HPA Modulation

Question 1

Somatotropin

Answer 1

Recombinant Growth Hormone

• SC Injection main delivery form
• Illicit uses– athletes (banned), elderly (small benefits, increased adverse effects)
• Side effects of bad use– GH tumor symptoms, basically
• ICH
• RARELY- Pancreatitis, gynecomastia

Question 2

Sermorelin, Tesamorelin

Answer 2

GHRH analogues

• Similarities to Grehlin
• No downregulation in continuous stimulation
• Rare adverse effects
• Sermorelin– banned!
• Tesamorelin– used mostly in HIV patients to prevent wasting

Question 3

Octreotide, Lanreotide

Answer 3

Somatostatin analogues

• GH inhibitor, but also TSH release inhibitor
• Alternative to surgical excision in pituitary excess of GH
• Can help control bleeding by action on vascular SM, less side-effects than ADH
• Can cause transient glucose intolerance
• Octreotide– IM, SC
• Lanreotide–SC

Question 4

Pegvisomant

Answer 4

Competitive inhibitor of GH

-Long half life so does not come off easily

Question 5

Cabergoline

Answer 5

DA agonist- D2 receptors

• For adjuvant therapy of high GH or high PRL
• More selective (D2), effective
• Better tolerated
• Causes valvular heart dz?

Question 6

Bromocriptine

Answer 6

Prototype DA agonist

• Off-target effect on D1 receptors
• Causes naus/vom, HA, postural hypoTN

Question 7

Desmopressin

Answer 7

Vasopressin analogue

• Better half life (90-150 min vs. 20)
• ADH is downreg by Etoh
• Acts on V2 receptors, off target effects in increasing release of FVIII and vWF
• May help treat bedwetting
• Indicated in central DI
• Oral version SideFx- GI symptoms, asthenia, high LFTs
• Other Side Fx- HA, naus, abd cramp, water intox

Question 8

Chlorpropamide

Answer 8

• Potentiates ADH, even in small amounts

- If allergy to desmopressin, option

Question 9

Demeclocyline

Answer 9

Inhibits ADH effect in distal tubule

• Indicated in SIADH
• Second line after changing inducing drugs, water restriction

Question 10

Tolvaptan, Conivaptan

Answer 10

• V2 receptor antagonists
• Indicated in hyponatremia (used in HF)
• Excessively aggressive correction– cerebellar pontine myelinolysis
• Tolvaptan- Oral
• Conivaptan-IV

Question 11

Vasopressin

Answer 11

• ADH– pressor function but needs HIGH levels
• Vassopressor for treating severe septic shock
• Alternative to epi in shock-refractory V-Tach, but may hurt survival

Question 12

Mecasermin

Answer 12

• Recombinant IGF-1

- Useful in GF insensitives

Question 13

Hydrochlorothiazide

Answer 13

• Thiazide Diuretic

- Paradoxically helpful in DI

Question 14

Indomethacin

Answer 14

• NSAID

- Useful in DI

Question 15

Lithium

Answer 15

• Bipolar medication

- Induces nephrogenic DI in up to 1/3 of patients who use it

Question 16

SSRIs, Haloperidol, TCADs

Answer 16

Induce SIADH