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PHARMACOLOGY > Introduction to Endocrinology: The Hypothalamic-Pituitary Axis > Flashcards

Introduction to Endocrinology: The Hypothalamic-Pituitary Axis Flashcards

1
Q

Anterior lobe (adenohypophysis) consists of:

A

Pars distalis
Pars tuberalis
Pars intermedia

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2
Q

Consists of pars nervosa which is connected by infundibulum
(pituitary stalk) to the median eminence (tuber cinereum) of
hypothalamus.

A

Posterior lobe (neurohypophysis)

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3
Q

Somatostatin: ____ growth hormone

A

Decrease

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4
Q

Somatostatin: _____ TSH

A

Decrease

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5
Q

Dopamine: ___ prolactin

A

Decrease

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6
Q

Thyrotropin-releasing hormone: ___ prolactin

A

Increase

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7
Q

Gonadtropin-releasing hormone: ___ FSH

A

Increase

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8
Q

Gonadtropin-releasing hormone: ___ LH

A

Increase

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9
Q

Acidophilic hormones:

A

Somatotropes

Mammotropes

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10
Q

Basophilic hormones:

A

Thyrotropes
Gonadotropes
Corticotropes

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11
Q

single polypeptide chain of 22 kDa; w/ 2 disulfide

bonds, not glycosylated

A

Growth hormone

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12
Q

Growth hormone gene resides on the long arm of __________.

A

chromosome 17

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13
Q

Most abundant ant. pituitary hormone

A

GH

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14
Q

Increased secretion in children

A

GH

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15
Q

greatest at night shortly after onset of deep sleep

A

GH

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16
Q

GH stimulus

A

Main GHRH and ghrelin

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17
Q

Minor stimulus of GH:

A 
DA
5HT
a2 receptor agonists
Hypoglycemia
Exercise
Stress
Emotional excitement
Ingestion of protein-rich meals
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18
Q

Major peripheral effector of GH

A

IGF-1

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19
Q

GH suppressors

A

IGF-1 (from peripheral tissues)
Somatostatin (from hypothalamus)
GH levels (from anterior pituitary)

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20
Q

Stimulates longitudinal growth of bones

A

GH

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21
Q

increase bone mineral density

A

GH

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22
Q

myeloblast differentiation & increased mm mass

A

GH

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23
Q

Increases GFR

A

GH

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24
Q

preadipocytes to adipocyte differentiation

A

GH

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25
Q

GH ____ glucose utilization

A

Decrease

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26
Q

GH ____ lipolysis

A

Increase

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27
Q

Anti-insulin action

A

GH

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28
Q

Induction of insulin-like growth factor (IGF-1)

A

GH

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29
Q

Height diagnosis of GH deficiency

A

> 2 to 2.5 SD below normal

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30
Q

“provocative testing”

A

<10ng/ml

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31
Q

severe deficiency

A

<5 ng/mL

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32
Q

Human GH by recombinant DNA Technology

A

Somatotropin

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33
Q

Somatotropin dosage in children

A

25-50ug/kg/day SQ in the evening

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34
Q

Somatotropin dosage in adults

A

150-300 ug/d

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35
Q

used to monitor initial response

& compliance

A

Normalization of serum IGF-1 levels

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36
Q

Long term monitoring

A

Evaluation of height

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37
Q

Increase in growth velocity occurs w/in the ______ of therapy

A

first 2 yrs

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38
Q

Continued until closure of ________

A

epiphysis

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39
Q

Somatostatin pharmacokinetics

A

70% bioavailability

Once daily dosing

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40
Q

For adults

A

Normalization of GH levels

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41
Q

________ inhibit GH action so that a
larger dose of GH is needed to maintain the same
IGF-1 level

A

Estrogens (e.g., birth control medications and

estrogen supplements)

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42
Q

Recombinant Human IGF-1

A

Mecasermin

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43
Q

For patients with impaired growth secondary to mutations

in the GHR or postreceptor signaling pathway

A

Mecasermin

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44
Q

patients who develop antibodies against GH that interfere

with its action

A

Mecasermin

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45
Q

patients with IGF-1 gene defects that lead to primary IGF-1

deficiency

A

Mecasermin

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46
Q

Less effective than recombinant GH for impaired growth
secondary to GH deficiency or with idiopathic short
stature

A

Mecasermin

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47
Q

Dose of mecasermin

A

40 to 80 ug/kg SQ twice daily

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48
Q

Max dose of mecasermin

A

120 ug/kg/dose BID

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49
Q

Adverse effects of Mecasermin:

A

Hypoglycemia
Lipodystrophy
Lymphoid tissue hypertrophy

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50
Q

Contraindications of mecasermin:

A

Closed epiphysis

Active or suspected neoplasia

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51
Q

synthetic human GHRH

A

Tesamorelin

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52
Q

increases GH and IGF-1 levels

A

Tesamorelin

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53
Q

its clinical effects are primarily to reduce visceral fat

accumulation, with minimal effects on insulin resistance

A

Tesamorelin

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54
Q

FDA-approved for treatment of HIV-associated lipodystrophy

but not for GH deficiency

A

Tesamorelin

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55
Q

If epiphyses are unfused

A

Gigantism

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56
Q

In adults (epiphyses have fused)

A

Acromegaly

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57
Q

Gold standard of growth hormone excess

A

Oral glucose tolerance test

58
Q

Normal response

A

Suppression of GH level to <1 ng/mL

59
Q

fail to suppress GH level or + paradoxical increase in GH

level

A

acromegaly

60
Q

Octreotide (Sandostatin) dosage

A

100 ug SQ TID

61
Q

Octreotide (Sandostatin) bioavailability

A

100%

62
Q

Octreotide (Sandostatin) peak effect

A

30 mins

63
Q

Octreotide (Sandostatin) half life

A

90 mins

64
Q

Octreotide (Sandostatin) Duration of action

A

12 hours

65
Q

Octreotide (Sandostatin) LAR

A

10
20
30 mg
once every 4 weels

66
Q

efficacy similar to Octreotide LAR

A

Lanreotide (Somatuline LA)

67
Q

binds to multiple SST receptors; better than O and L

A

Pasireotide

68
Q

Goal of treament of Pasireotide:

A

Decrease GH levels to <2.5 ng/mL after OGTT or normal IGF-1 level

69
Q

more problem with glucose tolerance

A

Pasireotide

70
Q

Somatostatin analogs

A

Octreotide
Lanreotide
Pasireotide

71
Q

a recombinant pegylated variant of

human GH

A

Pegvisomant

72
Q

For Acromegaly

A

Pegvisomant

73
Q

Pegvisomant dosage

A

40mg SQ loading dose then 10mg/day

74
Q

Not to be used in pts w/ liver dse

A

Pegvisomant

75
Q

Lipohypertrophy at injection sites

A

Pegvisomant

76
Q

May increase growth of GH secreting adenomas

A

Pegvisomant

77
Q

for pts who do not respond to SST analogues or given

as adjunct

A

Pegvisomant

78
Q

23,000-dalton protein of 199 AA w/ 3 intramolecular di-sulfide
bonds

A

prolactin

79
Q

the synthesis and secretion starts on the _____ week of gestation.

A

5th

80
Q

Caused by prolactin secreting pit. Adenoma (Prolactinomas)

A

Hyperprolactinemia

81
Q

suppress prolactin
production by activation of D2 dopamine receptors: also ↓ the
size of the tumor (TOC for most patients)

A

Dopamine receptor agonist

82
Q

Dopamine receptor agonists:

A
  1. Bromocriptine (Parlodel)
  2. Carbegoline (Dostinex)
  3. Quinagolide (Norpralac)
83
Q

more potent than Bromocriptine

A

Carbegoline (Dostinex)

84
Q 
Activates D2 (Dopamine) receptors to inhibit spontaneous & 
TRH-induced release of prolactin
A

Bromocriptine (Parlodel)

85
Q

Normalizes prolactin level (70 to 80%)

A

Bromocriptine (Parlodel)

86
Q

Decrease tumor size in >50% of pts

A

Bromocriptine (Parlodel)

87
Q

To avoid side effects of bromocriptine: Start at low dose (______) at bedtime; after
1 week increase to ____ daily: gradually increase every _______
up to ________ or until prolactin becomes normal

A

1.25mg
2x
3 to 7 days
5 mg 2x daily

88
Q

Bromocriptine at higher concentrations:

A

Treatment of acromegaly and parkinsons disease

89
Q

Safe to use in pregnancy

A

Bromocriptine

90
Q

Longer half-life, higher affinity and greater selectivity to D2
receptors

A

Carbegoline

91
Q

Preferred drug for Hyperprolactinemia (greater efficacy and lower adverse effects)

A

Carbegoline

92
Q

Carbegoline dose:

A
  1. 25 mg 2x a week
  2. 5 mg once a week

May increase once every 4 weeks

93
Q

Doses of ______ or less normalize PRL levels in 80% of patients

A

2 mg/week

94
Q

At higher doses – can be used in some patients with

acromegaly alone or in conjunction with SST analogues

A

Carbegoline

95
Q

linked to valvular heart disease at high doses

A

Carbegoline

96
Q

______ acts on testicular Leydig cells to stimulate de novo synthesis of Androgens (primarily testosterone) from
cholesterol

A

LH

97
Q

required for gametogenesis & for

maintenance of libido & secondary sexual characteristics

A

testosterone

98
Q

acts on the Sertoli cells; stimulates production of proteins &
nutrients for sperm maturation

A

FSH

99
Q

– stim. the growth of developing ovarian follicles &
induces expression of LH receptors on theca &
granulosa cells

A

FSH

100
Q

also regulates the activity of aromatase in

granulosa cells

A

FSH

101
Q

FSH stimulates production of ________

A

17 B estradiol

102
Q

Precursor of ovarian 17B-estradiol

A

Androstenedione

103
Q

required for the rupture of the dominant follicle
during ovulation & for the synthesis of progesterone by
the corpus luteum

A

LH

104
Q

A synthetic GnRH stimulate gonadotropin release

A

Gonadorelin acetate (Lutrepulse)

105
Q

diagnostically to differentiate between GnRH-dependent and

GnRH-independent precocious puberty

A

Leuprolide

106
Q

As management of precocious puberty

A

pharmacologic castration

107
Q

GnRH agonist (long acting)

A 
Lueprolide
Goserelin
Histrelin
Nafarelin
Triptorelin
108
Q

GnRH agonists treatment for endometriosis and uterine fibroids limited to _____ due to adverse effects

A

6 months

109
Q

GnRH antagonists

A

Ganirelix (Antagon)

Cetrorelix (Cetrotide)

110
Q

Suppress the LH surge; prevent premature follicular

luteinization in ovarian stimulation protocol

A

Ganirelix (Antagon)

Cetrorelix (Cetrotide)

111
Q

Treatment for advanced prostate CA

A

Degarelix

112
Q

suppresses testosterone levels to 50 ng/dL or less (i.e.,

medical castration)

A

Degarelix

113
Q

lowers prostate-specific antigen more rapidly than GnRH

agonists without an initial testosterone surge

A

Degarelix

114
Q

Therapeutic Uses of Gonadotropins

A

Male infertility

Cryptorchidism

115
Q

A cyclic nonapeptide

A

Oxytocin

116
Q

Differs from vasopressin by 2 AA

A

Oxytocin

117
Q

stimulate the frequency & force of uterine contractions

A

Oxytocin

118
Q

Milk ejection in breast

A

Oxytocin

119
Q

Estrogen dependent because estrogen increases the expression of ______ receptors.

A

Oxytocin

120
Q

Inhibitory action to oxytocin

A

Relaxin

121
Q

_______ antagonizes the stimulant effect of oxytocin

A

Progesterone

122
Q

CNS regulator of trust and in the autonomic NS

– linked to anxiety and fear

A

oxytocin

123
Q

Drug of choice for induction of labor

A

Oxytocin (Pitocin, Syntocinon)

124
Q

no sig. increase in uterine contraction;

higher rates are unlikely to be successful

A

If at 40mIU/min

125
Q

If uterine tetany develops – stop infusion (half-life: _______)

A

3 minutes

126
Q

Dose of ________, decrease water clearance by the

kidney

A

> 20mIU/min

127
Q

If hypotonic fluids like _____ is infused rapidly - increased risk
of water intoxication (convulsion, coma, even death)

A

D5W

128
Q

Augmentation of dysfunctional labor dose usually does not exceed ________.

A

10 mIU/min

129
Q

Prevention and treatment of post-partum hemorrhage

A

10 iu IM or 20iu of Oxytocin in 1L of IV fluid at
10ml/min until the uterus is contracted then ↓ to 1-
2ml/min

130
Q

Oxytocin antagonist

A

Atosiban

131
Q

Tocolytic therapy for established preterm labor

A

Atosiban

132
Q

Other Tocolytics

A 
β adrenergic receptor agonists
MgSO4
Ca2+ channel blockers
COX inhibitors
NO donors
133
Q

Vasopressin agonist

A

Desmopressin

134
Q

Vasopressin antagonist

A

Conivaptan

135
Q

Oxytocin antagonist

A

Atosiban

136
Q

Oxytocin agonist

A

Oxytocin

137
Q

GnRH receptor antagonist

A

Ganirelix

138
Q

GnRH receptor agonist

A

Leuprolide

139
Q

GnRH agonist

A

Gonadorelin

140
Q

Prolactin antagonist

A

Bromocriptine

141
Q

GH antagonist

A

Octreotide

Pegvisomant

142
Q

GH agonist

A

Somatotropin

Mecasermin

PHARMACOLOGY (6 decks)

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