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Pharm 3 module 1 > Hypothalamic - pituitary - gonadal axis > Flashcards

Hypothalamic - pituitary - gonadal axis Flashcards

1
Q

What are the main releasing hormones

A

GHRH
CRH
TRH
GnRH
PRH

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2
Q

What are inhibiting hormones

A

somatostatin (GHIH & TSH)
Dopamine (PIH)

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3
Q

What does growth hormone effects

A

liver

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4
Q

What does growth hormone produce

A

somatomedins

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5
Q

What is another name for growth hormone

A

somatotropin

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6
Q

What is the job of growth hormone

A

required for normal growth

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7
Q

What are the target tissues for growth hormone

A

bone
adipose
liver
muscle
growth plates (indirectly- chondrocytes)

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8
Q

What are the growth hormone modulators

A

somatropin
octreotide
Pregvisomant

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9
Q

What are the indications of somatotropin

A

GH deficiency
Growth failure
HIV patients with cachexia

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10
Q

What syndromes can cause growth failure

A

prader-wili
Noonan syndrome
Turner syndrome

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11
Q

What are adverse effects of somatotropin

A

pain at injection site
edema
arthralgia / myalgia
glucose tolerance
Increased ICP

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12
Q

Which patients should somatotropin NOT be used on

A

pediatric patients with closed epiphysis (late teens)

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13
Q

What type of hormone is somatostatin

A

inhibitory

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14
Q

Where is somatostatin made

A

hypothalamus

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15
Q

What is the MOA of somatostatin

A

acts on the anterior pituitary
binds to pituitary GHRH receptor
Suppress GH and TSH release

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16
Q

What is the use of somatostatin

A

Suppress secretions and motility in the GI tract

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17
Q

What are synonyms of somatostatin

A

GHIH
GHRIH
SRIF
SRIH

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18
Q

What is octreotide

A

Long acting somatostatin (12hrs - 6wks)

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19
Q

What are indications for Octreotide

A

Acromegaly
severe diarrhea from carcinoid
bleeding esophageal varices

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20
Q

What are adverse effects of Octerotide

A

CVS: Bradicardia & conduction issues

GI: Diarrhea, abd pain, nausea, steatorrhea

*gallbladder emptying is delayed and can cause gallstones

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21
Q

What is Pegvisomant

A

GH receptor antagonist

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22
Q

What is the MOA of Pegvisomant

A

modified human growth hormone with receptor blocking properties (Inhibits IGF 1 release)

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23
Q

What are indications of pegvisomant

A

Acromegaly that is refractory to other pharmacological, surgical, or radiologic intervention

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24
Q

What are adverse effects of Pegvisomant

A

Diarrhea, Nausea, pain, abnormal hepatic function tests

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25
Q

What are the ACTH & ACTH release modulators

A

Cotricotropin (ACTH)
Cosyntropin

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26
Q

What is the job of corticotropin

A

stimulates steroid biosynthesis

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27
Q

What is the job of corticotropin releasing hormone

A

Regulates synthesis and release of ACTH

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28
Q

What kind of drug is Cosyntropin

A

synthetic ACTH with full biologic potency

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29
Q

What is the MOA of Cosyntropin

A

Stimulates the adrenal cortex to secrete adrenal steroids, androgenic substances, and small amount of aldosterone

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30
Q

What are the indications of Cosyntropin

A

Diagnostic tool (ACTH stimulation test) to screen for adrenocorticosteroid deficiency

*Addisons disease

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31
Q

What are adverse effects of cosyntropin

A

Excess glucocorticoid toxicities
HTN, Peripheral edema, hypokalemia, osteoporosis

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32
Q

What is the normal level of cortisol in the morning

A

20ug/dL

33
Q

What is the MOA of GnRH

A

Gonadotropin-release hormone is released from the hypothalamus and binds to receptors in the anterior pituitary to release gonadotropins

34
Q

What hormones are gonadotropins

A

FSH
LH

35
Q

What type of secretion is essential for gonadotropin release

A

Pulsatile

36
Q

What is the result of continuous gonadotropin release

A

Results in the down regulation of GnRH receptor and suppression of gonadotropin release

37
Q

What are the indications for gonadotropin production suppression

A

Prostate cancer
endometriosis and fibroids
precocious puberty
suppressing sex hormones
infertility treatment

38
Q

What are adverse effects of GnRH in females

A

generalized menopausal symptoms
Ovarian cyst

39
Q

What are the adverse effects of GnRH in males

A

transient increase in testosterone
Decreased libido
hot flashes
gynecomastia
edema

40
Q

What drugs are FSH-LH release modulators

A

Leuprolide
Goserelin
Naferelin
Histrelin

41
Q

What is Leuprolide used for

A

Treat prostate cancer, breast cancer, endometriosis, uterine fibroids and early puberty

42
Q

What is Goserelin used for

A

suppress production of sex hormones, particularly in the treatment of breast and prostate cancer

43
Q

What is Nafarelin used for

A

Used in the treatment of endometriosis and early puberty

44
Q

What is Histrelin used for

A

Used to treat prostate cancer in adults, will reduce the level of testosterone

45
Q

Where is prolactin secreted from

A

anterior pituitary

46
Q

What is the job of prolactin

A

stimulate and maintain lactation
decrease libido

47
Q

What helps regular prolactin

A

via tonic inhibition by dopamine that increases prolactin secretion

and TRH stimulating the release

48
Q

What drugs are prolactin release modulators

A

Bromocriptime
Cabergoline

49
Q

What is the job of Bromocriptime

A

dopamine receptor agonist that treats hyperprolactinemia and parkinsons disease

50
Q

What is the first line agent in the management of prolactinomas and why

A

cabergoline
has a higher affinity for D2 receptor sites, has less severe side effects, and a more convenient dosing schedule

51
Q

What are the adverse effects of bromocriptine and cabergoline

A

headache, dizziness, psychosis, nausea

52
Q

What hormones are released from the posterior pituitary gland

A

Oxytocin
Vasopressin
Desmopressin

53
Q

What is the target tissue for oxytocin

A

uterus and breast

54
Q

What is the target tissue for vasopressin (ADH)

A

Nephron (CT & DC)
Vascular smooth muscle

55
Q

What are the indications for oxytocin

A

labor induction
postpartum hemorrhage

56
Q

What are the adverse effects of oxytocin

A

hypotension
arrhythmias
Fluid retention
placental abruption/uterine rupture
fetal distress / death

57
Q

What is the MOA of vasopressin

A

Stimulates arginine vasopressin receptor
V1- vascular smooth muscle
V2- nephron

58
Q

What receptor does Desmopressin act on

A

Selectively V2
Better for central diabetes insipidus

59
Q

What are the adverse effects of ADH

A

water intoxication
hyponatremia
headaches
bronchoconstriction
tremor

60
Q

Which patients should you NOT give desmopressin to

A

CAD
Epilepsy
asthma

*Children do to seizure risk with nasal spray

61
Q

What are naturally occurring glucocorticoids

A

Cortisol
Cortisone

62
Q

What is the primary action of glucocorticoids

A

stress hormone
-metabolism
-inflammatory / immune function

63
Q

Where is CRH released from

A

hypothalamus

64
Q

Where is cortisol released from

A

adrenal cortex

65
Q

What does cortisol inhibit

A

CRH
ACTH

66
Q

What drugs are corticosteroids

A

betamethasone
cortisone
dexamethasone
hydrocortisone
prednisone
methylprednisolone
triamcinolone

67
Q

What drugs are mineral corticoids

A

eplerenone
spironolactone
Fludrocortisone

68
Q

What is the PK of cortisone

A

It is a short acting steroid that also have mineralocorticoid activity

liver will convert cortisone to hydrocortisone

69
Q

What is the PK of hydrocortisone

A

kidney will convert hydrocortisone to cortisone

70
Q

What is the MOA of intermediate acting steroids

A

significantly more affinity to the glucocorticoid receptors

*triamcinolone have no mineralocorticoid effects

71
Q

What is the PK of prednisone

A

prodrug converted by liver to prednisone which is then metabolized

72
Q

What is the MOA of long acting steroids

A

only bind to glucocorticoid receptors

73
Q

When are long acting steroids used

A

high dose injections
lung maturation

74
Q

What steroid is used in the diagnosis of bushings syndrome

A

dexamethasone

75
Q

What steroid is used in primary adrenal insufficiency and congenital adrenal hyperplasia

A

hydrocortisone

76
Q

How do betamethasone and dexamethasone help with lung maturation

A

increases surfactant production

77
Q

What are naturally occurring mineralocorticoids

A

aldosterone

78
Q

What is the job of aldosterone

A

regulate salt and water metabolism

79
Q

What is the indication of Fludrocortisone

A

treatment of Addisons disease and associated mineralocorticoid deficiency

Pharm 3 module 1 (3 decks)

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