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🄼💊MSY2 Pharm (Endocrine/Repro/Thyroid) > Hypothalamus / Pituitary > Flashcards

Hypothalamus / Pituitary Flashcards

1
Q

Long loop negative feedback

A

1° Hormone inhibits Pituitary and/or Hypothalamus

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2
Q

short loop negative feedback

A

2° Hormone inhibits Hypothalamus

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3
Q

ultra short loop negative feedback

A

3° Hormone inhibits Hypothalamus

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4
Q

Which pituitary hormones function through [G protein coupled receptors] (4)

A

FAT Lacy was a G!

TSH, ACTH, FSH, LH

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5
Q

Which pitutiary hormones function through [JAK/STAT receptors] (2)

A

GH and Prolactin

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6
Q

Physiological action of GH in children (5)

A

Linear Growth of

  • long bones
  • cartilage
  • muscle
  • organ systems

+ [Blood Glucose promoter]

primary determinant of adolescent growth spurt

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7
Q

Physiological Action of GH in Adults (3)

A
  1. Catabolic for Fat
  2. Anabolic for Muscle & Bone
  3. Blood Glucose Promoter (INC Blood Glucose)
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8
Q

When are GH pulses generated

A

During sleep

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9
Q

Mechanism of GH pulsation

A

Interplay of GHRH and Somatostatin

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10
Q

GH tends to ____[DEC/INC] with age

A

DEC

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11
Q

Effects of GH are mostly mediated by _____, which is released from the ____ in response to ___

A

Effects of GH are mostly mediated by IGF1, which is released from the liver in response to GH

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12
Q

In addition to Musculoskeletal changes, what other changes occur in Adults with GH deficiency (3)

A
  • Hyperlipidemia
  • Cardiac Muscle Atrophy
  • [Fatigue / Depression / Malaise]
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13
Q

Adult onset GH deficiency is typically due to what?

A

Pituitary problem

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14
Q

Drugs for GH deficiency (4)

A

Sermorelin

Somatropin

Somatrem

Mecasermin

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15
Q

Name a Synthetic GHRH

A

Sermorelin

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16
Q

Somatropin Drug Class

A

Recombinant Human GH

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17
Q

Name 2 [Recombinant Human GH]

A
  1. Somatropin
  2. Somatrem
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18
Q

Mecasermin Drug Class

A

Recombinant IGF1

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19
Q

Sermorelin Indication

A

Defective hypothalamic GHRH release

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20
Q

Somatropin Indication (5)

A

SPAWN

  1. Pediatric growth failure (associated w/GH/chronic Renal Failure/Prader Willi/Turner)
  2. No idea: Idiopathic short stature (>2.25 SD below mean height)
  3. Adult GH deficiency
  4. Wasting in AIDS pts
  5. Short Bowel Syndrome in pts receiving nutritional support (it INC SA for digestion)
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21
Q

Somatrem Indication (5)

A

SPAWN

  1. Pediatric growth failure (associated w/GH/chronic Renal Failure/Prader Willi/Turner)
  2. No idea: Idiopathic short stature (>2.25 SD below mean height)
  3. Adult GH deficiency
  4. Wasting in AIDS pts
  5. Short Bowel Syndrome in pts receiving nutritional support (it INC SA for digestion)
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22
Q

Structure of Somatropin

A

Synthetic GH identical to native hGH

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23
Q

Structure of Somatrem

A

Synthetic GH that contains an extra methionine at N-terminus –> INC stability and less hypersensitivity

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24
Q

Somatropin SE (5)

A
  1. Leukemia (rapid melanocytic lesions)
  2. hypOthyroidism
  3. Insulin Resistance
  4. Arthralgia
  5. INC Cytochrome P450
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25
Q

Somatrem SE (5)

A
  1. Leukemia (rapid melanocytic lesions)
  2. hypOthyroidism
  3. Insulin Resistance
  4. Arthralgia
  5. INC Cytochrome P450
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26
Q

Somatropin Contraindications (4)

A
  • Pedatrics with closed epiphyses
  • Active intracranial lesion
  • Malignancy
  • Diabetic Retinopathy
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27
Q

Somatrem Contraindications (4)

A
  • Pedatrics with closed epiphyses
  • Active intracranial lesion
  • Malignancy
  • Diabetic Retinopathy
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28
Q

Mecasermin Indication

A

Pediatric IGF1 deficiency from [Laron GH receptor Dwarfism] vs. [Ab against GH]

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29
Q

Tx for GH microadenoma (3)

A
  1. Octreotide/Lantreotide
  2. Pegvisomant
  3. Bromocriptine

MACROAdenomas are surgically removed

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30
Q

Octreotide [Drug Class and MOA]

A

Somatostatin Analogue (45x more potent and long lasting) –> blocks GH secretion

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31
Q

Why isn’t somatostatin used clinically?

A

short half-life

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32
Q

Octreotide Indications (4)

A
  • Pitutiary microadenoma
  • Carcinoid Crisis (flushing/diarrhea/Cyanosis)
  • Secretory Diarrhea 2° to VIP tumors
  • Acute GI Bleeding
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33
Q

Octreotide SE (4)

A

“8 sums Can Be Hairy & Gross”

  • GI sx (NV / GI discomfort)
  • Bradycardia & Conduction problems
  • hypOglycemia
  • Cholelithiasis
34
Q

Octreotide Contrainidcations

A

Hypersensitivity

35
Q

Pegvisomant [Drug Class and MOA]

A

[GH R Blocker] and does not appropriately bind to second GH receptor –> Blocks dimerization and signal transduction –> DEC IGF1

36
Q

PEGvisomant Structure

A

Recombinant with [multiple PEG (PolyEthylene Glycol)] residues –> prolongs half life

37
Q

Pegvisomant Indications (2)

A

Refractory Acromegaly

Pituitary microadenoma

38
Q

Pegvisomant SE (2)

A
  • INC Pitutiary Adenoma Size (pts being treated with Pegvisomant should have yearly MRI to exclude enlarging adenoma)
  • INC Aminotransferase levels
39
Q

Pegvisomant Contraindication

A

Hypersensitivity

40
Q

Successful tx of infertility due to neuroendocrine factors depends on _____

A

Competent Gonads

41
Q

Source of Menotrophins (FSH & LH)

A

Urine of Menopausal Women

42
Q

Source of Urofollitrophin

A

Urine of PostMenopausal Women

43
Q

Name the Gonadotropins (4) and what their MOA is

A

Replaces FSH and LH

  • Menotrophins (FSH and LH)
  • hCG
  • Urofollitropin (FSH from menopausal women urine)
  • Follitropin
44
Q

Gonadotropins Indication (3)

A
  1. Ovulation in [women with hypOgonadotropic hypOgonadism] vs. IVF
  2. PCOS/Obesity
  3. Infertility in [Men with hypogonadotropic hypOgonadism]
45
Q

Gonadotropin SE (4)

A
  • Ovarian hyperstimulation syndrome (ovarian enlargement/Ascities/Hydrothorax/Shock)
  • Multiple Pregnancies
  • Gynecomastia
  • [Ovarian CA / cyst / Hypertrophy]
46
Q

Gonadotropin Contraindications (5)

A
  • Use in any endocrine DO other than anovulation
  • 1° gonadal failure
  • [Pituitary vs. Sex-hormone dependent] Tumors
  • [Ovarian CA/Cyst/Hypertrophy]
  • Pregnancy
47
Q

How does GnRH or [short half life GnRH analog] affect gonadal axis

A

Stimulates Gonadtroph cells to make/secrete LH & FSH

48
Q

Gonadorelin SE (4)

A

Anaphylaxis with multiple administration

Lightheadedness

Flushing

Generalized Hypersensitivity Dermatitis

49
Q

List [long half life/HIGH potency] GnRH analogs (5)

A

Go Learn Hx N’ Trip

Goserelin

Leuprolide

Histerelin

Nafarelin

Triptorelin

3 hour Half life

50
Q

[GnRH analog] MOA

A

Desensitizes GnRH receptors and inhibits FSH and LH release

(i.e. Leuprolide, Triptorelin)

51
Q

Biphasic Effect of [GnRH analogs]

A

1st: Flare = Transient (7-10 days) INC in gonadal hormone levels from agonist effect
2nd: Long-lasting suppresion of Gonadotropins and gonadal hormones from inhibition

52
Q

Triptorelin Indication

A

[Androgen dependent Prostate CA] adjunct

53
Q

Histerelin Indication

A

[Androgen dependent Prostate CA] adjunct

54
Q

Goserelin Indication (2)

A
  1. [Androgen dependent Prostate CA] adjunct
  2. Endometriosis & Uterine Fibroids
55
Q

Nafarelin Indication (3)

A
  1. Endometriosis & Uterine Fibroids
  2. Central Precocious Puberty
  3. Keeps LH surge low –> multiple mature oocytes for reproductive technology
56
Q

Leuprolide Indication (4)

A
  1. Endometriosis & Uterine Fibroids
  2. Central Precocious Puberty
  3. Keeps LH surge low –> multiple mature oocytes for reproductive technology
  4. [Androgen dependent Prostate CA] adjunct
57
Q

[GnRH synthetic analogs] general indication (4)

A

Advanced Breast CA

Advanced Ovarian CA

Amenorrhea

Infertility in Women with PCOS

58
Q

[GnRH synthetic analog] SE (4)

A
  • [Hot flashes/sweats/HA]
  • Osteoporosis
  • Urogenital atrophy
  • Exacerbation of Precocious Puberty during inital weeks
59
Q

[GnRH synthetic analog] Contraindications (3)

A
  • Hypersensitivity
  • Pregnancy
  • Breast Feeding
60
Q

List the [GnRH R Blockers] (3)

A

“Don’t Block me from getting my Rolex”

  1. Ganirelix
  2. Cetrorelix
  3. Abarelix

These are Dose-Dependent

61
Q

How is administration between [GnRH synthetic analogs] and [GnRH R Blockers] different (2)

A
  1. [GnRH R Blockers] produce immediate Blocking effect = Duration of Admin is shorter during IVF
  2. [GnRH R Blockers] don’t produce Flare Effect
62
Q

Ganirelix Indication

A

Keeps LH surge low in IVF –> Improved implantation/pregnancy

63
Q

Cetrorelix Indication

A

Keeps LH surge low in IVF –> Improved implantation/pregnancy

64
Q

Abarelix Indication (2)

A
  1. Metastatic Prostate CA (PEE)
  2. Tumor encroaching Spinal Cord (NERVES)

Abby has no PEE NERVES!

65
Q

Cetrorelix SE (2)

A
  1. Ovarian Hyperstimulation Syndrome
  2. Anaphylaxis
66
Q

Abarelix SE (2)

A
  1. Ovarian Hyperstimulation Syndrome
  2. QT prolongation

A for Arrhythmia

67
Q

Ganirelix SE (4)

A
  1. Ovarian Hyperstimulation Syndrome
  2. Ectopic Pregnancy
  3. Thrombotic DO
  4. Spontaneous Abortion
68
Q

[Ganirelix, Cetrorelix, Abarelix] Contraindications (6)

A

” Don’t PLOT to kill the VP with a rolex”

  1. Pregnancy
  2. Lactation
  3. [Ovarian cyst/enlargement not from PCOS]
  4. Thyroid/Adrenal dysfunction
  5. Vaginal Bleeding that’s idiopathic
  6. Primary Ovarian Failure
69
Q

Drugs given during [Follicular Proliferative Phase] during IVF (2)

A
  • Gonadotropin injection is given 3 days after menses to develop Follicles.
  • [GnRH analogs or GnRH Blockers] are given to prevent premature LH
70
Q

Drug Given when transitioning into [Luteal Secretory Phase] during IVF.

How do you know mensturation is transitioning into [Luteal Secretory phase]

A

hCG injection is given when [oocyte follicles are mature] (assesed with serum estrogen & US) –> Ovulation

71
Q

Physiologic Actions of Prolactin (3)

A
  1. Mammogenesis
  2. Milk production and secretion
  3. Suppresses Ovulation by inhibiting GnRH release
72
Q

Most common cause of Hyperprolactinemia

A

Prolactinoma

73
Q

Hyperprolactinemia Tx and why (3)

A
  1. Bromocriptine
  2. Cabergoline
  3. Pergolide

These are [D2 Dopamine Agonist]

74
Q

Prolactin Deficiency Tx

A

None

75
Q

Bromocriptine Indication (5)

A
  1. Pituitary Prolactinoma
  2. PMS
  3. Acromegaly (Use High Doses and only if tumor secretes both Prolactin & GH)
  4. Parkinson’s Dz
  5. Type2DM
76
Q

Pergolide Indication

A

Parkinson’s Dz

77
Q

Cabergoline Indication (3)

A
  1. Pituitary Prolactinoma
  2. PMS
  3. Parkinson’s Dz
78
Q

Bromocriptine SE (3)

A
  1. Orthostatic hypOtension
  2. Vascular Dz (CVA vs. MI)
  3. Seizure
79
Q

Cabergoline SE (3)

A
  1. Orthostatic hypOtension
  2. Pulmonary Fibrosis
  3. Pleural Effusion
80
Q

Pergolide SE (2)

A
  1. Orthostatic hypOtension
  2. Heart Vascular Dz (Arrhythmia/MI/HF)
81
Q

[Bromocriptine, Cabergoline, Pergolide] Contraindications (3)

A
  • Ergot Derivative Hypersensitivity
  • Uncontrolled HTN
  • Pregnancy Toxemia

🄼💊MSY2 Pharm (Endocrine/Repro/Thyroid) (6 decks)

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