Hypothal/Pit Flashcards
Which two anterior pituitary hormones activate JAK/STAT receptors? What receptors do all the other ant pit hormones act on?
GH and prolactin (also DA but not ant. pit.)
others activate G-coupled receptors
Which pituitary hormone leads to the release of IGF-1 at its target tissue?
GH
How are the JAK/STAT receptors activated?
requires binding of two molecules (1 to two different receptors) which leads to receptor dimerization
Which pituitary hormone is important in the regulation of blood glucose due to its anti-insulin actions? If it is missing, how is blood glucose affected?
GH
lack of GH means you lose inhibition of insulin so you get hypoglycemia
two recombinant GH drugs are somatropin and somatrem. How are they different?
Somatropin: recombinant GH (identical to human hormone)
Somatrem: GH analog (modified to inc bioavailability etc)
How are most pituitary/hypopit replacement hormones given? why?
subcutaneously - cant give proteins orally, they get degraded in stomach
What drug can be given to improve wasting in HIV patients?
Somatropin (recombinant GH)
Intracranial HTN, otitis media, hypothyroidism, and scoliosis are important adverse effects of what hypothal/pit hormone? how do you get hypothyroidism?
Somatropin - hypothyroidism caused by negative feedback on other pit hormones
these are AE in children!
which hypothal/pit hormone can cause peripheral edema, myalgias, carpal tunnel, and proliferative retinopathy? this drug is contraindicated in what patients?
Somatropin (recombinant GH)
Contraindicated in patients with a known maligancy (WONT cause primary tumor, but can cause existing ones to grow)
Which drug can be used in growth hormone deficiency, has few adverse effects, and is less expensive than somatropin? why is it also less effective than somatropin?
Sermorelin - GHRH - wont work if the defect is in the anterior pituitary
Some kids with delayed growth have neutralizing antibodies to GH. What can be given to help these kids? what is an important side effect and how should it be given?
Mecasermin - IGF-1 analog
because it has some effect on insulin receptors, it can cause hypoglycemia so it needs to be given 20 min before or after a meal
What are two rare side effects of mecasermin and which is more important to watch out for?
Intracranial HTN - can be fatal!!
elevation of liver enzymes - asymptomatic
Mecasermin - IGF-1 analog (GH)
what cells in the pituitary are responsible for causing acromegaly in adults or gigantism in kids?
somatotrophs - secrete GH
Which drug can be used in acromegaly/gigantism because it blocks the GH receptor?
Pegvisomant
somatostatin inhibits the release of what 4 substances?
GH
Glucagon
Insulin
Gastrin
what drug can be given to reduce symptoms caused by hormone-secreting tumors? what kind of drug is it?
octreotide - somatostatin analog
acromegaly, carcinoid syndrome, gastrinoma, diabetic diarrhea etc
what drug can be given to control acute bleeding from esophageal varices?
octreotide - somatostatin analog
which hypothal/pit drug can cause nausea, vomiting, flatulence, gallstones, sinus bradycardia and vit B12 deficiency?
octreotide - somatostatin analog
what two drugs can be used to treat prolactinomas? what type of drugs are they? which has more adverse effects? why do they work?
Dopamine agonists: Bromocriptine (way more AEs) and Cabergoline
Most prolactinomas retain their ability to be inhibited by dopamine
chonic high-dose therapy of what hypothal/pit drugs leads to cold-induced peripheral digital vasospasm and pulmonary infiltrates?
Dopamine agonists: Bromocriptine (way more AEs) and Cabergoline
the menotropins are what?
Purified extract of BOTH FSH and LH
what two drugs contain purified FSH but no LH?
Follitropin and Urofollitropin
which hypothal/pit drug is purified from urine and injected daily?
hCG
name the two ways you can treat male infertility using gonadotropins
hCG alone or a combination of urofollitropin, rFSH, and rLH
Name the two most important adverse effects in women taking gonadotropin drugs. Name the 1 in men.
Women: ovarian hyperstimulation syndrome and multiple pregnancies
Men: gynecomastia
Woman presents with ovarian enlargement, ascites, hydrothorax and hypovolemia as a consequence of a drug reaction. What was she most likely taking?
gonadotropin (follitropin, urofollitropin, hCG, or menotropin)
Name the synthetic GnRH. Name the 3 GnRH analogs.
Gonadorelin
Goserelin, Leuprolide, Nafarelin
explain how GnRH given in pulsatile doses can evoke a difference reaction than when given continuously
pulsatile GnRH: stimulates release of LH and FSH
sustained: inhibits FSH and LH release
when giving GnRH or its analogs, what is important to remember about the first few initial treatments if your goal is to inhibit FSH and LH release?
initial treatments, body can’t tell if the dose is pulsatile or sustained, LH and FSH are both released initially - give with a receptor antagonist at first (Cetrorelix or Ganirelix)
which gonadotropin analog can be given as a nasal spray?
Nafarelin (N for nasal!)
what drugs would you use to diagnose LH responsiveness to tell whether delayed puberty was due to constitutional delay or hypogonadotropic hypogonadism?
GnRH and analogs (Gonadorelin and Goserelin, Leuprolide, Nafarelin)
what drugs are used to treat endometriosis?
Goserelin, Leuprolide, Nafarelin
what drugs are used to treat uterine leiomyomata?
Goserelin, Leuprolide, Nafarelin
what two drugs can be used to treat central precocious puberty?
leuprolide and nafarelin
what drugs can be used to treat amenhorrhea and infertility in women with PCOD?
Goserelin, Leuprolide, Nafarelin
Patient with a gonadotropin-secreting pituitary adenoma presents with sudden pituitary apoplexy and blindness - what drug was he being treated with?
Gonadorelin - GnRH
What group should never receive GnRH analogs? name them
pregnant and breast-feeding women
Goserelin, Leuprolide, Nafarelin
which hypothal/pit drugs can cause hot flushes, sweats, decreased libido, and reduced bone density in both men and women?
GnRH analogs - Goserelin, Leuprolide, Nafarelin
what two drugs are used to prevent LH surge during controlled ovarian hyperstimulation?
GnRH receptor antagonists: Cetrorelix and Ganirelix
which ant pit/hypothal hormone drugs (2) are used to differentiate between Addison’s disease and secondary adrenal insufficiency (ie dec ACTH secretion)?
ACTH analogs: corticotropin and cosyntropin
which hypothal/pit drug can be used to treat infantile spasm? what kind of drug is it?
corticotropin - ACTH analog
which pituitary hormone has its highest concentration at 6am and is lowest in the evening?
ACTH
name the two posterior pituitary hormones - where are they produced?
ADH and oxytocin - made in hypothalamus (post pit just stores)
explain when oxytocin would be given IV vs IM
IV: for initiation and augmentation of labor
IM: for control of postpartum bleeding
woman in labor is experiencing sustain contractions. What drug was given incorrectly and how? what AE should you be concerned about?
they gave a high dose of oxytocin which can lead to fetal distress or placental abruption - smaller doses wont cause this
bolus injection of oxytocin can lead to what?
hypotension
what drug is used to treat preterm labor but is not available in the US due to the availability of many safer options?
Atosiban
describe the actions of V1 and V2 receptors (ADH receptors)
V1: vasoconstriction
V2: water reabsorption in kidney
which ADH agonist has minimal vasoconstriction effects? what receptor does it mainly act on? which ADH agonist acts on both?
desmopression (acts mostly on V2, little V1 effects)
vasopressin acts on V1 and V2
name the two drugs of choice for diabetes insipidus
Vasopressin and desmopressin
which ADH agonist can also help treat esophageal variceal bleeding and colonic diverticular bleeding?
Vasopressin
which ADH agonist can also help treat coagulopathy in Hemophilia A and von Willebrands?
Desmopressin
overdose of vasopressin agonists can lead to what 2 adverse effects?
Hyponatremia and seizures - too much of an affect
what drug is approved for used in patients with hyponatremia due to elevated vasopressin - how does it work?
Conivaptan - vasopressin antagonist at both V1 and V2 receptors
