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RRPA Pharmacology III > hypothalamic-pituitary hormones (Exam 1) > Flashcards

hypothalamic-pituitary hormones (Exam 1) Flashcards

1
Q

What is another name for the Growth Hormone?

A

Somatropin

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2
Q

A child needs replacement therapy of growth hormone. Which is more effective for dosing?

A. Daily at bedtime via SC or 3 times a week IM?

A

daily at bedtime via SC- this mimics natural release pattern

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3
Q

What can you use to treat children who have a growth hormone insensitivity? (laron dwarf)

A

can treat recombinant IGF-1

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4
Q

What is the drug name for recombinant IGF-1?

A

Mecasermin-Increlex

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5
Q

What should pts due before injecting recombinant IGF-1?

A

Eat some carbs before injection because there is a concern for hypoglycemia

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6
Q

What is the most common causes of growth hormone deficiency?

A

usually due to pituitary tumor or consequences of its treatment- (surgery/radiation )

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7
Q

What increases the release of growth hormone?

A

the release is increased by GHRH

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8
Q

What decreases the release of growth hormone?

A

somatostatin also paradoxically decreased by dopamine agonists in acromegaly

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9
Q

limited studies of Illicit use of growth hormone in the elderly for anti-aging suggest what?

A

That it is associated with small changes in body composition and INCREASED rates of adverse effects (edema, joint pain, muscle pain, carpal tunnel

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10
Q

True or false can your recommend growth hormone to the elderly for anti aging?

A

False it can not be recommended

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11
Q

What side effects can occur with the use of somatropin?

A
  1. insulin resistance and glucose intolerance may occur
  2. Slight increased risk for idiopathic intracranial hypertension
  3. Rarely pancreatitis, gynecomastia, nevus growth
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12
Q

What is somatostatin?

A

This is a growth hormone- inhibiting hormone can also be called Somatotropin release-inhibiting factor

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13
Q

Where is somatostatin present in the body?

A

it is in the…

  1. hypothalamus
  2. nervous system
  3. gut
  4. endocrine and exocrine glands
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14
Q

True or false: Somatostatin inhibits GH release via GPCR coupled to Gi decreasing cAMP levels and activating K+ channels

A

True

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15
Q

True or false Beetches: somatostatin INCREASES secretion of gastric enzymes and acid- INCREASED GI motility- STIMULATES the release of serotonin

A

False. The bolded words should be

  1. decrease
  2. decreased
  3. suppresses
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16
Q

True or false: Somatostatin reduces insulin and glucagon release

A

True

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17
Q

Does somatostatin interfere with TRH ability to release TSH

A

yes it does

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18
Q

What is the half life of somatostatin following exogenous administration?

A

it is only 3-4 min which limits its therapeutic effects

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19
Q

What organ system has a major role in the clearance of somatostatin?

A

The kid knees

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20
Q

What are the names of two other meds that are similar to somatostatin?

A

Octreotide and Lanreotide

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21
Q

What is the half life of Octreotide in the plasma? how long does it last? How often is it given and by what method?

A
  1. plasma half life 90min
  2. duration 12 hours
  3. Given SC every 6-12 hours
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22
Q

How else can Octreotide be given and how often?

A

can be IM and every 4 weeks

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23
Q

How is Lanreotide administered and how often?

A

SC and every 4 weeks

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24
Q

What is Octreotide and Lanreotide used for?

A
  1. Pituitary or excess of growth hormone

2. control of bleeding from esophageal varices and GI hemorrhage

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25
Q

What are two conditions associated with pituitary excess where Lanreotide and Octreotide can be used?

A
  1. Acromegaly and gigantism
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26
Q

What treatment is preferred for when the pituitary releases excess growth hormone?

A

Surgical resection- unless adenoma does not appear fully resectable

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27
Q

After a response is seen with the use of SC Octreotide, what med is utilized next

A

Long acting somatostatin analog

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28
Q

Are dopamine agonists as effective as SST (somatostatin) analogs?

A

no they are not; however Cabergoline is a preferred agent for adjunctive management of acromegaly with advantage of oral administration

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29
Q

What is Pegvisomant (somavert)?

A
  • this is a GH receptor antagonist
  • It binds to receptors blocking GH access, but does not activate signaling transduction
  • administered single dose SC
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30
Q

true or false: SST analogs can be used for WDHA (watery diarrhea, hypokalemia, achlorhydria)

A

True

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31
Q

What is a side effect of SST drugs?

A
  • transient hyperglycemia

- cardiac effects (brady and conduction disturbances)

32
Q

what is prolactin release under control of?

A

under inhibitory control by hypothalamic dopamine at D2 receptors

33
Q

what is the main stimulus for the release of prolactin?

A

suckling causes 10-100 fold increase

34
Q

If there are sufficient levels of, insulin, estrogen, progestin, and corticosteroids what will prolactin stimulate?

A

milk production

35
Q

Prolactin stimulates milk production, what else does it stimulate?

A

Proliferation and differentiation of mammary tissue during pregnancy?

36
Q

So what does prolactin inhibit?

A

inhibits gonadotropin (FSH/LH) release and or ovarian response to these hormones

37
Q

What two drugs are used for prolactin issues?

A

Cabergoline and bromocriptine

38
Q

Is there any treatment available for prolactin deficiency?

A

no there isn’t

39
Q

why are prolactinomas that cause hyperprolactinemia amenable to pharmacotherapy?

A

this is because of the availability of dopamine agonists that both decrease secretion and reduces tumor size.

40
Q

What are some frequent side effects of bromocriptine?

A

nausea, vomiting, headache, postural hypotension

41
Q

Does bromocriptine activate D1 receptors?

A

yes

42
Q

What is the preferred agent for hyperprolactinemia?

A

Cabergoline

43
Q

which is more selective for D2 receptors? and more effective in reducing prolactin secretion?

A

cabergoline

44
Q

which is better tolerated? cabergoline or bromocriptine?

A

cabergoline

45
Q

What is another name for vasopressin?

A

it is the antidiuretic hormone, ADH

46
Q

what is the half life of vasopressin?

A

about 20 minutes

47
Q

Which one is more stable desmopressinor vasopressin?

A

desmopressin, it has a half life of 1.5-2.5 hours

48
Q

What part of the kidney does desmo and vasopressin act on?

A

the collecting tubules

49
Q

What are the stimuli in the body that cause the release of vasopressin?

A
  1. main stimuli is rising blood osmolarity

2. decrease circulating blood volume

50
Q

True or false: alcohol can inhibit the release of ADH

A

true

51
Q

What receptors mediate the renal actions of ADH?

A

V2 receptors

52
Q

What are the non-renal actions of ADH?

A

release of coagulation factor VIII and von willebrands factor

53
Q

Other than the V2 receptors what other receptors does ADH-vasopressin act on?

A

V1 receptors

54
Q

What is the effect of ADH on V1 receptors?

A
  • mediates vasoconstriction of vascular smooth muscle

- BUT pressor responses only at much higher concentrations than for maximal antidiuresis

55
Q

Central diabetes insipidus is a posterior pituitary disease resulting in hypofunction. what two medications can be used to treat it?

A
  1. Desmopressin

2. Chlorpropamide

56
Q

What is central diabetes insipidus?

A

this is when you have inadequate ADH secretion from the posterior pituitary

57
Q

Which of the two is the treatment of choice for central diabetes insipidus? why?

A. Desmopressin
B. Chlorpropamide

A

A. Desmopressin because it is highly selective for V2 receptor with little vasopressor or uterotonic actions

58
Q

Can desmopressin be given nasally?

A

Yes and an adverse reaction can be nasal irritation.

59
Q

When taken orally what can be some adverse reactions?

A
  1. Mild elevation of liver enzymes
  2. asthenia
  3. water intoxication,
  4. abdominal cramps
60
Q

What 2 drugs can induce nephrogenic diabetes insipidus?

A
  1. Lithium. This drug reduces V2-receptor mediated stimulation of adenyl cyclase
  2. Demeclocycline- possibly acts via block of ADH binding to receptor
61
Q

What is one treatment for nephrogenic diabetes insipidus that doesnt seem to make sense?

A

The use of thiazide diuretics

62
Q

How does the use of thiazide diuretics work for nephrogenic diabetes insipidus?

A

Paradoxically reduce the polyuria of patients.

-somehow antidiuretic effect parallels ability to cause natriuresis

63
Q

Other than the use of thiazide diuretics for nephrogenic diabetes insipidus what other drug can you use?

A

NSAIDS

64
Q

how do NSAIDS work for nephrogenic diabetes insipidus?

A

Prostaglandins attenuate ADH-induced antidiuresis so INHIBITION of PG synthesis by indomethacin may relate to the antidiuretic response.

-INDOMETHACIN HAS GREATEST EFFICACY AMONG NSAIDS

65
Q

What combined therapy can be used for treatment of nephrogenic diabetes insipidus?

A

Thiazide and indomethacin

66
Q

We have talked about hypofunction of posterior pituitary. What is a condition of hyperfunction of posterior pituitary?

A

SIADH

67
Q

What disorders can cause SIADH?

A
  1. Malignancies
  2. Pulmonary disease
  3. CNS trauma, infections, tumor
68
Q

What drug classes most commonly implicated can lead to life threatening hyponatremia and then seizures?

A
  1. Psychotropic agents: SSRIs, haloperidol, tricyclic antidepressant
  2. Sulfonylureas (chlorpropamide)
  3. Vinca alkaloids chemotherapy
  4. Methylenedioxy methamphetamine (MDMA)
69
Q

what is the initial conservative approach for treatment of hyponatremia?

A

initially just restriction of free water intake

70
Q

What drug inhibits ADH effect on distal tubule and has been the preferred drug in patients with inadequate response to conservative therapy for Hyponatremia?

A

Demeclocyline

71
Q

What two drugs are V2 receptor antagonists and have been used for hyponatremia?

A
  1. Tolvaptan

2. Conivaptan

72
Q

If severe symptomatic hyponatremia is present, what can be given along with conivaptan?

A

hypertonic saline 3% which permits a more rapid correction

73
Q

If there is a to rapid correction of hyponatremia what can occur?

A

cerebellar pontine myelinolysis

74
Q

Vasopressin is a V1 receptor mediated drug. Can it be used for bleeding in esophageal varices? is there another option that is better tolerated and preferred?

A
  1. Vasopressin can be used

2. The better option is octreotide

75
Q

True or false: Vasopressin can be used for severe septic shock and formerly used for shock-refactory ventricular tachycardia?

A

True

76
Q

Which medication is V2 receptor mediated and can be used for nocturnal enuresis?

A

Desmopressin

77
Q

What two blood conditions can desmopressin be used for?

A
  1. Von willebrands disease

2. Moderate hemophilia A (elevates factor VIII)

RRPA Pharmacology III (9 decks)

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