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Pharm block 4 > Hypothalamic/Pituitary > Flashcards

Hypothalamic/Pituitary Flashcards

1
Q

What is GHRH used for?

A

Recombinant form used to stimulate growth hormone secretion in people with short stature

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2
Q

What is somatostatin used for?

A

Inhibits release of glucagon, insulin, gastrin, TSH, and growth hormone; an example is Octreotide

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3
Q

What is GnRH used for?

A

Stimulates release of FSH and LH; when given pulsatile simulates physiological action

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4
Q

What is CRH used for?

A

Stimulates release of ACTH from anterior pituitary through activation of cAMP

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5
Q

What is TRH used for?

A

Stimulates release of thyrotropin from anterior pituitary, and prolactin

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6
Q

What does dopamine do in the pituitary pathway?

A

Inhibits prolactin release

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7
Q

What time of day, and stage of human development do growth hormone and prolactin peak?

A

At night (around midnight) and puberty

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8
Q

What happens to blood glucose when IGF is increased?

A

Blood glucose decreases

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9
Q

What happens when too much growth hormone is released?

A

In childhood you have gigantism, in adulthood you have acromegaly

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10
Q

What drug is used for growth hormone deficiency that is responsive to growth hormone treatment?

A

Somatropin

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11
Q

What drug treats growth hormone receptor mutation, or abnormal signaling that is not responsive to growth hormone treatment?

A

Mescasermin (IGF-1 agonist)

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12
Q

Where does somatropin act, and what are it’s effects?

A

Acts through growth hormone receptors to increase IGF-1; restores normal growth and metabolic defects in GH deficient patients

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13
Q

What are symptoms of somatropin toxicity and what is it contraindicated in?

A

TOX: Malignancy, papilledema, visual disturbances, GH replacement therapy can cause diabetes mellitus, scoliosis, edema, etc.

CONTRA: Active malignancy

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14
Q

Other than GH deficiency, what are other uses of somatropin?

A
  1. Prader-Willi (decrease obesity, growth, and carbohydrate intolerance)
  2. Turner Syndrome (treated w/ growth factor and gonadal steroid)
  3. Idiopathic short stature
  4. Chronic renal failure
  5. AIDS related wasting
  6. Malabsorption due to short bowel syndrome.
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15
Q

What is the mechanism of action, and effects of Mescasermin?

A

Recombinant form of IGF-1 that stimulates the IGF-1 receptors; restores normal growth in patients with a receptor mutation of GH or IGF-1 deficiency who are resistant to GH

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16
Q

What are some Mescasermin toxicities?

A

Hypoglycemia, intracranial hypertension, increased liver enzymes

17
Q

What drug is used in gigantism and acromegaly patients?

A

Somatostatin

18
Q

What is the mechanism and effects of Octreotide?

A

Agonist of somatostatin receptors, inhibiting GH production, and to a lesser extent glucagon, insulin, and gastrin

19
Q

What are some clinical applications of Octreotide?

A

Acromegaly, carcinoid syndrome, acute bleeding from esophageal varices, diabetic diarrhea, localization of GI serotonin tumor

20
Q

What are some toxicities of Octreotide?

A

GI disturbances, gallstones, bradycardia, and other cardiac conductibility disturbances.

21
Q

What is similar to Octreotide and used in long-acting therapy?

A

Lanreotide

22
Q

What is the mechanism of action and some effects of Pegvisomant?

A

Blocks GH receptors; ameliorates effects of excess GH production in acromegaly patients.

23
Q

What is the toxicity for Pegvisomant?

A

Elevated liver enzymes

24
Q

What is the difference in V1 and V2 for the ADH receptor?

A

V1 - smooth muscle - vasoconstriction

V2 - kidney - aquaporin - water resorption

25
Q

What is the mechanism and effects of Atosiban?

A

Blocks oxytocin receptors causing decreased uterine contractions; tocolysis for preterm labor.

26
Q

What are some toxicities of Atosiban?

A

Concern about rates of increased infant deaths.

NOTE: This is the first IV drug administration, the GH ones were subcutaneous

27
Q

What does vasopressin (ADH) do, and what is it used for?

A

Activates V2 to increase water permeability and resorption, concentrating urine. Used in Central Diabetes Insipidus

Activates V1 to cause vasoconstriction. Used in variceal or controlled bleeding.

28
Q

What are side effects of vasopressin (ADH)?

A

Hypertension and bradycardia

29
Q

What is the mechanism of action of Desmopressin, and some effects?

A

Activates vasopressin (V2 > V1) receptors; so agonist, acts in kidney to decrease excretion of water, acts on extra-renal V2 receptors to increase Factor VIII & Von Willebrand

30
Q

What are the clinical applications, route of administration, and toxicities of Desmopressin?

A
  1. Pituitary diabetes inspidius, hemophilia A & Von Willebrand disease, nocturnal enuresis.
  2. Oral, IV, SC, or nasal
  3. GI disturbances, headache, hyponatremia, allergic rxns
31
Q

What is the water deprivation test, and how is it interpreted?

A
  1. Diagnose between central and nephrogenic diabetes insipidus.
  2. Normal person the urine after water deprivation and desmopressin is >750 mOsmol/kg; diabetes insipidus is <300 mOsmol/kg. Central if increases after AVP, nephro if not changed by AVP
32
Q

What is SIADH and the treatment for it?

A

Inappropriate secretion of ADH, usually caused by tumor or injury in lung/brain, characterized by low blood sodium

Tx: Restrict water intake, hypertonic saline, Conivaptan, Demeclocycline, and Lithium

33
Q

What are some important side effects of lithium?

A

Nephrogenic diabetes insipidus, and hypothyroidism

34
Q

What is the mechanism of action, how it’s administered and some effects of Conivaptan?

A

Antagonist of V1a and V2 receptors, which increases renal excretion of water. Used for hyponatremia patients in hospitalized SIADH.

Administered via IV

35
Q

What are symptoms of microadenoma of the pituitary and what is it treated with?

A

Amenorrhea, galactorrhea, treated with bromocriptine and cabergoline. More common in females.

36
Q

What are the symptoms of macroadenoma of the pituitary and what is it treated with?

A

Visual field defect, treated with surgery (trans-sphenoid approach) and radiation. More common in males.

Pharm block 4 (16 decks)

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