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Pharm II- Exam 1 > Hypothalamus and Pituitary therapy > Flashcards

Hypothalamus and Pituitary therapy Flashcards

1
Q

except for prolactin, hormones released from the ____ pituitary stimulate production of hormones by a _____

A

anterior

peripheral endocrine gland, liver, or other tissues

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2
Q

which hormones act directly on target tissues?

A

posterior pituitary hormones (vasopressin & oxytocin)

prolactin

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3
Q

which factors regulate the release of anterior pituitary hormones?

A

hypothalamic factors

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4
Q

Hypothalamic hormones: GnRH clinical uses

A

treat infertility

LA forms: precocious puberty, transgender/gender variant, men w/prostate CA and women undergoing assisted reproductive tecnology (ART)

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5
Q

Hypothalamic hormones: Dopamine clinical uses

A

tx of hyperprolactinemia

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6
Q

Growth hormone (GH, -somatotropin): describe the link between hypothalamic hormone, target organ, primary target organ hormone or mediator

A

hypothalamic hormone = GHRH (+) & Somatostatin (-)

liver, bone, muscle, kidney, others

insulin-like growth factor-I (IGF-I)

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7
Q

GH or somatotropin physiology

A

direct anti-insulin effects on lipid and carbohydrate metabolism

stimulates gluconeogenesis in hepatocytes, impaires tissue glucose uptake, decr’s insulin-receptor sensitivity, impairs postreceptor insulin action

stimulates formation of IGF-1 in the liver and peripheral tissues

lowest during infancy, peak during adolescence, decline during middle-age years

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8
Q

Growth hormone deficiency agonists?

A

somatropin

mecasermin

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9
Q

What lab studies detect GH deficiency?

A

no gold standard for dx exists

give provocative pharmacologic GH stimuli: insulin-induced hypoglycemia, clonidine, L-dopa, arginine, glucagon, GHRH

subnormal GH response during childhood = peak GH serum concentration less than 10ug/L

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10
Q

Who is tx for GH deficiency recommended for?

A

children who have “idiopathic short stature” and pass GH provocative testing +

height >2.25 SD’s below mean for age, subnormal growth velocity, delayed bone age, low serum IGF-1, etc…

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11
Q

GH tx’s

A

Somatotropin: Genotropin
Mecasermin: increlex

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12
Q

Why do we need GH?

A

required for normal growth

regulates lipid and carbohydrate metabolism and lean body mass

regulates production in peripheral tissues of insulin-like growth factor 1 (IGF-1)

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13
Q

What is the recombinant form of Human GH?

A

somatropin

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14
Q

Indications for somatropin?

A

short stature (Turner’s, Noonan’s, Prader-Willi syndromes)

failure to thrive

small-for-gestational age

controversial use: children w/idiopathic short stature (may add 1.5-3in)

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15
Q

What are the GH products on the market?

A 
Genotropin
Humatrope
Norditropin
Nutropin AQ
Omnitrope
Saizen
Serostim
Zomactin
Zorbtive
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16
Q

What is the primary therapeutic objective in an adult with GH deficiency?

A

improved metabolic state, increased lean body mass, sense of well-being

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17
Q

What is the primary therapeutic objective in an adult with wasting in pt’s with HIV?

A

increased lean body mass, weight, physical endurance

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18
Q

What is the primary therapeutic objective in an adult with short bowel syndrome?

A

improved GI fx

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19
Q

Somatropin ADE’s in children

A

pseudotumor cerebri
slipped capital femoral epiphysis
progression of scoliosis
hypergylcemia

*monitor in children for concurrent deficiency of other ant. pituitary hormones

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20
Q

Somatropin ADE’s in adults

A

generally tolerated
peripheral edema
myalgia
arthralgia

21
Q

Drug interactions of somatropin?

A

glucocorticoids - may inhibit growth-promoting effects of recombinant GH

concomitant administration of other hormones - accelerate epiphyseal closure and compromise final height

22
Q

Mecasermin

A

recombinant human IGF-1 (insulin like growth factor 1)

23
Q

Who should you tx w/ Mecasermin?

A

children w/growth failure unresponsive to GH therapy and deficiency in IGF-1

24
Q

ADE’s of Mecasermin?

A

hypoglycemia - consumption of a snack or meal shortly before dose

tonsillar/adenoidal hypertrophy, lymphoid hypertrophy

coarsening facial features

anaphylaxis and arthralgia

25
Q

agents used to tx GH excess

A

dopamine agonists, bromocriptine, cabergoline

antagonists: octreotide, lanreotide, pasireotide, pegvisomant

26
Q

GH-secreting pituitary adenomas result in…

A

acromegaly (adults) and gigantism (children)

27
Q

What is the TOC for pt’s w/acromegaly?

A

pituitary transsphenoidal microsurgery

28
Q

Diagnostic tools: oral glucose tolerance test

A

postprandial hyperglycemia inhibits the secretion of GH for at least 1-2 hrs

oral glucose load expected to suppress GH concentrations but pt’s w/acromegaly will continue to secrete GH during OGTT

29
Q

What serum level can be measured to aid in the diagnosis of acromegaly?

A

serum IGF-1 bc GH stimulates its production

30
Q

Pharmacologic tx options for GH excess

A

dopamine agonists - bromocriptine, cabergoline

somatostatin analogs - more effective than dopamine agonists

GH-receptor antagonist pegvisomant

31
Q

ADE’s assoc. w/dopamine agonists used for acromegaly

A

CNS sxs - ha, dizzy, nervous, fatigue

GI sxs- N/D, abd pain

Respiratory sxs - *thickening of bronchial secretions and nasal congestion

32
Q

Which agents are GH antagonists?

A

somatostatin analogs

ie. Octreotide, lanreotide, pasireotide

33
Q

somatostatin analogs MOA

A

inhibit the release of GH, glucagon, insulin, and gastrin

34
Q

Somatostatin analog uses

Octreotide, lanreotide, pasireotide

A

tx acromegaly and other neuroendocrine tumors

LA forms w/4-6 week duration

35
Q

Somatostatin analog ADE’s

Octreotide, lanreotide, pasireotide

A 
gallstones - inhibition of CCK release
cardiac conduction abnormalities
HTN
abnormalities in glucose metabolism
subclinical hypothyroidism
36
Q

GH antagonist: pegvisomant MOA

A

inhibits IGF-1 production

blocks the physiologic effects of GH on target tissues

37
Q

GH antagonist: pegvisomant use

A

acromegaly in pt’s who have failed to achieve normalization of IGF-1 serum concentrations wother tx

38
Q

GH antagonist: pegvisomant ADE’s

A

*increased liver enzymes
edema
flu-like syndrome
N/D

39
Q

Raloxifene and Tamoxifen

A

Selective estrogen receptor modulator (SERM)

estrogens more potent in IGF-1 reduction than SERMs

40
Q

Which pt’s would you Rx Raloxifene and Tamoxifen?

A

persistent acromegaly in men/womenn who are postmenopausal or who have had breast CA

41
Q

Hyperprolactinemia may be caused by

A

benign prolactin-secreting pituitary tumors aka prolactinomas

various meds - increases the release of prolactin or antagonizes dopamine

42
Q

drug-induced hyperprolactinemia

A

*prolactin stimulators (methyldopa, reserpine, estrogens, TCA’s)

or

*dopamine antagonists (antipsychotics, phenothiazines, metoclopramide, verapamil)

43
Q

What are hyperprolactinemia tx options?

A

clinical obs.
dopamine agonists
radiation therapy
transsphenoidal surgical removal of the tumor

44
Q

What drugs used for hyperprolactinemia tx is more effective than surgery?

A

Dopamine agonists

45
Q

D2-receptor agonists MOA

A

inhibits the release of prolactin

bromocriptine, caergoline

46
Q

Bromocriptine ADE’s

A

*Infertility

CNS sxs (ha, dizzy, fatigue), GI effects (N/D, abd pain)

47
Q

Carbergoline ADE’s

A

mild-to-moderate decreases in BP

48
Q

what is panhypopituitarism?

A

complete or partial loss of pituitary function which involves ant/posterior pituitary

49
Q

T of panhypopituitarism requires…

A

replacement of multiple hormones or life w/constant monitoring

ie. glucocorticoids, thyroid hormone preparations, sex steroids

Pharm II- Exam 1 (6 decks)

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