Hypothal and Pituitary Hormones, Drugs acting on the uterus, gonadal hormones, Flashcards
Mifepristone is classified as what type of drug
Anti progestin (only one we cover)
its works as part of a Two person team with Misoprostol (a PGE1 analogue) for medical abortion
MIFE and MISO!
but when combined==> INC RISK OF GI AE. *DIARRHEA*
whats the treatment for Chronic (Addison’s disease)-Primary adrenal Insufficiency
- hyperpigmentation (due to: increased ACTH)
- hyponatremia (hypervolemic type)
- hypotension
- no H+ secretion–>metabolic acidosis (normal anion gap)
- High H+ in serum–> low bicarb
- no K+ secretion–> hyperkalemia
-
Daily hydrocortisone-short acting (increase dose during stress) +
mineralocorticoid (fludrocortisone)
***DO NOT administer glucocorticoids lacking salt- retaining effects or long acting ones either like (Triamcinolone or Dexamethasone)
name the Androgen Receptor Antagonists
what the relationship between Bicalutamide, nilutamide & Flutamide?
Flutamide
- Bicalutamide*
- Nilutamide*
Cyproterone
Spironolactone
**Bicalutamide and Nilutamide are similar to flutamide butlower risk of hepatotoxicity
whats the treatment for a Prolactinoma
- dopamine agonists (eg., ergot alkaloids such as bromocriptine, cabergoline)
- transsphenoidal resection.
Can Methylprednisolone be given via Aerosol or topical admin?
NO! just oral, IM and iV
what effect does a Pituitary prolactinoma have on GnRH?
it causes GnRH to ↓ —-> hypogonadism, amenorrhea, galactorrhea & osteoporosis
what are expected lab values during Acute adrenal insufficiency, or Addisonian crisis?
Laboratory findings may include hyponatremia, hyperkalemia, metabolic acidosis, azotemia as a consequence of aldosterone deficiency; and hypoglycemia, and eosinophilia as a consequence of cortisol deficiency.
how do you administer growth hormone
subcutaneously bc since its a protein it will be broken down too quickly if its given orally
list all the ways Triamcinolone can be administered
Aerosol, IM, topical and Oral
not IV
What adverse effects are commonly associated with mineralocorticoids?
Hypokalemia
metabolic alkalosis
increased plasma volume
hypertension
whats the most common cause of Primary adrenal insufficiency (Addison disease) in the US and worldwide
The most common cause in the United States is autoimmune destruction of the adrenal glands.
The most common cause worldwide is tuberculous adrenalitis.
***In primary adrenal insufficiency, the glands themselves are destroyed so that the patient becomes deficient in cortisol and aldosterone.
List the SERMs
TR-TC
Tamoxifen
Raloxifene
Toremifene
Clomiphene
List the Competitive GnRH ANTAGONISTS (2)
-relix
Cetrorelix
Ganirelix
*prevents LG surge during controlled ovarian hyperstimulation
SUBCUTANEOUS injection
list the Mineralocortocoids
• Aldosterone
Most important mineralocorticoid in humans
• Fludrocortisone
Synthetic corticosteroid. Most commonly prescribed salt-retaining hormone
list the synthetic GCs
- Prednisone
- Methylprednisolone
- Dexamethasone
- Beclomethasone
- Triamcinolone
a 1000-fold increase in estriol is an indicator of…
fetal well being.
list the synthetic GCs that can be given via the aerosol route
Beclomethasone
Triamcinolone
list the corticosteroid synthesis inhibitors
Ketoconazole
Aminoglutethimide
Metyrapone
list Long-acting glucocorticoids
Dexamethasone
Elevated ACTH with low cortisol is diagnostic of _________________
Low ACTH and low cortisol suggest__________
fill in the blank with
primary adrenal insufficiency or
secondary adrenal insufficiency.
primary adrenal insufficiency, particularly in patients who are severely stressed or in shock.
secondary adrenal insufficiency.
is primary or secondary adrenal insufficiency being described below
patients are deficient in cortisol because of a lack of ACTH from the pituitary, but aldosterone production is maintained by the renin- angiotensin system. Therefore, volume depletion and hyperkalemia are not present and the patient will not manifest the typical hyperpigmentation.
secondary
List the estrogens
MC DEEE
Mestranol
Conjugated estrogen
Diethylstilbestrol
Ethinyl estradiol,
Estrone
Estriol
characteristic abnormalities of serum electrolytes in adrenal insufficiency are:
low sodium
high potassium
low bicarbonate
high BUN.
What signaling pathway does GH use to mediate its effects via cell surface receptors
Mediates effects via cell surface receptors that activate JAK/STAT signaling cascades
what is the name of the anti androgen drug that inhibits 5α-reductase
and what are its main clinical uses
Finasteride
Benign prostatic hyperplasia (BPH)
male- pattern hair loss
In secondary adrenal insufficiency are mineralocorticoids and cortisol levels deficient as in primary (addisons)?
nah, In secondary adrenal insufficiency, the renin-angiotensin system usually is able to maintain near-normal levels of aldosterone so that the patient is deficient only in cortisol.
what are the 3 ways Cortisol (Hydrocortisone) evokes its antiimflamm effects
matory Effects
- Inhibition of phospholipase A2 (through induction & activation of annexin I) which blocks arachidonic acid release (major precursor of prostaglandins).
- Cyclooxygenase-2 synthesis is reduced (through inhibition of NF-B)
.3. Induction of MAPK phosphatase I (inhibits MAPK activated proinflammatory signaling pathways)
List GCs that can be given via IV/IM route
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
List the Short -medium acting GCs
“P-M-H”
Prednisone
Methylprednisolone
Hydrocortisone
List all the Androgens
D(a)MN, SO FO!
(damn, so fo-ward!)
Danazol
(a)
Methyltestosterone,
Nandrolone,
Stanozolol
Oxandrolone
Fluoxymesterone,
Oxymetholone
list the gonadotropin analogues
Follitropin
Urofollitropin
hCG
Menotropins
what is Secondary adrenal insufficiency and whats the most common cause of it
Secondary adrenal insufficiency is adrenal failure caused by a lack of ACTH stimulation from the pituitary gland.
It can be caused by an autoimmune, infiltrative, metastatic disease of the pituitary.
The most common reason, however, is chronic exogenous administration of corticosteroids, which can suppress the entire hypothalamic-pituitary-adrenal axis.
List all the Progestrins
@ PM NNN & DD
[@ night, Nani and D get together]
Progesterone
Medroxyprogesterone
Norgestrel
Norgestimate
Norethindrone
Desogestrel
Drospirenone
what are the physiological effects of Growth Hormone (aka: somatotropin)
- Stimulation of longitudinal growth of bones
- Increased bone mineral density
- Increased muscle mass (in GH deficient people)
- Increased GFR
- Stimulation of preadipocyte differentiation into adipocytes
- Anti-insulin actions (decreased glucose utilization & increased lipolysis)–> eventually leads to diabetes
- Development & increased function of immune system
Dopamine antagonists (eg., antipsychotics) can cause ____________ due to hyperprolactinemia
galactorrhea
LIst Intermediate- acting glucocorticoids
Triamcinolone
just one in this category!
what are the two ways Beclomethasone can be admin
aerosol and topical
not IV or IM
list the corticosteroid antagonists
Mifepristone
Spironolactone
List GCs that can be given via Topical route
Beclomethasone
Dexamethasone
Hydrocortisone
Triamcinolone
List the aromatase inhibitors
LAE
Lance aux epines
Letrozole
Anastrozole
Exemestane
