Hypothalamic and Pituitary Drugs

Question 1

Somatropin, somatotropin

Answer 1

Recombinant GH
Tx: GH deficiency, or short stature
Tox: peds: pseudomotor cerebri, scoliosis progression, edema, hyperglycemia (insulin resistance)
Tox: adults: edema, myalgia, arthralgia, carpal TS

Question 2

Mecasermin

Answer 2

Recombinant IGF-1
Tx: GH resistance
AE: hypoglycemia (potentiates insulin)

Question 3

Octreotide, lanreotide

Answer 3

SST Receptor agonist
Inhibit GH production
Tx: acromegalic somatotroph tumors
AE: N+V, cramps, farts, gallstones, sinus bradycardia, conduction disturbances

Question 4

Pegvisomant

Answer 4

GH-R antagonist

Tx: acromegaly

Question 5

Urofollitropin, follitropin alpha and beta

Answer 5

FSH-R agonist
Tx: women: controlled ovarian hyperstim. (IVF), use after clomiphene
Tx: men: infertility due to hypogonadotropic hypogonadism
AE: ovarian hyperstimulation, multiple pregnancy

Question 6

Lutotropin alpha

Answer 6

LH-R agonist
With follitropin-alpha for COH in infertility and LH deficiency
AE: OHSS, multiple pregnancy

Question 7

Choriogonadotropin alpha

Answer 7

LH-R agonist
Tx: women: COH after clomiphene
Tx: men: infertility due to hypogonadotropic hypogonadism
AE: OHSS, multiple pregnancy

Question 8

Leuprolide, goserelin, histrelin, nafarelin, triptorelin

Answer 8

GnRH-R agonist
Intermittent: increase FSH/LH
Continuous: reduce FSH/LH
Tx: Ovarian suppression in OHS, endometriosis, uterine fibroids, prostate cancer, central precocious puberty
Continuous AE: women: menopause, depression, decreased libido, pain, vaginal dryness, breast atrophy, ovarian cysts, reduced bone density
Continuous AE: men: hot flashes, edema, gynecomastia, decreased libido, hematocrit, bone density, asthenia

Question 9

Ganirelix, cetrorelix, degarelix

Answer 9

GnRH-R antagonist
Reduces FSH/LH
Tx: prevent early LH surge in COH, degarelix in advanced prostate cancer
AE: lower risk of OHSS; degarelix leads to androgen deprivation

Question 10

Bromocriptine, cabergoline

Answer 10

Agonist at D2 receptor
Suppress pituitary PRL
Tx: hyperprolactinemia
AE: nausea, HA, light-headedness and orthostatic hypotension, fatigue, psychosis, cabergoline associated with cardiac valvuloplasty

Question 11

Oxytocin

Answer 11

O-R agonist
Gives uterine contractions
Tx: induces labor, control uterine hemorrhage postpartum
AE: fetal distress, placental abruption, rupture, no in prone fetuses, activates V2 to fluid retention, hyponatremia, heart failure and seizure

Question 12

Desmopressin acetate

Answer 12

V2-R agonist
Antidiuresis
Tx: DI
AE: HA, nausea, cramps, agitation, allergy

Question 13

Conivaptan, tolvaptan

Answer 13

V- antagonist V2»>V1
Promotes water excretion
Tx: SIADH, reduce hyponatremia and HF
AE: infusion reaction, tolvaptan only for 30 days (hepatotoxicity)