Other Endocrine Med classes- FINAL Flashcards
ACTH (Anterior Pituitary)
MOA ADE
- Stress ↑ release of ACTH; cortisol ↓ its release
-MOA—works in adrenal cortex,
results in the synthesis of adrenal steroids and adrenal androgens
-ACTH has limited medical use— mainly to help differentiate Addison’s
disease from 2⁰ adrenal failure [caused by a pituitary issue]
-ADE: none with short term use; with longer use similar to using steroids
chronically
-Ex: Corticotropin, Cosyntropin
Growth Hormone AKA Somatotropin
(Anterior Pituitary)
- GHRH stimulates release of GH
-Amount of GH produced declines with age
-Stimulates cell proliferation, bone growth, lean muscle mass production, skin thickness and ↓ adiposity
-MOA—GH effects exerted directly on its target organs, yet some effects mediated through insulin
-Used to treat GH deficiency in children; growth failure in Prader- Willi, HIV wasting & adults with documented low GH; used off
label as “antiaging” hormone
-ADE:edema, arthralgias, ↑ risk of DM
-CI: children with closed epiphyses, those with diabetic eye disease, patients with Prader-Willi that are obese
Growth Hormone Inhibiting Hormone AKA Somatostatin
(Anterior Pitiutary)
-Binds to receptors that suppress GH & TSH release; this hormone also suppress release of insulin, glucagon & gastrin
-Octreotide & Lanreotide are the synthetic versions of Somatostatin (treats acromegaly, GO bleeding, & s/e of carcinoid tumors)
-ADE—diarrhea, abdominal pain, gas, nausea & steatorrhea
Gonadotropin Releasing Hormone
(Anterior Pituitary)
Examples
-Hypothalamus releases GnRH to
stimulate release of FSH & LH
-Continuous release of GnRH causes
down regulation of the receptors & inhibits release of the gonadotropins
-These agents used to ↓ production of gonadal steroids—androgen &
estrogen (use in prostate cancer, endometriosis & precocious puberty)
-CI: pregnancy & Lactation
-ADE in women: hot flushes, sweating, decreased libido,
depression & ovarian cysts
-ADE in men: bone pain, edema,
gynecomastia, diminished libido, metabolic bone disease
-Ex: Leuprolide, Goserelin,
Nafarelin, Histrelin
Gonadotropins (Anterior Pituitary)
-FSH/LH—these regulate gonadal steroid production (Used as prescriptions in infertility)
-Are given IM over 5-12 days—the
ovarian follicle grows & matures
-ADE: ovarian enlargement & possible
hyperstimulation
Prolactin (Anterior Pituitary)
-Stimulates & maintains lactation; yet it ↓ sexual drive & reproductive functions
-Hyperprolactinemia causes galactorrhea & hypogonadism
-For ↑ prolactin [not related to drugs], we prescribe Bromocriptine or Cabergoline
-NOTE* Reglan & all antipsychotics that act as dopamine ANTAGONISTS
will increase secretion of prolactin
Anterior Pituitary Hormones (2)
- Oxytocin:
-Used to stimulate uterine contraction & to induce labor
-Causes milk ejection by contracting cells around the mammary alveoli - Vasopressin:
-Antidiuretic hormone
-Has both antidiuretic & vasopressor effects
-Used to treat diabetes insipidus
* Can also be used in cardiac arrest & to ↓ bleeding in esophageal varices
-ADE—H2O intoxication & low Na+
-Desmopressin [DDAVP]—analog of ADH
-Longer acting than ADH; used for DI and nocturnal enuresis
-Given PO or nasally
Diethylpropion
Sympathomimetic anorectic, short-term use for weight loss.
Phentermine
Sympathomimetic anorectic, short-term use, avoid in uncontrolled hypertension.
Phentermine/Topiramate (Qsymia)
Combination drug for weight loss, monitor for psychiatric side effects.
Liraglutide (Saxenda)
GLP-1 receptor agonist for weight loss, can cause GI side effects.
Semaglutide (Wegovy)
GLP-1 receptor agonist, reduces appetite and calorie intake.
Tirzepatide (Zepbound)
GLP-1 and GIP receptor agonist, significant weight loss, reduces CV risk.
Orlistat
Lipase inhibitor, prevents fat absorption, common side effect: fecal urgency.
Naltrexone/Bupropion (Contrave)
Regulates reward system, avoid in seizure disorder or opioid users.
Treats obesity in adults with lifestyle changes.
Desmopressin
Used for diabetes insipidus, synthetic ADH analogue.
Octreotide
Somatostatin analog, used for acromegaly and carcinoid tumors (anti proliferative).
Esophageal varices (Inhibition of gastric acid secretion, Decrease in intestinal motility, and Reduction of splanchnic blood flow)
Leuprolide
GnRH analog, treats prostate cancer and endometriosis.
hCG
Used in fertility treatments, mimics LH effects.
Levothyroxine
T4 replacement for hypothyroidism, take on an empty stomach.
Liothyronine
T3 replacement, faster onset but higher risk of cardiotoxicity.
Methimazole
Antithyroid drug for Grave’s disease, blocks T4 synthesis, preferred over PTU (Propylthiouracil).
Propylthiouracil (PTU)
Antithyroid drug, inhibits T4 to T3 conversion, hepatotoxicity risk.
Hydrocortisone
Short-acting glucocorticoid, replacement for adrenal insufficiency.
Prednisone
Intermediate-acting glucocorticoid, commonly used for inflammation.
Dexamethasone
Long-acting glucocorticoid, used in suppression tests and inflammation.
Fludrocortisone
Mineralocorticoid, used in Addison’s disease for sodium retention.
Spironolactone
Aldosterone antagonist, used for resistant hypertension and hyperaldosteronism.
Oxytocin
Stimulates uterine contractions and milk ejection.
Vasopressin
ADH analog, used for diabetes insipidus and esophageal varices.
Function of HPA Axis
(Hypothalamic-Pituitary-Adrenal)
The Hypothalamic-Pituitary-Adrenal (HPA) axis regulates stress response, immune function, mood, emotions, energy storage/expenditure, and homeostasis through hormone secretion.
Risks & Benefits of Exogenous Steroids
Benefits: Reduce inflammation, suppress immune responses, manage symptoms.
Risks: Immunosuppression, infection risk, osteoporosis, hyperglycemia, adrenal suppression.
Thyroid Gland Functions
Regulates metabolism, growth, development, heart rate, and body temperature through thyroid hormone secretion (T3, T4).
Thyroid Function Tests (TFTs)
TSH: Sensitive screening tool.
T3/T4: Total hormone levels.
Free T4: Active hormone.
Most useful for screening: TSH.
Drug Therapy for Hypothyroidism
Levothyroxine (synthetic T4) is the primary treatment.
Pharmacokinetics & Side Effects of Thyroid Hormones
Pharmacokinetics: Absorbed in the gut, metabolized in liver.
Uses: Hypothyroidism, goiter, thyroid cancer.
Side Effects: Hyperthyroid symptoms.
Interactions: Calcium, iron, antacids.
Contraindications: Untreated adrenal insufficiency, acute MI.
Hyperthyroidism Presentation & Therapy
Presentation: Weight loss, heat intolerance, palpitations, anxiety.
Therapy: Antithyroid drugs, beta-blockers, radioactive iodine, surgery.
Drug Therapy for Hyperthyroidism
Methimazole and propylthiouracil (PTU) reduce thyroid hormone production.
Methimazole & PTU Pharmacology
Pharmacokinetics: Oral absorption, liver metabolism.
Uses: Hyperthyroidism.
Side Effects: Rash, agranulocytosis, liver toxicity.
Contraindications: Pregnancy (methimazole in 1st trimester), liver disease.
Hyperthyroidism Adjunct Therapies
Propranolol: Manages symptoms.
Potassium Iodide: Inhibits hormone release.
Radioactive Iodine: Destroys thyroid tissue.
Hypothalamus & Pituitary Hormones
Hypothalamus: CRH, TRH, GnRH, GHRH, somatostatin, dopamine.
Anterior Pituitary: ACTH, TSH, GH, LH, FSH, prolactin.
Posterior Pituitary: Oxytocin, vasopressin (ADH).
Hormonal Agents MOA & Effects
ACTH: Stimulates cortisol. AE: Edema, hypertension.
Somatotropin: Growth stimulation. AE: Hyperglycemia.
Somatostatin: Inhibits GH, TSH. AE: GI effects.
GnRH Agonists (Lupron, Zoladex): Cancer therapy. AE: Hot flashes.
DDAVP: Treats diabetes insipidus. AE: Hyponatremia.
Obesity Definition & Prevalence
Defined as BMI ≥30 kg/m²; prevalent globally with multiple comorbidities.
Obesity Treatment & Indications
Lifestyle: Diet, exercise, behavioral therapy.
Pharmacological: BMI ≥30 or ≥27 with comorbidities.
Weight Loss Drug Classes
- Anorexiants: Appetite suppression.
- Lipase Inhibitors: Block fat absorption.
- Serotonin Agonists: Regulate satiety.
- Combination Agents: Multiple mechanisms.
- GLP-1 Receptor Agonists: Slow gastric emptying.
