Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm: Endocrine and Derm > Hypothalamus, Pituitary, and Thyroid Meds > Flashcards

Hypothalamus, Pituitary, and Thyroid Meds Flashcards

1
Q

Clinical Uses of Gonadotropin Replacement

A

Controlled ovarian stimulation

Induced follicle development and ovulation

Stimulate spermatogenesis in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LH & FSH replacement Drug and MOA

A

Menotropins (hMG) (Menopur ®; Repronex ®)

actions occur as a result of both FSH and LH

In females: timulates the development and maturation of the ovarian follicle (FSH), cause ovulation (LH), and stimulate the development of the corpus luteum (LH)
In males: it stimulates spermatogenesis (LH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

FSH Replacement Drug

A

Follitropin alfa (Gonal-f ®); beta (Follistim®)

Urofollitropin (uFSH) (Bravelle ®)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

LH Replacement Drug

A

Lutropin alfa (Luveris ®)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

hCG Replacement Drug

A

Choriogonadotropin alfa (rhCG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Uses of Menotropins in Females with HCG

A

Induce ovulation in patients with functional oligoanovulation or anovulation

Stimulation of multiple follicle development in ovulatory patients as part of an assisted reproductive technology (ART)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Uses of Menotropins in Males (off-label)

A

Stimulation of spermatogenesis in primary or secondary hypogonadotropic hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Use of Urofollitropin (Bravelle) and MOA

A

Highly purified human FSH extracted from the urine of postmenopausal women

LH activity is removed

Stimulates ovarian follicular growth in women who do not have primary ovarian failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Follitropin alfa (Gonal-f ®) and Follitropin beta (Follistim®) Uses and MOA

A

Recombinant FSH; identical to human FSH

Shorter half-life but equal or more efficient estrogen secretion

Stimulate ovarian follicular growth in women who do not have primary ovarian failure, and stimulate spermatogenesis in men with hypogonadotrophic hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lutropin Alfa (Luveris) Use and MOA

A

Recombinant LH

Administration leads to increased follicular estradiol secretion needed for follicle stimulating hormone induced follicular development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Choriogonadotropin alfa (rhCG) Use and MOA

A

Induces ovulation and pregnancy in anovulatory, infertile females; treatment of hypogonadotropic hypogonadism, prepubertal cryptorchidism; spermatogenesis induction with follitropin alfa

Stimulates production of gonadal steroid hormones by causing production of androgen by testes; as a substitute for LH to stimulate ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Gonadtropins ADE

A

HA, depression, edema, precocious puberty, hCG antibody production (rare)
Commonly Reversible, uncomplicated ovarian enlargement
Gynecomastia in men

Serious: Multiple pregnancies,
Increased risk of gestational diabetes, preeclampsia, preterm labor.
Ovarian hyperstimulation syndrome (OHSS)
0.5-4%
Ovarian enlargement, ascites, hydrothorax, hypovolemia, fever, arterial thromboembolism, sometimes resulting in shock – can be fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GnRH Agonist Names

A 
Gonadorelin
Goserelin
Histrelin
Leuprolide
Nafarelin
Triptorelin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GnRH Agonists MOA

A

Regulates FSH, LH release from anterior pituitary:
Pulsatile release stimulates FSH, LH release; promotes ovulation
or
Continuous (non-pulsatile) release inhibits FSH, LH release; used to treat hormone sensitive cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

GnRH Agonist Pulsatile Stimulation Use and Administration

A

Female infertility:
Induces LH surge in women undergoing ovulation induction with gonadotropins
Portable IV pump delivers pulse every 90 minutes
Less likely to cause multiple pregnancies

Male infertility:
IV as above
Regular serum testosterone levels, semen analyses needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

GnRH Agonist Continuous Suppression Use

A

Prostate cancer:
GnRH and a androgen receptor antagonist reduces serum testosterone
Reach hypogonadal levels within 2 weeks

Blocks LH surge that could prematurely trigger ovulation during controlled ovarian hyperstimulation in IVF protocols

Endometriosis:
Estrogen-sensitive endometrium-like tissue outside the uterus
Blocks cyclical changes in estrogen/progesterone resulting in abdominal pain

Uterine benign fibroids:
Estrogen-sensitive fibroids cause menorrhagia with associated anemia and pelvic pain

Central precocious puberty:
Onset of secondary sex characteristics before age 8 in girls, age 9 in boys

Other uses:
Advanced ovarian and breast cancer, thinning of endometrial lining, amenorrhea and infertility in women with PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is Endotmetriosis GnRH agonist treatment limited to 6 months?

A

Treatment beyond this length of time can result in reduced bone density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GnRH Antagonist Uses

A

Suppression of gonadotropin production:
Prevents LH surge which may trigger early egg release

Advanced prostate cancer:
Abarelix
When GnRH agonist not tolerated
Avoids testosterone surge seen with GnRH agonist

Usually well tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GnRH Antagonist MOA and drugs

A

Inhibits FSH and LH release

Available agents: Ganirelix, cetrotelix, abarelix, degarelix

20
Q

Hypoprolactinemia Replacement Drugs

A

Replacement drugs unavailable

21
Q

Hyperprolactinemia Drug MOA

A

PRL release inhibited by dopamine agonists

Dopamine (DA) D2 receptor agonists stimulate the DA receptor -> replace endogenous DA -> inhibits PRL release from the anterior pituitary

22
Q

Hyperprolactinemia Drugs

A

Bromocriptine (Parlodel ®), cabergoline (Dostinex ®) - these are Dopamine agonists

23
Q

Dopamine Agonists ADE

A

Common: nausea, HA, dizziness, orthostatic hypotension, fatigue
(Cabergoline and/or vaginal administration less nausea)

Psychiatric manifestations: nervousness/anxiert

Pulmonary infiltrates and fibrosis with chronic high-dose

24
Q

GH Replacement Drugs

A

Nine GH products in the US, we focused on:
Somatrem (Protropin ®)
Somatropin

25
Q

GH Toxicity

A

Generally well tolerated

Hyperthyroidism, pancreatitis, gynecomastia

26
Q

GH Contraindications

A

Adults (DO NOT USE ONCE GROWTH PLATES HAVE CLOSED)

Known Malignancy

May increase mortality in critically ill patients

27
Q

Treatment for growth retardation resistant to GH

A

IGF-1 (Mecasermin), approved for IGF-1 deficiency not responsive to recombinant GH

28
Q

IGF-1 Replacement ADE

A

Most common: hypoglycemia – administer 20 minutes after snack or meal

Intracranial hypertension

Asymptomatic liver enzyme elevation

29
Q

IGF-1 must be administered with what?

A

IGFBP, because IGF-1 and IGFBP-1 release are stimulated by GH

30
Q

GH Overproduction 1st Line Treatment

A

1st Line treatment: transsphenoidal surgical resection of the GH-secreting adenoma. Octreotide (synthetic somatostatin analogue) given prior to surgery to reduce tumor size
(Cure rate 50-90%)

31
Q

GH Overproduction 2nd Line Treatment

A

2nd Line: Radiation therapy
poor surgical candidates and non-responders to previous surgery
Delayed therapeutic effects

32
Q

GH Overproduction 3rd Line Treatment Should be Used when?

A

Symptomatic control
Indication with meds if
surgery and irradiation are contraindicated
Rapid control of symptoms needed
Treatment failure with other agents to normalize GH and IGF-1 concentrations

33
Q

GH reduction meds

A

Somatostatin analogs:
Octreotide (Sandostatin ®)
Lantreotide (Somatuline ®)

Dopamine receptor agonists:
Bromocriptine (Cycloset ®; Parlodel ®)
Cabergoline
Lisuride

(Last Resort Drug) GH receptor antagonist: Pegvisomant (Somavert)

34
Q

Somatostatin Analogue MOA

A

Octreotide (Sandostatin ®) and Lantreotide (Somatuline ®)

Long acting analog
45x more potent than somatostatin at inhibiting GH release

Suppresses [GH] < 5 mcg/L and normalizes [IGF-1] in 50-60% of acromegaly patients

Only 2x as potent in reducing insulin secretion
Hyperglycemias rare

35
Q

Somatostatin Analogues Indications

A

Reduces symptoms due to hormone secreting tumors

Bleeding from esophageal varices

Radiolabeled octreotide to localize neuroendocrine tumors with somatostatin receptors
(May aid to predict response to octreotide therapy)

Lantreotide (Somatuline ®)- approved to treat acromegaly butmed not commonly used.

36
Q

Somatostatin Analogues ADE

A

GI (most common): N/V, abdominal cramps, flatulence, steatorrhea (fatty stools), malabsortion of fat

Sinus Bradycardia (25%)

Biliary sludging

Gall stones in 20-30% after 6 months (1% yearly incidence)

Endocrine system: hypothyroidism, abnormalities in glucose metabolism (keep an eye on blood sugar)

37
Q

GH Receptor Antagonists ADE

A

Generally well-tolerated

Injection-site pain, nausea, diarrhea, and flu-like symptoms

Significant but reversible LFT elevations (<1%)

38
Q

Oxytocin (Pitocin ®) Uses

A

Labor induction and augmentation

Postpartum uterine bleeding

39
Q

Oxytocin (Pitocin ®) ADE

A

Rare with judicious use

Excessive uterine contractions

  • Fetal distress, placental abruption, uterine rupture
  • Maternal and fetal monitoring can detect early

Vasopressin receptor activation

  • Fluid retention/water intoxication
  • Hyponatremia, heart failure, seizures, death (due to the seizures and hyponatremia)
40
Q

Oxytocin (Pitocin ®) Contraindications

A

Fetal distress, abnormal fetal presentation or other predispositions to uterine rupture

41
Q

Vasopressin Analog Drug and Pharmacokinetics

A

Desmopressin (DDAVP; Stimate ®)

Minimal V1 (vasoconstriction and BP elevation) activity. 
4000x greater antidiuretic effect compared to ADH

Long-acting
Half-life: 1.5-2.5 hours (ADH = 15 min)

Multiple dosage formulations
Oral, IV, SC, intranasal

42
Q

Vasopressin Uses

A

Pituitary diabetes insipidus (ADH deficiency treatment of choice)- reduces polyuria, polydipsia, hypernatremia

Nocturnal bedwetting (MC, in her experience)

Given IV ->Treat bleeding due to:
Esophageal variceal
Conlonic diverticula

Coagulopathies:
Hemophillia A and
von Willebrand’s disease

43
Q

Vasopressin ADE

A

Rare: HA, nausea, abdominal cramps, agitation, allergic reactions

Hyponatremia, seizures in overdose

Vasoconstriction -use caution in coronary artery disease (CAD)

DDAVP nasal insufflation less effective in nasal congestion, otherwise this form is pretty harmless

44
Q

Vasopressin Antagonist Drugs and Use:

A

Therapeutic agents available:
Conivaptan (Vaprisol ®)
Effects on V1a and V2 receptors

Tolvaptan (Samsca ®)
V2 > V1

USE:
Treatment of hyponatremia (not a drug for first choice for this b/c could use a cheap hypertonic solution), acute heart failure

45
Q

Vasopressin Receptor Effects

A

V1  Vasoconstriction and blood pressure elevation

V2 Renal -> Reduced diuresis (water retention)

V2 Extra Renal -> Regulate coagulation factor VIII, von Willebrand factor

Pharm: Endocrine and Derm (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions