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Test 9 > Pharm 1 Pituitary > Flashcards

Pharm 1 Pituitary Flashcards

1
Q

Growth Hormone regulation

A

++ GRH

– Somatostatin (SRIF, somatotropin release-inhibiting factor)

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2
Q

Somatostatin functions (GI, brain)

A
  • Suppress basically every GI hormone

- Inhibit GH, TSH secretion (not synthesis)

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3
Q

Somatostatin regulation

A

++ low pH

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4
Q

Posterior pituitary hormones

A

Vasopressin (ADH)

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5
Q

Growth hormone synonym

A

Somatotropin

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6
Q

Growth hormone replacement

A

Species specific (only human)

  • Risk of CJD
  • Use synthetic (recombinant rhGH)
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7
Q

Growth hormone feedback mechanism

A

Liver IGF-1 (insulin-like growth factor)

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8
Q

2 ways to induce SRIF

A

IGF-1

B-agonist

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9
Q

GH actions

A
  • Synthesize chondroitin and collagen
  • Grow bone and soft tissue
  • Renal retain N, K, PO4
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10
Q

GH MOA (important)

A

Cytokine membrane receptors ->

a) IGF-1 (mitogen & antiapoptogen)
b) + triglyceride hydrolysis, insulin resistance, protein synthesis

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11
Q

IGF-1 v IGF-2

A

Adult vs infant

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12
Q

GH interaction with diabetes

A

Causes more problems in morning (GH secreted at night)

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13
Q

Most common pituitary tumor

A

Prolactinoma

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14
Q

Age associated GH pathology

A

Up to 1/3 of elderly

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15
Q

Gigantism

A

GH hypersecretion before fusion of epiphysis

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16
Q

Acromegaly enlargements

A

Head, face, hands, feet, thorax

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17
Q

Acromegaly clinical

A
  • Carpal tunnel syndrome
  • Hypogonadism
  • Glucose intolerance and hyperinsulinemia
  • Heat intolerance, sweating, fatigue, lethargy
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18
Q

rhGH therapeutic uses

A
  • GH deficient patients
  • Very short children with normal GH
  • HIV related wasting or cachexia
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19
Q

Prader-Willi syndrome

A

Parental allele not expressed (chromosome 15 unbalanced)

-Retardation, obesity, hypogonadism, hypotonia

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20
Q

AngelMan’s syndrome

A

Maternal allele not expressed (15)

-Retardation, inappropriate laughter, ataxic gait, seizures

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21
Q

Prader-willi and AngelMan’s pathology

A

Disorder of genomic Imprinting (silencing of paternal/maternal alleles)

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22
Q

-rhGH-
administration
adverse effects

A
  • Subcutaneous
  • Carpal tunnel, arthralgia in adults
    • few AE in children
    • NO hyperglycemia
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23
Q

-rhIGH-1-

receptor

A

Tetrameric receptor autophosphorylation (like insulin)

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24
Q

-rhIGH-1-
indication
administration
contraindications

A
  • Children who don’t respond to GH
  • Subcutaneously before or after meal (prevent hypoglycemia)
  • Neoplasia; closed Epiphyses
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25
Q

Somatostatin drug

A

Octreotide

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26
Q

Octreotide advantages over somatostatin

A

Increased half life (1.7 hours v 1-3 minutes)

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27
Q

Somatostatin production

A
  • Hypothalamic anterior periventricular nucleus

- Pancreas Delta cells

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28
Q

Somatostatin (octreotide) MOA

A

Gi-protein -> decrease cAMP -> decrease GH, TSH secretion

29
Q

Octreotide indications

A
  • Acromegaly after surgery
  • Carcinoid tumors
  • VIPomas (pancreas)
30
Q

VIPoma pathology

A

WDHA syndrome

  • Watery Diarrhea (dehydration)
  • Hypokalemia
  • Achlorhydria
31
Q

Octreotide AE

A

GI disturbances

Reduced bile, gallbladder contractility

32
Q

-Pegvisomant-
indication
MOA
Cindication

A
  • Acromegaly (most effective Tx)
  • Prevent GH-R dimerization and signaling (rhGH analog)
  • Liver dysfunciton
33
Q

Measure effectiveness of acromegaly Tx

A

-Normalize IGF-1 levels

34
Q

3 Tx for acromegaly

A 
Somatostatin
GH analog (receptor antagonist)
Dopamine agonist (Bromocriptine)
35
Q

Prolactinoma hypogonadism mechanism

A

hyperprolactinemia inhibits pulsatile GnRH secretion

36
Q

Prolactinoma Tx

A

Cabergoline (more effective than bromo)

-Also helps GH hypersecretion

37
Q

Drug for LH

A

hCG (human chorionic gonadotropin)

38
Q

Drug for LH & FSH

A

hMG; menotropin (human menopausal gonadotropin)

39
Q

Drug for FSH

A

rFSH (recombinant FSH)

uFSH (Urofollitropin; menotropin with LH removed)

40
Q

FSH action (female, male)

A
  • Stimulate ovarian follicle development

- Stimulate androgen-binding globulin (maintain T levels in testes)

41
Q

LH action (female, male)

A
  • Stimulate production of estrogen and progesterone
    • induce ovulation
  • Stimulate production of testosterone
42
Q

Ovarian stimulation routine

A

FSH for 6-12 days followed by LH for 1 day

43
Q

OHSS - Ovarian hyperstimulation syndrome

A

Increase in vascular permeability -> rapid fluid accumulation in peritoneum, thorax, pericardium

44
Q

-Clomiphene-
indication
MOA

A

Estrogen receptor competitive inhibitor

  • infertility (non hormonal)
  • Decrease estrogen negative feedback -> increase pulsatile LH, FSH
45
Q

Clomiphene similar drug

A

Tamoxifen

46
Q

-Leuprolide Acetate-
MOA
indication

A

Synthetic GnRH -> downregulate GnRH-R -> suppress LH/FSH release

  • Precocious puberty, ovarian cyst, prostate cancer
  • suppress endogenous LH surges during menotropin Tx
47
Q

-Leuprolide Acetate-
t1/2
AE

A
  • 3 hours (normal GnRH is 5 minutes)

- Early menopause - hypogonadism, osteoporosis, hyperglycemia

48
Q

-Ganirelix Acetate-

indication

A

GnRH-R antagonist (analog)

-inhibit premature LH surges during controlled ovulation

49
Q

Posterior pituitary

A

Nerve endings from

  • Supraoptic hypothalamus (oxytocin)
  • Paraventricular hypothalamus (vasopressin)
50
Q

Vasopressin synonyms

A

AVP (arginine vasopressin)

ADH

51
Q

AVP inhibitor

A

Ethanol

Phenytoin

52
Q

AVP stimulator

A

Nicotine
Epinephrine
Angiotensin II

53
Q

AVP MOA

A

V1a - contract vascular and GI smooth muscle
V1b - ACTH secretion by a.pituitary
V2 -> cAMP -> collecting duct aquaporins

54
Q

AVP dosing

A

V2 effects at much lower concentrations than V1
(V1 probably for extreme hypovolemia & hypotension)
-both circulate plasma unbound

55
Q

-Desmopressin-

indication

A

Synthetic AVP

  • Tx Diabetes Insipidus (central, not nephrogenic)
  • differentiate btwn central and nephrogenic DI
56
Q

-Desmopressin-
t1/2
administration

A
  • 12-24 hours (AVP is 15 minutes)

- Oral or subcutaneous

57
Q

-Desmopressin-

AE

A

Primarily due to V1 effects

  • Vessel constriction
  • GI stimulation
  • Uterine contraction (oxytocin cross-rxn)
58
Q

Uses for Vasopressin (not desmopressin)

A
  • Post-operative Ileus, dispel abd. gas before imaging

- Emergency Tx of hemorrhagic varices/gastritis

59
Q

SIADH Tx (non drug)

A
  • Water restriction
  • IV hypertonic saline
  • Loop diuretics
60
Q

-Demeclocycline-

A

Antibiotic

  • Reduces renal AVP sensitivity (Tx SIADH)
  • SE nephrotoxicity
61
Q

SIADH Tx (drug)

A
  • Conivaptan (V-R antagonist)

- Tolvaptan (V2-R selective antagonist)

62
Q

Oxytocin main stimulation

A
  • Parturition (distention), suckling

- Plasma hypertonicity, hemorrhage

63
Q

Oxytocin inhibition

A

Opioids
Pain
Heat

64
Q

Oxytocin action

A
  • Uterine contraction

- Mammary myoepithelial contraction

65
Q

Oxytocin MOA

A

G-protein (phospholipase C)

66
Q

-Oxytocin-

indication

A
  • Induction of term labor
  • Control of postpartum bleeding
  • Increasing milk ejection
67
Q

-Oxytocin-

AE

A

-Uterine rupture, infant trauma (monitor closely)

68
Q

Other uterine stimulators

A
  • Methylergonovine (2nd line for bleeding; CI in HTN)
  • Dinoprostone (PGE - for abortion)
  • Carboprost (PGF - for bleeding and abortion)
69
Q

-Terbutaline-

A

B2-agonist (asthma)

-used to delay pre-term labor

Test 9 (17 decks)

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