Hypothalmic and pituitary

Question 1

Corticorelin Ovine Triflutate is what class/type of drug? Why do we give it?

Answer 1

Corticotropin Releasing Hormone (CRH)

Diagnostic drug to diff between Cushings and Ectopic production of ACTH

Question 2

Gonadorelin, Goserelin, Leuprolide, Naferalin, Histrelin, and Triptorelin are all what class/type of drug? What are they generally used for?

Answer 2

GnRH/LHRH agents (-elin and one lide)

Prostate cancer : Goserelin and Leuprolide continuous

Endometriosis : Goserelin, Leuprolide and Naferelin Acetate continous x 6 months

Central Precocious Puberty: Naferalin continous

Question 3

Ganirelix, Cetrorelix and Degarelix are what class/type of drug, what do they do?

Answer 3

GnRH receptor ANTAGONIST (-relix)

Inhibit LH surge in ovarian hyperstim procedure : Gani and Cetro

Advanced prostate cancer: Degarelix

Question 4

Octreotide and Lanreotide are what class/type of drug, what do they do?

Answer 4

GHIH (Somatostatin, -otide)

Acromegaly /VIP secratory diarrhea/Esophageal varices bleed : Octreotide

Acromegaly only : Lanreotide

Question 5

Pegvisomant is what class/type of drug, what do they do?

Answer 5

Gh Receptor ANTAGONIST

Treat Acromegaly that is resistant to/ unable to tolerate other treatments

Question 6

Somatropin is what class/type of drug, what do they do?

Answer 6

Growth hormone

Tx:
(Kids) Growth failure, Growth failure due to CHronic Renal Inssuff, Prader-Willi syndrome

(Adults) HIV w/ wasting, Gh deficiency, Short BOWEL syndrome

Question 7

Thyrotropin Alfa is what class/type of drug, what do they do?

Answer 7

Thyroid stimulating hormone

Diagnostic: detect blood levels of thyroglobulin to exclude diagnosis of thyroid CANCER following thyroidectomy.

Question 8

Corsyntropin is what class/type of drug, what do they do?

Answer 8

Adrenocorticotropic hormone (ACTH)

Diagnostic: Diff b/t primary adrenal insuff (Addisons) ad secondary

Question 9

Follitropin alfa and beta, urofollitropin and Lutropin alfa are what class/type of drug, what do they do?

Answer 9

FSH/LH

Induce ovulation and Male infertility (FSH)

Question 10

Bromocriptine and Cabergoline are what class/type of drug, what do they do?

Answer 10

Dopamine (D2) Agonists

Tx: Hyperprolactinemia, Prolactin secreting Adenoma, Acromegaly**

Question 11

Vasopressin and Desmopressin are what class/type of drug, what do they do?

Answer 11

Anti-Diuretic Hormone

Vaso: Used to treat diabetus insipidus but no more

Vaso Tx: Esophageal varices and Vasodilatory shock

Desmo: Diabetes Insipidus, Polyuria and Dipsia surg and head trauma, *Control bleed in von Willebrands, Bed wetting

Question 12

Conivaptan and Tolvaptan are what class/type of drug, what do they do?

Answer 12

Vasopressin ANTAGONIST

Con V1a and V2, Tol V2»V1

Conivaptan: Raise serum Na in HOSPITALIZED pts. ** NO HEART FAILURE

Tolvaptan: Hypervolemic and Euvolemic Hyponatremia *** Including Pts w/ HEART FAILURE and SIADH

Question 13

Oxytocin is what class/type of drug, what do they do?

Answer 13

Oxytocin

Stimulate lactaion
Induce labor
Postpartum bleeding

Question 14

Both GnRH/LHRH analogs and GnRH antagonist can be used to treat LH surges in women undergoing controlled ovarian hyperstim procedure and advanced prostate cancer. Why might GnRH antagonists be a better idea?

Answer 14

Agonists lower hormone levels by “flooding” the target receptors influencing negative feedback. This results in:

Initial stimulation of LH and Testosterone

Clinical “flare” due to initial surge

Temporary PSA rise.

**Antagonists are complete and immediate

Question 15

Preferred treatment for Acromegaly if due to tumor is what? When would we use pharm tx?

Answer 15

Surgical resection

If

1. Control BEFORE surgery
2. surgery not possible
3. Surgical failure/relapse

Question 16

If someone is taking Bromocriptine and they complain of bad nausea, what drug can you switch them to?

Answer 16

Carbergoline

Question 17

Treating what condition requires weighing the risk of inducing Central Pontine Myelinolysis (CPM)? What drugs carry this black box warning?

Answer 17

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Vassopressin - 2 receptor Antagonists - Conivaptan and Tolvaptan

Question 18

When raising serum sodium in SIADH patients, what numbers guide how we raise it? How fast, how slow?

Answer 18

Raise serum sodium by 0.5-1 mEq/hr
NO MORE THAN 10-12 mEq in first 24hrs.
Max - 125-130 mEq/L

Question 19

What are our four treatment options for SIADH in the EMERGENCY setting?

Answer 19

3% hypertonic saline (513)
Loop diuretics w/ saline
Vasopressin-2 receptor antagonist
Water restriction

Question 20

What are our two treatment options for SIADH in the chronic asymptomatic setting?

Answer 20

Vasopressin-2 receptor antagonist (if unavailable, use diuretic)
Fluid restriction.

Question 21

Metoclopramide is what type of drug. What is its important off label use? Why are we concerned about it?

Answer 21

Dopamine antagonist

Stimulate lactation

CNS effects in infants

Question 22

What will a Hyperprolactinemia patient present with? What drugs can we use to treat this?

Answer 22

Men - Erectile Dysfunction, decreased libido, Gyno, reduced muscle

Women - Amenorrhea, Anovulation, Infertility, Hirsutism, and acne

Both: ** Headache and Visual disturbances

Drugs: Dopamine agonists - Bromocriptine and Cabergoline