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Pharmacology > Hypothalamic and Pituitary Hormones > Flashcards

Hypothalamic and Pituitary Hormones Flashcards

0
Q

dopamine aka

A

PROLACTIN-INHIBITING HORMONE

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1
Q

GHRH or GROWTH HORMONE RELEASING HORMONE aka

A

SOMATROPIN-RELEASING HORMONE

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2
Q

GROWTH HORMONE aka

A

SOMATROPIN

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3
Q

ACTH or adrenocorticotropic hormone aka

A

CORTICOPTROPIN

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4
Q

TSH aka

A

thyrotropin

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5
Q

two distinct components of the pituitary gland

A

adenohypophysis

neurohypohysis

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6
Q

connects hypothalamus and pituitary gland

A

hypothalamic or pituitary stalk

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7
Q

hormones that pass thru the pituitary portal stalk to stimulate the pituitary gland to release or inhibit hormone production

A

hypophysiotrophic hormones secreted by neurosecretory cells in the hypothalamus

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8
Q

hormones produced in the PPG will act

A

directly on target organs

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9
Q

PPG hormones secreted in response to stimulus

A

VASOPRESSIN/ ADH

OXYTOCIN

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10
Q

prolactin from APG acts

A

directly on mammary glands

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11
Q

hormone that acts both directly and indirectly

A

GROWTH HORMONE

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12
Q

hypothalamic and pituitary hormones are ALL

A

peptides

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13
Q

hormones of the posterior pituitary are stored in

A

granules

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14
Q

makes the hormone susceptible to destruction by proteolytic enzymes of the digestive tract

A

peptidyl nature

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15
Q

TRH may

A

increase levels of PROLACTIN causing galactorrhea

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16
Q

no pharmacologic preparation available

A

PROLACTIN

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17
Q

hormones used for diagnosing pituitary insufficiency

A 
GHRH
CRH
TRH
TSH
ACTH
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18
Q

hormones released by the hypothalamus

A 
TRH
CRH
GHRH
GnRH
Dopamine
somatostatin
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19
Q

anterior pituitary gland hormones

A 
TSH
ACTH
GH
FSH, LH
PRL
GH
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20
Q

posterior pituitary gland relese the ff hormones

A

VASOPRESSIN / ADH

OXYTOCIN

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21
Q

steroid or steroid-like hormones are _____ in the circulation

A

protein bound

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22
Q

only the ____ form of steroid and steroid like hormones that is active and can enter the cell membrane

A

free

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23
Q

peptides cannot enter the cell membrane therefore they are

A

hypdrophilic

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24
Q

receptor for GH and PRL

A

Jak STAT

Januse kinase signal transducer and activator of transcription

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25
Q

receptor for GHRH, TSH, FSH, LH, ACTH, VASOPRESSIN

A

Gs

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26
Q

Gs function

A

stimulates adenylyl cyclase

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27
Q

receptor for SST and DOPAMINe

A

Gi

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28
Q

Gi function

A

inhibits adenylyl cyclase

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29
Q

GnRH, OXYTOCIN, VASOPRESSIN 1A & B receptor

A

Gq

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30
Q

Gq function

A

muscarinic receptor

2nd messenger for IP/DAG

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31
Q

SST or somatostatin aka

A

growth hormone-inhibiting hormone

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32
Q

SST is secreted by

A

the D cells of the stomach

the delta cells of the islets of Langerhan

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33
Q

somatostatin moa

A

inhibits secretion of GH, TSH, INSULIN, GLUCAGON, GASTRIN, and other GI hormones

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34
Q

use of somatostatin is limited due to

A

short duration of action
multiple effects esp in cho metabolism
rebound hypersecretion

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35
Q

SST analogs

A

OCTREOTIDE (Sandostatin)

LANTEOTIDE

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36
Q

receptors for OCTREOTIDE

A

SSt-2

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37
Q

selectivity of OCTREOTIDE to SST2 receptors have less

A

effect on insulin therefore less hyperglycemia

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38
Q

OCTREOTIDE preparation

A

50-200 mcg SC q8hr, once a month

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39
Q

indication for SST ANALOGS

A

acromegaly
GEP tumors such as carcinoid and gastrinoma
bleeding esophageal varices

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40
Q

SST analog dosage for acromegaly

A

initially 0.05 - 0.1 mg, SC q8-12 hr

max of 1.5 mg per day

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41
Q

gep tumor tx of sst analog dosage

A

initially 0.05 mgOD/BID

may gradually inc to 0.1-0.2mg TID

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42
Q

SST analog adverse effects

A

GIT 50%

Gallstones 20%

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43
Q

GH receptor antagonist

A

PEGVISOMANT

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44
Q

effect of PEGVISOMANT

A

blocks peripheral effects of GH ➡️ decrease IGF 1

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45
Q

PEGVISOMANT administration

A

daily via SC route

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46
Q

PEGVISOMANT Indication

A

px with acromegaly who do not respond to SST analogs

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47
Q

PEGVISOMANT AE

A

inc in tumor size- uncommon

changes in liver fxn tests

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48
Q

physiological fxn of GnRH

A

released in PULSATILE manner that controls the synthesis and release of FSH and LH

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49
Q

pharmacological fxn of GnRH

A

pulsatile: every 4hrs, stimulates GONADOTROPIN release
continuously: via injection, inhibits GONADOTROPIN RELEASE

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50
Q

cause of iNhibitory release of gonadotropin when released continuously

A

receptor desensitization
downregulation
changes in signaling pathways

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51
Q

GnRH analogs

A 
LEUPROLIDE
GOSERELIN
NAFRELIN
GONADORELIN HCL
BUSERELIN
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52
Q

LEUPROLIDE preparation

A

7.5mg per month IM for prostatic cancer
q3months

1mg/day SC

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53
Q

GOSERELIN preparations

A

3.6 mg SC q28days

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54
Q

NAFARELIN preparation

A

nasal spray 200 mcg BID

not available!

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55
Q

uses (rare) of GnRH

A

pulsatile: pituitary stimulation in GnRH deficiency (male or female)
continuous: suppress gonadotropins

diagnostic

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56
Q

GnRH use for pituitary stimulation in GnRh deficiency addresses

A

male or female infertility or hypogonadism

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57
Q

suppression of gonadotropins through continous admin of gnRh is for

A 
endometriosis
central precocious puberty
prostatic cancer and BPH
uterine leiomyoma
contraception
ART
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58
Q

form of GnRH analog for GnRH deficiency

A

GONADORELIN INFUSION PUMP, IV or SC

short half life

59
Q

cause of GnRH use in assistied reproductive technology

A

prevent premature ovulation caused by FSH and LH injection

60
Q

GnRH is a diagnostic tool for

A

delayed puberty in hypogonadism

61
Q

GnRH analogs AE

A

flare or worsening of symptoms
headache, abdominal discomfort, hot flushes
decreased bone density with prolonged use

62
Q

flare occurs during

A

first 7-10 days of treatment

63
Q

GnRH antagonist moa

A

suppress gonadotropin release

potent mast cell degranulators

64
Q

GnRH antagonists

A

CETRORELIX
GANIRELIX
DEGARELIX

65
Q

CENTRORELIX (Cetrotide) preparation

A

250 mcg SC OD

66
Q

use of GnRH antagonists

A

female infertility, ART

advanced prostate cancer

67
Q

specific GnRH antagonist drug for advanced prostate cancer

A

DEGARELIX

68
Q

GnRH antagonist most common AE

A

nausea, headache

69
Q

GnRH antagonist ae

A

nausea, headache
hot flushes, sweats, depression, decreased libido

NO FLARE SYMPTOOOOMS!

70
Q

Dopamine action

A

reduces elevated PROLACTIN level caused by physiologic, pathogenic, iatrogenic conditions

71
Q

PIH analogs are _____ agonists

A

D2

72
Q

effect of PIH analogs on normal patients

A

increase GH release

73
Q

PIH analogs effect on acromegaly patients

A

suppress GH release

74
Q

PIH analogs are given

A

orally

75
Q

only available PIH analog

A

BROMOCRIPTINE (parlodel)

76
Q

PIH analogs

A

BROMOCRIPTINE
CABERGOLINE
PERGOLINE
QUINAGOLIDE

77
Q

main use of PIH analogs

A

hyperprolactinemia in patients with prolactinoma or hypothyroidism

78
Q

uses of PIH analogs

A

hyperprolactinemia
suppress physiologic lactation
Parkinson’s dse
acromegaly

79
Q

BROMOCRIPTINE is not recommended for physiologic lactation because

A

risk of thromboembolism

80
Q

AE of PIH analogs

A 
nausea, vomiting
headache, dizziness
constipation
fatigue
cramps
hair loss
hallucination
dyskinesia
dry mouth
81
Q

direct effects of SOMATOTROPIN

A

increased lipolysis➡️increased fat utilization➡️increased FFA in plasma

mixed effect on CHO metabolism

82
Q

somatotropin directly decreases sugar levels by

A

increasing IGF ➡️increased INSULIN

83
Q

indirect effects of SOMATOTROPIN

A

skeletal growth
increased cell proliferation
increased protein anabolism
increased formation of HYDROXYPROLINE from PROLINE boosts cartilage synthesis

84
Q

approved uses of SOMATOTROPIN

A 
GH deficient children and adults
hypogonadism and growth failure in Turner's sx,  Prader-Willi sx
CRF in pedia patients
SGA or small for gestational age
NGHDSS
85
Q

approved uses of SOMATOTROPIN in adults without GH deficiency

A

wasting in AIDS px

short bowel sx in patients on parenteral nutrition

86
Q

unapproved uses of SOMATOTROPIN

A

increase muscle mass in adult athletes

anti-aging

87
Q

AE of SOMATOTROPIN

A

Creutzfeldt-Jakob dse

children: hypothyroidism,scoliosis,increased intracranial pressure
adults: peripheral edema,myalgia,arthralgia, new onste of Type 2 DM

88
Q

CI of GH

A

acute critical illness ➡️ increased mortalities

evidence of neoplasm

closed epiphyses

89
Q

GH on drug interaction

A

increases CYP450 activity, enzyme inducer

90
Q

rHGH drugs

A

SOMATROPIN
SOMATREM
HUMAN GROWTH HORMONE

91
Q

SOMATROPIN preparation

A

0.025-0.07 mg/kg/week IM/SC x 4 years or until epiphyses have fused

inc dose for px with Turner’s sx and chronic renal insufficiency

92
Q

highest level of GH are released in pulsatile manner during

A

SLEEP!

93
Q

elevated GH levels in patients with acromegly are reflected by

A

increase in IGf-1

94
Q

FSH stimulates

A

gametogenesis, folliculare development

spermatogenesis

95
Q

stimulated by FSH to provide nutrients to spermatogenic epithelium

A

Sertoli cells

96
Q

FSH effect in women

A

responsible for early development and growth of ovarian follicles

97
Q

LH regulates

A

gonadal steroid hormone production or steroidogenesis

98
Q

LH in men

A

stimulates growth of Leydig cells which produce androgens causing ext sexual maturation

99
Q

LH in women

A

responsible for final maturation of the ovarian follicles and estrogen secretion

for ovulation, the initial formation of corpus luteum, and secretion of progesterone

100
Q

hCG function

A

stimulates ovaria corpeus luteum to produce progesterone and maintiain placenta

101
Q

hCG is a substitute for

A

LH

102
Q

hCG is derived from

A

syncytiotrophoblast of placenta

103
Q

1st line of drug for women suffering anovulation

A

CLOMIFENE

104
Q

gonadotropic hormone preparation for female infertility derived from urine of postmenopausal women

A

hMG or uFSH

75 iu IM OD, 7-12 days ➡️CG 5000-10000 IU im

105
Q

oligospermia is treated with this gonadotropic hormone preparation

A

hCG+hMG x 4-6 months

give both LH and FSH for sperm maturation

106
Q

pregnancy diagnosis

A

hCG levels

107
Q

ovulation diagnosis

A

LH level

108
Q

ART day 1-11

A

hMG or uFSH with or without LH

stimulate follicular enlargement

109
Q

ART day 7-11 n

A

give GnRH antagonist (CETRORELIX) to suppress premature ovulatio

110
Q

ART day 12

A

give hCG

to mimic LH surge

111
Q

ART after 34-46 hours - day 13?

A

egg retrieval or insemination either by ISCI or IVF

give PROGESTERONE to prime the uterus before implanting

112
Q

gonadotropic hormones AE

A

multiple pregnancies 15-20%

113
Q

multiple pregnancies as AE of gonadotropic tx result to

A

increased risk of premature delivery, gestational diabetes, preeclampsia, CS

114
Q

ovarian hyperstimulation results to

A

ascites, hydrothorax, hypovolemic shock, thromboembolism, death

115
Q

purified extract of FSH and LH

A

MENOTROPIN

116
Q

Menotropin is derived from

A

urine of postmenopausal women

117
Q

primarily FSH preparation with LH removed

A

UROFOLLITROPIN or uFSH

118
Q

stimulates estrogen secretion more efficiently

has short half life

A

rFSH

119
Q

rFSH available as pen that can be injected

A

FOLLITROPIN alpha- Gonal-f

120
Q

LH substitute that induces ovulation

A

hCG

121
Q

may only be used with rFSH follitropin alpha for stimulation of follicular development in infertile women with LH deficiency

A

rLH/ LUTROPIN

122
Q

LUTROPIN is NOT used

A

to induce ovulation

to stimulate endogenous LH surge for follicular development and ovulation

123
Q

not regulated by releasing hormones

A

posterior pituitary hormones

124
Q

posterior pituitary hormone structure

A

nonapeptide with a circular structure due to disulfide bridges

125
Q

effects of OXYTOCIN

A

milk ejection
induce uterine contraction
weak antidiuretc and pressor effects

126
Q

onset of OXYTOCIN

A

fast

127
Q

preparation for induction or augmentation

A

IV

128
Q

prep for postpartum hemorrhage

A

IV, IM

129
Q

half life of oxytocin

A

short, 3 mins

130
Q

assess term or post-term pregnancy for fetal well being

A

oxytocin challenge test or contraction stress test

131
Q

oxytocin AE

A

uterine overstimulation
hypertension
water retention
afibrogenemia

132
Q

oxytocin CI

A

fetal distress
prematurity
abnormal fetal presentation
cephalopelvic disproportion

133
Q

preparation of oxytocin

A

5 iu per mL , IV or IM

134
Q

IV oxytocin

A

induction of labor

135
Q

IM oxytocin

A

postpartum hemorrhages

136
Q

induced by high plasma tonicity and low BP

A

vasopressin or ADH

137
Q

v1 is found in

A

vascular smooth muscles ➡️ vasoconstriction

Gq receptor

138
Q

V2 is found in

A

renal tubular cells

endothelium

139
Q

v2 receptor activation

A

stimulate and inc cAMP➡️inc PKA➡️inc synthesis of aquaporin channel 2➡️inc water resorption

140
Q

extrarenal v2 receptors regulate

A

release of factor 8 and vWF

141
Q

uses of vasopressin

A

central diabetes insipidus
nocturnal enuresis
haemophilia A and vWF dse
variceal bleeding

142
Q

central diabetes insipidus tx

A

0.1-0.2 mg TID DESMOPRESSIN

143
Q

nocturnal enuresis tx

A

0.2mg at HS

144
Q

AE of ADH

A 
GIT disturbances
nausea and vomiting
hyponatremia
vasoconstriction- angina or MI
headache
145
Q

parenteral ADH for pressor effect like septic shock

A

VASOPRESSIN

146
Q

nasal spray, oral, parenteral preparation of ADH commonly used with more v2 effect

A

DESMOPRESSIN

Pharmacology (8 decks)

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