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Pharm II > Hypothalamic & Pit Hormones - DONE > Flashcards

Hypothalamic & Pit Hormones - DONE Flashcards

0
Q

Release of pituitary hormones is mediated by _____.

A

hypothalamic control and feedback regulation

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1
Q

Hypothalamic-pituitary-endocrine gland systems governs systmic functions such as…..

A

metabolism, growth, and reproduction

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2
Q

Which pituitary hormone is NOT influenced by the hypothalamus?

A

prolactin

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3
Q

What inhibits GnRH, LH, & FSH via feedback inhibition?

A

estrogen and progesterone in women

androgens in men

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4
Q

What negatively regulates both TRH & TSH?

A

T4 & T3

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5
Q

____ negatively regulates both CRH and ACTH

A

cortisol

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6
Q

Release of GH is prevented by…..

A

somatostatin, GH, & IGF-1

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7
Q

Release of PRL is inhibited by ____

A

dopamine (D2 receptors)

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8
Q

Which hormone is a 191 amino acid peptide with 2 disulfide bridges?

A

GH

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9
Q

Endogenous GH has a half life of _______ and is metabolized by the ____.

A

20-25 min

liver

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10
Q

What is the primary peripheral effecto required during childhood and adolescence for normal growth?

A

IGF-1

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11
Q

Where is IGF-1 produced?

A

bone, cartlage, muscle, and kidney

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12
Q

what promate longitudinal bone growth until epiphyses close at the end of puberty?

A

IGF-1

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13
Q

What does a deficiency in GH during development (childhood to adolescence) result in?

A
  1. short stature
  2. increased body fat mass
  3. decreased lean muscle mass
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14
Q

Where does GH have catabolic effects?

A

in lipids (decreases adiposity)

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15
Q

What are the effects of GH on insulin?

A
  1. GH reduces insulin sensitivity
  2. IGF-1 has insulin-like effects
  3. Defective GH receptors shift balance to IGF-1 dominated effects (decreased insulin and lower serum glucose)
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16
Q

How is GH deficiency diagnosed?

A
  1. growth rate <4 cm per year

2. NO serum GH response to 2 secretagogues

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17
Q

A 35 year old male come to the clinic of feeling tired all the time. Upon physical exam you find he has generalized obesity, reduced muscle mass, asthenia, and reduced cardiac output. What do you suspect is wrong with this patient and how would you treat it?

A

Adult GH deficiency

tx: GH

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18
Q

autosomal dominant disease associated with growth failure, obesity, and carbohydrate intolerance

A

Prader-Willi syndrome

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19
Q

What are some toxicity and contraindications for GH?

A
  1. hypothyroidism (common)
  2. pancreatitis
  3. gynecomastia
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20
Q

What are the major side effects of GH in children?

A

intracranial HTN (vision changes, HA, N/V)

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21
Q

What are side effects of GH therapy that are more common in adults?

A
  • edema
  • myalgia
  • arthralgia (hands & wrists)
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22
Q

What is rarely used in critically ill patients because it can increase mortality?

A

GH

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23
Q

GH producing cells in the ant. pit. tend to form ______.

A

secreting tumors (leads to acromegaly most commonly)

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24
Q

A 40 yr old female comes to the clinic presenting with abnormal growth of cartilage and bone, with complaints of noticing her shoe size and ring size getting larger. Upon further investigation you notice she also has cardiomegaly and hepatomegaly. You determine she has…..

A

acromegaly

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25
Q

What inhibits the release of GH, glucagon, insulin, and gastrin?

A

somatostatin

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26
Q

what is the half life of somatostatin?

A

1-3 minutes

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27
Q

What is the most widely used somatostatin analog?

A

octreotide

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28
Q

What is octreotide indicated use for?

A

acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, watery diarrhea, hypokalemia, achlorhydria syndrome, diabetic diarrhea

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29
Q

what is the half life of octreotide?

A

80 min

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30
Q

This medication is a long acting somatostatin analog, approved for treatment of acromegaly, and has a similar profile to octreotide.

A

lanreotide

31
Q

This hormone directs ovarian follicular development.

A

FSH

32
Q

Which hormones re needed for ovarian steroidogenesis?

A

FSH & LH

33
Q

What stimulates androgen production by the theca cells of the ovary during the follicular stage of the menstrual cycle?

A

LH

34
Q

Which hormone stimulates the conversion of androgens to estrogens in granulosa cells?

A

FSH

35
Q

What is the primary regulator of spermatogenesis?

A

FSH

36
Q

What hormone is the main stimulus of testosterone production by Leydig cells?

A

LH

37
Q

purified human FSH from urine of postmenopausal women

A

urofollitropin

38
Q

recombinant FSH preparations that are identical in AA sequence to human FSH and has a shorter half life than purified FSH and more expensive.

A

folitropin alpha or beta

39
Q

recombinant form of human LH that has been approved for used wth follitropin alpha for follicular development in infertile women with extreme LH deficiency

A

Lutropin alpha (it was withdrawn in July 2012)

40
Q

recominant hCG = _____

A

choriogonadotrpin alpha

41
Q

Hypogonadal infertility in men requires administration ______

A

gonadotropins for sperm maturation

42
Q

what is the primary adverse affect women have to worry about with the use of gonadotropins and hCG?

A

ovarian hyperstimulation syndrome

43
Q

describe the dual regulation of gonadotropin release.

A
  1. stimulation - caused by PULSATILE release of GnRH

2. inhibition - caused by SUSTAINED, NONPULSATILE release of GnRH

44
Q

____ = acetate salt of synthetic human GnRH

A

Gonadorelin

45
Q

Name the 5 synthetic GnRH analogs

A
  1. Goserelin (sq or iv)
  2. histrelin (sq or iv)
  3. Leuprolide (sq or iv)
  4. nafarelin (intranasally)
  5. Triptorelin (sq or iv)
46
Q

Describe the biphasic response to constant GnRH analog administration.

A
  1. first 7-10 days - initial “flare” where LH & FSH release is increased.
  2. sustained response - after “flare” the serum concentrations of gonadotropin and gonadal steroids decreases.
47
Q

What are the adverse side effects of GnRH and its analogs?

A

induces menopause like symptoms (hot flashes, sweats, HA), depression, diminished libido, generalized pain, vaginal dryness, breast atrophy, decreased bone density

48
Q

How do GnRH agonists aid in overcoming female infertility?

A

it can be used to initiate LH surge and ovulation in women undergoing IVF

49
Q

What can pulsatile administration of GnRH agonist treat in men?

A

hypothalamic hypogonadotrophic hypogonadism (though not common)

50
Q

How can the use of GnRH agonists be helpful in the diagnosis of LH responsiveness?

A
  • Admin of GnRH can distinguish if hypogonadotropic adolescence is due to hypothalamic or pit. dz.
  • admin should increase serum LH >15.6 miU/ml is suggest of dz
51
Q

What are GnRH agonists useful for in the inhibition of gonadotropin production?

A
  1. controlled ovarian hyperstimulation
  2. endometriosis
  3. uterine fibrosis
  4. prostate cancer
  5. central precocious puberty
  6. ovarian & breast cancer
52
Q

How is ovarian hyperstimulation controlled by GnRH agonists?

A

the use of leuprolide or nafarelin to suppress endogenous LH surge in IVF procedures

53
Q

Which GnRH agonists are approved to suppress ovarian steroidogensis?

A

leuprolide, goserelin, & nafrelin (limited to 6 mth use due to decrease in bone density)

54
Q

How are GnRH agonists used clinically for prostate cancer?

A

used in combination with an androgen receptor antagonist to “chemically castrate” and to reduce testosterone production

55
Q

What are the 3 GnRH antagonists?

A
  1. ganirelix
  2. cetrorelix
  3. degarelix
56
Q

GnRH antagonists ____ gonadotropin production

A

suppress

57
Q

What are the effect of GnRH antagonists similar to?

A

sustained administration of a GnRH agonist

58
Q

In patients with advanced prostate cancer where GnRH agonist was not appropriate, what drug can be used?

A

degarelix

59
Q

Which hormone is produced in the ant. pit. and mediate lactation?

A

PRL

60
Q

PRL elevation is caused by…..

A

PRL secreting tumors (hyperprolactinemia)

61
Q

PRL release is inhibited by….

A

dopamine receptor agonists

62
Q

What are two dopamine receptor agonists that are used to treat hyperprolactinemia?

A

bromocriptine and cabergoline

63
Q

what causes contraction of uterine smooth muscle and milk ejection in lactating women?

A

oxytocin

64
Q

what is administered IV for initiation and augmentation of labor?

A

oxytocin

65
Q

How do variations in dose of oxytocin affect labor?

A
  • small doses increase frequency and force of contraction

- large doses produce a sustained contraction

66
Q

What is administered IM or IV for postpartum bleeding?

A

oxytocin

67
Q

What are contraindications of the use of oxytocin?

A
  1. fetal distress
  2. prematurity
  3. abnormal fetal presentation
  4. cephalopelvic disproportion
  5. predisposition to uterine rupture
68
Q

what is release in response to increased plasma tonicity or decreased BP?

A

ADH

69
Q

lack of ADH production or renal insensitivity resulting in excretion of large amounts of dilute urine

A

DI

70
Q

What are the vasopressin receptors and where are they located and what is there fxn?

A

V1 - vascular sm. muscle cells and mediate constriction
V2 - renal tubule cells, increase water permeability and increase water resorption in collecting tubules (reduce diuresis)

71
Q

long acting synthetic analog of vasopressin with minimal V1 activity and antidiuretic

A

desmopressin

72
Q

What are the TOC for pituitary DI?

A

vasopressin and desmospressin

73
Q

What are the adverse effects of vasopressin and desmopressin?

A

HA, nausea, abdominal cramps, agitation, allergic rxn (rare)

74
Q

What are the vasopressin antagonists?

A

conivaptan (IV) and tolvaptan (PO)

75
Q

conivaptan and tovaptan are approved for use in ______

A

hyponatremia

Pharm II (13 decks)

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