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Pharmacology II > Hypothalamus and Pituitary > Flashcards

Hypothalamus and Pituitary Flashcards

1
Q

Name the drug class and examples that are used to treat hyperprolactinemia

A

Dopamine agonists

ex. Bromocriptine, cabergoline

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2
Q

Levels twice the upper limit of Insulin-like growth factor suggest what disease?

A

Acromegaly

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3
Q

Who is GH treatment generally recommended for?

A
  • “idiopathic short stature”
  • Height more than 2.25 standard deviations below mean for age
  • GH provacative testing
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4
Q

Somatropin: genotropin, growth hormone treatment regulates what?

A
  • lipid and carbohydrate metabolism
  • builds lean body mass
  • regulates insulin-like growth factor 1 production in peripheral tissues
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5
Q

Somatropin indications

A

-Short stature (ex. Turner syndrome, Prader-Willi syndrome)

  • Failuire to Thrive
  • Small for gestastional age
  • Idiopathic short stature (may add 1.5-3 inches
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6
Q

Name 3 indications for GH in adults

A
  1. Growth hormone deficiency
  2. Wasting in HIV patients
  3. Short bowel syndrome
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7
Q

Somatropin ADEs in children

A
  1. Pseudotumor cerebri (increased intracranial hypertension)
  2. Slipped capital femoral epiphysis
  3. Progression of scoliosis
  4. Hyperglycemia
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8
Q

Somatropin drug interactions

A
  1. Glucocorticoids - may inhibit growth promoting effects
  2. Use with other hormones may accelerate epiphyseal closure and compromise final height (ex. androgens, thyroid hormones)
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9
Q

Mecasermin (recombinant IGF-1) use

A

If not growing and unresponsive to GH therapy + IGF-1 deficiency

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10
Q

Mecasermin (recombinant IGF-1) ADEs

A
  1. Hypoglycemia (eat snack/meal before dose!)
  2. Tonsillar/adenoidal hypertrophy. Lymphoid hypertrophy
  3. Coarsening facial features
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11
Q

Treatment of choice for acromegaly

A

transsphenoidal microsurgery

Acromegaly in adults
Gigantism in children/adolescents

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12
Q

How is glucose used to determine GH disease?

A

oral glucose tolerance test (OGTT) - give large dose of glucose orally and expect GH to be supressed….if they continue to secrete GH there’s a problem (ex. acromegaly)

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13
Q

GH excess: pharmacologic treatment

A
  1. Dopamine agonists (cheap, low cost, only works for some)
  2. Somatostatin analogs (more effective than Dopamine agonists)
  3. Pegvisomant (GH-receptor antagonist) - very helpful in normalizing IGF-1
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14
Q

Dopamine agonists in Acromegaly

A
  • Cause a paradoxical decrease in GH

- normalize IGF-1 (cabergoline > Bromocriptine)

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15
Q

Dopamine agonists for acromegaly: ADEs

A

Respiratory: thickening of bronchial secretions and nasal congestion**

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16
Q

Somatostatin analogs (GH antagonists) examples and ADEs

A

Ex. Octreotide, Lanreotide, Pasireotide

  • Gallstones
  • Cardiac conduction abnormalities
  • HTN
  • Abnormalities of glucose metabolism
  • Subclinical hypothyroidism
17
Q

Pegvisomant (GH antagonist) MOA

A
  • inhibits IGF-1 production

- Blocks the physiologic effects of GH on target tissues

18
Q

Pegvisomant (GH antagonist) ADE

A

Increased liver enzymes (AST, ALT)

19
Q

When to use Pegvisomant?

A

only if other treatments have failed

20
Q

Selective estrogen receptor modulator (SERM) examples

A

Raloxifene and Tamoxifen

  • can be useful in postmenopausal women, or those who have had breast cancer
  • serum testosterone levels increase in men
21
Q

What is an appropriate medication for most GH patients?

A

somatostatin analog

22
Q

What is the most appropriate treatment in mild GH?

A

Dopamine agonist

23
Q

Which drugs can cause hyperprolactinemia because they are dopamine antagonists?

A

Antipsychotics*

24
Q

Prolactin stimulating drugs

A
  • Methyldopa
  • Reserpine
  • Benzodiazepines
  • SSRIs
  • H2 receptor blockers
  • Opioids
  • Cocaine
25
Q

Which type of drug is typically more successful than surgery in hyperprolactinemia?

A

Dopamine agonists

26
Q

Transsphenioidal surgery for hyperprolactinemia: indications

A
  • reserved if patient is refractory to therapy or can’t tolerate dopamine agonists
  • Large tumors that are compressing adjacent tissues
27
Q

D2-receptor agonists: which is most effective and considered 1st line

A

Cabergoline is more effective than Bromocriptine

28
Q

Which dopamine agonist is probably the best to start with for a patient with prolactinoma and wishes to become pregnant?

A

Bromocriptine

29
Q

Cabergoline: ADE

A

Decreased blood pressure (mild/moderate)

-nasal congestion

30
Q

Bromocriptine ADE

A

nausea

Pharmacology II (31 decks)

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