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Pharmacology > HPA - bk > Flashcards

HPA - bk Flashcards

1
Q

GH receptor

A

jak stat

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2
Q

Criteria for dx of GH deficiency

A

growth rate of < 4 cm per year

no GH in serum despite bein g given to secretagogyes

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3
Q

Name the recombiant Growth Hormone(s)

A

Somatropin - recombiant GH

Somatrem - GH analogue

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4
Q

~*Effects of somatropin and somatrem in GH deficient adults

A

improved metabolic state
increased lean body mass
sense of well being

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5
Q

~* Effects of somatropin and somatrem in HIV positive patients

A

increased lean body mass and weigh and physical endurance

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6
Q

Use of somatropin and somatrem in short bowel syndrome

A

improved GI function when receiving specialized nutritional support

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7
Q

A/se of somatropin and somatrem

A

generally well tolerated BUT

  • scoliosis (due to rapid growth)
  • hypothyroidism
  • intracranail hypertension - rare
  • otitis media (increased risk at turners)
  • pancreatitis
  • gynecomastia
  • nevus growth
  • diabetic syndrome (opposes insulin) at chronic used
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8
Q

A/se of GH in adults

A 
peripheral odema
myalgia
arthralgia @ hand and wrists
carpal tunnel syndrome
proliferative retinopathy
**ie think acromegaly symtpoms
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9
Q

Mecasermin = ?

A

recombinant IGF-1 analog and recombinant IGF-binding protein 3

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10
Q

use of Mecasermin?

A

children wtih growth faiure that have an IGF-1 deficiency (due to mutations in GH receptor and development of neutralizing Gh abs)

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11
Q

A/se mecasermin

A

** opposite of what you would think = hypglycemia
intracranial hypertension
asymptomatic elevation fo lvier enzymes

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12
Q

How to treat Gh secreting adenomas please

A

Gh receptor antagonists
Somatostatin analogs
DA receptor agonists

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13
Q

What is pegvisomant?

A

GH receptor antagonist

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14
Q

Ocreotide =

A

somatostatin

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15
Q

Ocreotide MOA

A

inhibits release of GH, TSH, glucagon, insulin and gastrin

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16
Q

Advantage of Ocreotide acetate over ocretoide alone-zees

A

long acting suspension that you can give at 4 week itnervals

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17
Q

~*~Use of Ocreotide

A

1) reduce symptoms caused by all the lil hormone secreting tumours (acro, carcinoid, gastrinoma etc)
2) localizing neuroendocrine tumours
3) acute control of esophageal varices ****

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18
Q

SHARK: provide acute control for bleeding from esophageal varices

A

ocreotide!!!

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19
Q

A/se for DOC @ gastrinoma

A 
n/v, ab cramps, flatulence, steatorrhea
constipation
biliary sludge and gallstones
sinus bradycardia and conduction disturbaces
vitamin B 12 deficiency@ long term use
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20
Q

Name some DA agonists:

A

bromocriptine (shark flash back - parkinsons)

cabergoline

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21
Q

Treat a pit adenoma that is secreting a bunch a prolactin

A 
bromocriptine or cabergoline
DA agonists (inhibi of prolactin @ pti)
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22
Q

Uses of Bromocriptine/cabergoline

A

hyperprolatinemia

acromegaly (alone or with surgery, radiation, ocreotide)

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23
Q

A/se bromocriptine/cabergoline

A

nausea (worse with B over C), h/a light headedness, orthostatic hypotension, fatigue
psych manifestations
high dose = cold induced peripheral digital vasosapsm
pulmonary infiltirares - chronic high doages terapy **repeat from parkinson lecture = pulmoanry infiltrates with ergot derviatives

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24
Q

Name the analogs of FSH and LH

A

menotropins - FSH and LH
follitropin - recombinant FSH
urofollitropin - purified human FSH extract

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25
Q

Name the human chorionic gonadotropin extract and where we get it from

A

choriogonadotropin = recominant

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26
Q

how do you give choriogonadotropin?

A

SC or IM

27
Q

Receptor of gonadotropins please :)

A

GPCRs

28
Q

CLinical application of gonadotropins

A

1) ovluation induction

2) male infertility (FSH and LH required; can give choriogonadotropin alone or with urofollitropin, rFHS and rLH)

29
Q

A/se of gonadotropins in a) women and b) men

A

WOMEN - ovarion hyperstimulation syndrome + multiple pregnancies (ie mom getting jerm and jerm <3), headache, depression, oedema, precocious pubery
MEN - gyneCOmastiaaa

30
Q

Name the Gonadotropin releasing hormone analgos

A

gonadorelin - GnRH
goserelin - GNRH analog
leuprolide - GnRH analog
nafarelin - GnRH analog

31
Q

If I say goserelin, you think?

A

leuprolide and nafarelin

GNRH analogs

32
Q

Describe the differences in the effects of PULSATILE and SUSTAINED NONPULSATILE administration of GnRH (gonadorelin, goserelin, leuprolide, nafarelin)

A

pulsatlie - stimulats release of LH and FSH ie jsut liek real physiology time

sustained non pulsatile - inhibits FSh and LH –> hypogonadism

33
Q

Advantage of goserlin/leuprolide and nafenlin vrs gonadorelin

A

analogs (goserelin, leuprolide and nafenelin) are more potent and longer lasting than gonadarelin

34
Q

Describe the PK of the gonadtropin releasing hormone and analogs

A

gonadorelin - IV or Sc
analongs (goserelin ,leuprolide, naferelin) –> SC, IM , nasal (naferlin), Sc implant NOT IV!!! makes sense bc of long t1/2 - wont be used in emergent sitautions

35
Q

If I give a patient a continuous administartion of gonadorelin what would I expect to see?

A

a BIPHASIC response

a) first 7 days get a reponse flare
b) chronic effects - inhibitory (downregulation and changes in signalling pathways)

36
Q

Clinical applications of the GNRh and analogues

A

1) Female infertility - UNCOMMON
2) Male infertility - with hypothalamic hypogonagotropic hypogonadism @ pulsatile gonadorelin
3) diagnosis of LH responsiveness - differentiates between pubtery due to constitutional delay of hypogonadotropic hypogonadism

37
Q

~*~ DOC @ controlled ovarian hyperstimulation (SHARK: side effect of mentropins/follitropin and urofollitropin)

A

Leuprolide and nafarelin (GnRh analgoues) (same treatment as prostate cancer - no nafarelin)

38
Q

~*~ DOC @ endometriosis

A

leuprolide, goserelin, nafarelin - pain decreased due to cyclical changes of e and p stopped.

39
Q

~*~ DOC @ uterine leiomyomata

A

leuprolide, goserelin, nafarelin

40
Q

~*~ DOC @ prostate cancer

A

leuprolide, goserelin ( ovariona hyperstimulation same meds, no nafarelin)

41
Q

Other uses of suppresion by GnRH analogs: times four

A

a) central precocious puberty with leuprolide and nafarelin (opp prostate cancer and ovarian hyperstimulation - leuprolie and goserelin)
b) advanced breast and ovarian cancer
c) treatmetn of amenorrhoea and infertilty in women wtih PCOD
d) thinning of endometrial lining

42
Q

A/se Gonadorelin

A

h/a, lightheadedness, n, glusing
swelling at injection site
generalized hypersensitivity dermatitis @ long term administration
rate acute hypersensitivy reactions
**sudden pituitary apoplexy and blindness

43
Q

Name the GNRH receptor ANTAGONISTS

A

Cetrorelix
Ganirelix
COMPETITVE antags of GnRh receptors

44
Q

Cxl app for cetrorelix and ganirelix

A

suppression of gonadotropin production - prevent LH surge @ controled ovarian hyperstimulation

45
Q

Name the adrenocorticotropic hormone analogs

A

corticotropin
cosyntropin
ACTH analogs

46
Q

I say MC2R, you think?

A

a GPCR = icnreased cAMP

47
Q

Uhoh. Im not sure if the patient has primary adrenal insufficiency/addisons disease or secondary adrenal insufficiency/not enough ACTH around, what do i do?

A

give em an adrenocorticotropic hormone analog ie coticotropin or cosyntropin hurrah! one day for real!!

48
Q

Effects of small vrs higher doses of oxytocin

A

1) small dose - increases force and frequency of contractions
2) higher dose - evokes sustained contractions and weak ADH and aldoseterone activitin
3) milk ejection

49
Q

Uses of oxytocin

A

IV – initation and augmentation of labour

IM – used to control postpartum bleeding

50
Q

Control the uterine hemorrhage!!!

A

oxytocin. bamalam

51
Q

Control the esophageal varice bleeding!

A

ocreotide!

52
Q

A/se oxytocin

A

1) excessive uterin contractions
2) inadvertent activation of vasopressin receptors
3) bolus causing HYPOTENSION (opposite of what you’d think from the whole mimicks vasopression/ADH weak activity thing, hurrayy!)

53
Q

What is Atosiban?

A

oxytocin antagonist

54
Q

Uses of atosiban

A

preterm labout, jk. not in the US.. canada?

55
Q

Name the ADH agonists

A

vasopression

desmopressin

56
Q

MOA and kinetic-y things of Desmopressin please

A 
long acting
minimal V1 (vasoconstrictive) effects
antidiuretic : pressin activity - 4000x
57
Q

DOC @ diabetes insipiduse

A

vasopression

desmopression

58
Q

uses for vasopression

A

esophageal variceal bleeding (with ocreotide), colonic diverticular bleeding ** vasoconstriction

59
Q

uses for demsopressin

A

coagulopathy treatment in hemophilia A and vWF disease

60
Q

Name a vasopressin antagonist and its love for what receptors

A

conivaptan loves V1 AND V2.

61
Q

DOC @ hemophilia A and vWf

A

desmopressin

62
Q

DOC @ colonic diverticular bleeding

A

vasopressin

63
Q

`DOC @ patients with hypnatremia due to elevated vasopression

A

conivaptan

Pharmacology (70 decks)

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