushing’s in pregnant women?

A

metyrapone

34
Q

which drugs can be used to treat Cushing’s Disease?

what are their individual AEs?

A
  • ketoconazole - hepatotoxicity
  • metyrapone - fluid retention/hirsutism
  • mitotane - depression / somnolence
35
Q

which adrenal antagonist can be used to treat primary hyperaldosteronism?

A

spironolactone

Pharmacology II (5 decks)

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