Parathyroid, Pituitary, Adrenal disorders Flashcards
Medications for parathyroid
Hypoparathyroidism
-Vitamin D
-Calcitriol
Hyperparathyroidism
-Bisphosphonates
-Calcimimetics
Medications for Pituitary
Hypothalamic/Anterior Pituitary Hormones
-Corticotropin (H.P Acthar)
-Cosyntropin (Cortrosyn)
-Follitropin alfa (Gonal-F)
-Follitropin beta (Follistim AQ)
-Goserelin (Zoladex)
-Histrelin (Supprelin LA, Vantas)
-Lanreotide (Somatuline Depot)
-Leuprolide (Lupron)
-Menotropins (Menopur)
-Nafarelin (Synarel)
-Octreotide (Sandostatin)
-Somatotropin (Humatrope, Genotropin)
-Urofollitropin (Bravelle)
Posterior pituitary
-Desmopressin (DDAVP)
-Oxytocin (Pitocin)
-Vasopressin (ADH)(Vasostrict)
Dopamine agonists
-Bromocriptine (Cycloset, Parlodel)
-Cabergoline
Medications-Adrenal
Corticosteroids
-Betamethasone (Celestone, Diprolene)
-Cortisone
-Dexamethasone (Decadron)
-Fludrocortisone
-Hydrocortisone (Corteg)
-Methylprednisolone (Medrol)
-Prednisolone (Orapred, Pediapred)
-Prednisone (Deltasone)
-Triamcinolone (Kenalog, Nasacort, Aristrospan)
Inhibitors of Adrenocorticoid Biosynth or fxn
-Eplerenone (Inspra)
-Ketoconazole (Nizoral)
-Spironolactone (Aldactone)
Hypoparathyroidism tx
*1. Oral calcium carbonate
-increases serum calcium, cheap
-high dose= constipation (bc heavy metals)
*2. Vitamin D (Calcitriol)
-increases calcium absorption and phosphorus excretion in GI tract
3. Recombinant human parathyroid hormone (Natpara)-> for pts failing multiple things
Hyperparathyroidism
1st line: Surgery (parathyroidectomy)
2nd line: meds if surgery not possible, symptoms, severe Hypercalcemia, Osteoporosis
1. Bisphosphonates (-onate)
-MOA: bind to active sites of bone remodeling-> decrease bone resorption and inhibit osteoclasts-> residual benefits when stopped
-indications: any condition from excess bone resorption
–alendronate, ibandronate, risedronate, zoledronic acid– familiar w/ names
-AE: OSTEONECROSIS OF THE JAW (chornic use), hypocalcemia, fragility fractures
-AVOID IN RENAL INSUFF (BC HOW ELIM) AND HYPOCALCEMIA- if cant be upright for 30 min or swallowing disorders-> TAKE WITH FULL GLASS OF WATER
2. Calcimimetics (dont need to know)
3. Combination therapy
KNOW exists:
Sevelamer (Renagel, Renvela)= phosphate binder
-tx high phos and 2ndary hyperparathyroidism
Glossary
-tropin = stimulating effect of a hormone or target organ
-statin = stops others from being secreted
-medin = to intercede/middle of
Pituitary hormones- ACTH
preps specific to hormonal def: IM, SQ, Intranasal
Oral= susceptible to proteolytic degradation by GI
Anterior pituitary:
ACTH
- diurnal rhythm conc highest in early AM
-stress-> secretion which cortisol then feedback mech to suppress release
MOA: Stim Adrenal Cortex to secrete Adrenal steroids (including cortisol)
Therapeutic uses: DIAG TOOL TO DIFF PRIMARY (ADDISONS= DESTRUCTION) VS SECONDARY ADRENAL INSUFF (NO ACTH FROM PITUITARY)
Synthetic human ACTH= Cosyntropin
-DIAG TOOL AND TX INFANTILE SPASMS AND MULTIPLE SCLEROSIS
AE: SHORT TERM IS FINE
LONG TERM= LIKE GLUCOCORT= HTN, EDEMA, HYPOK, EMOTINOAL DISTURB
Growth Hormone or Somatotropin
Hypoth: GHRH
Pituit: GH
Inhibition: Somatostatin
released in pulsatile manner-> highest during sleep-> GH decreases with less muscle mass in elderly
Synthetic GH= recombinant DNA tech
MOA: EFFECTS DIRECTLY AT TARGETS OR THROUGH SOMATOMEDINS (INSULIN LIKE GROWTH FACTORS 1 AND 2)
-acromegaly
-gigantism
Therapeutic uses:
TX OF GH DEFICIENCY
GROWTH FAILURE IN KIDS
HIV W/ CACHEXIA (WASTING SYND)
REPLACE GH IN ADULTS W/ DEFICIENCY
AE: pain at injxn site, edema, arthral
Contraind:
1. NO KIDS W/ CLOSED EPIPHYSES
2. PTS W/ DIABETIC RETINOPATHY
3. OBESE W/ PRADER WILLI SYND (mc obesity syndrome)
Adults lead to : increased muscle mass, higher bone density, increased skin thickness, lower adipose tissue
OFF LABEL USE BY ATHLETES PERFORMANCE ENHANCEMENT
Growth Hormone Inhibiting Hormone (Somatostatin)
Suppress GH and TSH release (insulin, glucagon, and gastrin too)
receptors w/in neurons in hypoth, intest, stomach, pancreas
Octreotide and Lanreotide:
tx of : ACROMEGALY
octreotide= IV USE FOR ESOPHAGEAL VARICES
Gonadotropin-releasing hormone agonists/Analogs
stim FSH and LH from the anterior pituitary
Leuprolide (Lupron)
-synthetic GnRH analong
-suppresses production of FSH and LH
Indications:
-ADVANCED PROSTATE CANCER
-ENDOMETRIOSIS
-PRECOCIOUS PUBERTY
-SUPPRESS LH SUG AND PREMATURE OVULATION IN WOMEN IN CONTROLLED OVARIAN STIMULATION PROTOCOLS FOR TX OF FERT
AE: hot flushes, low libido
Contra:
PREGNANCY
BREASTFEEDING
Gonadotropins
FSH and LH
long list-> dont mem (menotropins, urofollitropin, hcg)
IM OR SQ
AE: OVARIAN ENLARGEMENT
OVARIAN HYPERSTIMULATION SYNDROME-> CAUSING MULTIPLE BIRTHS
Prolactin
peptide hormone secreted by anterior pituitary
PRIMARY FXN TO STIM AND CONTINUE LACTATION
-DRUGS ACTING AS DOPAMINE ANTAGONISTS -> INCREASE PROLACTIN SECRETION BC DOPAMINE INHIBIT SECRETION
Hyperprolactinemia: galactorrh and hypogonadism
-TX W/ DOPAMINE 2 RECEPTOR AGONISTS
1. BROMOCRIPTINE- alt tx for T2DM
2. CABERGOLINE
both tx PITUITARY MICROADENOMAS
Posterior pituitary
Vasopressin and Oxytocin w/ no releasing hormones (synth in hypoth and released in response to physio)=
HIGH PLASMA OSMOLARITY AND PARTURITION (DELIVERY)
Oxytocin (Pitocin)
love hormone
-IN OBSTETRICS TO STIM UTERINE CONTRACTIONS AND INDUCE LABOR + MILK EJECTION
-AE: htn, uterine rupture, water retention, fetal death
Vasopressin
aka ADH antidiuretic hormone
BOTH AN ANTIDIURETIC AND VASOPRESSOR
-KIDNEY-> INCREASES WATER PERMEABILITY AND RESORPTION IN COLLECTING TUBULES
-TISSUES-> VASCULAR SMOOTH MUSCLE CONSTRICTION
Uses:
-MAJOR ENDOCRINOLOGIC USE IN DIABETES INSIPIDUS
-septic shock
AE:
-WATER RETENTION
-HYPONATREMIA
Desmopressin
MINIMAL PRESSOR EFFECTS
PREFERRED OVER VASOPRESSIN IN TX FOR DIABETES INSIPIDUS AND NOCTURNAL ENURESIS (bed wetting)
CAUSING SEIZURES IN KIDS IF USED IN NASAL SPRAY FORM
regulation of corticosteroid secretion
Zona glomerulosa-> Aldosterone (mineralcorticoid- electrolyte regulating)
Zona Fasiculata -> Cortisol (glucocorticoid- metabolic activity)
Zona Reticularis -> Androgens (Corticosteroid)
Medulla-> Epi and Norepi
corticosteroid activity
MECHANISM MEANS EFFECTS TAKE HOURS TO DAYS TO OCCUR
binds to receptor-> dimerizes- recruits coactivator-> translocates in to the nucleus-> attaches to gene promoter elements
Activity of ALL glucocorticoids
- Promote normal intermediary metabolism
- increase resistance to stress
- Alter blood cell levels in plasma
- possess antiinflammatory action
- affect other systems
Adrenal hormones
Corticosteroids:
-betamethasone
-cortisone
-dexamethasone
-fludrocortisone
-hydrocortisone
-methylprednisolone
-prednisolone
-prednisone
-triamcinolone
inhibitors:
-eplerenone
-ketoconazole
-spironolactonve
Corticosteroids uses
replacement therapy
tx: allergic rxns
-asthma, RA, inflamm disorders
Effects:
ANTI INFLAMM EFFECTS
SALT RETAINING EFFECTS
Hydrocortisone in addisons
Addisons= Primary Adrenocortical Insufficiency
tx: hydrocortisone-> 0 tx = DEATH
DOSED TO MIMIC DIURNAL VARIATION OF CORTISOL (2/3 DOSE IN AM 1/3 DOSE EVENING)
may need FLUDROCORTISONE to correct mineralcorticoid deficiency
2ndary-> defect in ACTH production by pituitary-> tx hydrocortisone
3rd-> defect in CRH production by hypothalamus-> tx hydrocortisone
Dexamethasone in Diagnosing Cushing Syndrome
Cushing syndrome: hypersecretion of glucocorticoids-> excess ACTH by anterior pituitary or adrenal tumor
cortisol levels + deamethasone suppression test= diagnose cushings
DEXAMETHASONE SUPPRESSES CORTISOL RELEASE IN NORMAL BUT NOT IN CUSHINGS-> CHRONIC HIGH DOSES OF GLUCOCORTICOIDS CAN CAUSE CUSHING SYNDROME
Replacement therapy for Congenital Adrenal Hyperplasia
enzyme defect in synth of adrenal steroid hormones
CHOICE OF REPLACEMENT DEPENDS ON SPECIFIC ENZYME DEFECT
