Hypothalamic/pituitary Pharm

Question 1

Peptide hormone released by posterior pituitary
Acts as ADH
Use in patients who need to be hemodynamically stabilized who cannot be with traditional methods
V1 Receptors: Vascular SM and mediate vasoconstriction
V2 Receptors: Renal tubule cells (where desmopressin exclusively acts)
Extrarenal V2 receptors also regulate the release of coagulation factor VIII and von Willebrand factor

Answer 1

Vasopressin

Question 2

Somatostatin analog
45 times more potent than somatostatin in inhibiting GH and insulin secretion
Used in VIPomas, Glucagonomas, Insulinomas
AES - N/V, steatorrhea, gallstones, cardiac issues

First aid - acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices

Answer 2

Octreotide

Lanreotide approved for acromegaly, effects comparable to octreotide

Question 3

GH receptor antagonist

Inhibits signal transduction

Answer 3

Pegvisomat

Question 4

Dopamine D2 agonists (2 drugs)
Treat hyperprolactinemia, acromegaly, Parkinson’s and possible inhibition of GH
AEs - HA, nausea, orthostatic hypotension, fatigue, pulmonary infiltrates at high doses

Answer 4

Bromocriptine

Cabergoline

Question 5

Stimulates uterine contractions and elicits milk ejection in lactating women
IV for labor augmentation and initiation
IM for postpartum bleeding

First aid - labor induction (stimulates uterine contractions), milk letdown, controls uterine hemorrhage

Answer 5

Oxytocin

Question 6

Recombinant IGF-1 and recombinant IGFBP-3
Treats growth failure due to IGF-1 deficiency possibly due to GH gene mutations
Can cause HYPOGLYCEMIA

Answer 6

Mecasermin

Question 7

Vasopressin antagonists (2 drugs)
_______ - V2: promotes excretion of free water
_______ - V1 and V2: used in CHF and SIADH

First aid - SIADH, block action of ADH at V2-receptor

Answer 7

Tolvaptan (V2 only)

Conivaptan (V1 and V2)

Question 8

JAK-STAT pathway
Primary mediator is IGF-1
Has anabolic effects in muscle and catabolic effects in lipid/ adipose cells
Indicated in pediatric patients with deficiency- Prader Willi Syndrome, Turner Syndrome, idiopathic
GH decreases insulin effects while IGF-1 promotes insulin effects
Target organs - liver, muscle, bone, kidney, others
First aid - ____ deficiency, Turner syndrome

Answer 8

GH/somatotropin

Question 9

Long-acting synthetic analog of vasopressin with minimal V1 activity (no vasopressor effects)
Use in pituitary diabetes insipidus, hemophilia A, von Willebrand
CAUTION in patients with coronary artery disease because of vasoconstriction

First aid - central (not nephrogenic) DI, vWD, sleep enuresis, hemophilia A

Answer 9

Desmopressin