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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
Somatostatin drug
Octreotide
26
Octreotide advantages over somatostatin
Increased half life (1.7 hours v 1-3 minutes)
27
Somatostatin production
- Hypothalamic anterior periventricular nucleus | - Pancreas Delta cells
28
Somatostatin (octreotide) MOA
Gi-protein -> decrease cAMP -> decrease GH, TSH secretion
29
Octreotide indications
- Acromegaly after surgery - Carcinoid tumors - VIPomas (pancreas)
30
VIPoma pathology
WDHA syndrome - Watery Diarrhea (dehydration) - Hypokalemia - Achlorhydria
31
Octreotide AE
GI disturbances | Reduced bile, gallbladder contractility
32
-Pegvisomant- indication MOA Cindication
- Acromegaly (most effective Tx) - Prevent GH-R dimerization and signaling (rhGH analog) - Liver dysfunciton
33
Measure effectiveness of acromegaly Tx
-Normalize IGF-1 levels
34
3 Tx for acromegaly
``` Somatostatin GH analog (receptor antagonist) Dopamine agonist (Bromocriptine) ```
35
Prolactinoma hypogonadism mechanism
hyperprolactinemia inhibits pulsatile GnRH secretion
36
Prolactinoma Tx
Cabergoline (more effective than bromo) | -Also helps GH hypersecretion
37
Drug for LH
hCG (human chorionic gonadotropin)
38
Drug for LH & FSH
hMG; menotropin (human menopausal gonadotropin)
39
Drug for FSH
rFSH (recombinant FSH) | uFSH (Urofollitropin; menotropin with LH removed)
40
FSH action (female, male)
- Stimulate ovarian follicle development | - Stimulate androgen-binding globulin (maintain T levels in testes)
41
LH action (female, male)
- Stimulate production of estrogen and progesterone - induce ovulation - Stimulate production of testosterone
42
Ovarian stimulation routine
FSH for 6-12 days followed by LH for 1 day
43
OHSS - Ovarian hyperstimulation syndrome
Increase in vascular permeability -> rapid fluid accumulation in peritoneum, thorax, pericardium
44
-Clomiphene- indication MOA
Estrogen receptor competitive inhibitor - infertility (non hormonal) - Decrease estrogen negative feedback -> increase pulsatile LH, FSH
45
Clomiphene similar drug
Tamoxifen
46
-Leuprolide Acetate- MOA indication
Synthetic GnRH -> downregulate GnRH-R -> suppress LH/FSH release - Precocious puberty, ovarian cyst, prostate cancer - suppress endogenous LH surges during menotropin Tx
47
-Leuprolide Acetate- t1/2 AE
- 3 hours (normal GnRH is 5 minutes) | - Early menopause - hypogonadism, osteoporosis, hyperglycemia
48
-Ganirelix Acetate- | indication
GnRH-R antagonist (analog) | -inhibit premature LH surges during controlled ovulation
49
Posterior pituitary
Nerve endings from - Supraoptic hypothalamus (oxytocin) - Paraventricular hypothalamus (vasopressin)
50
Vasopressin synonyms
AVP (arginine vasopressin) | ADH
51
AVP inhibitor
Ethanol | Phenytoin
52
AVP stimulator
Nicotine Epinephrine Angiotensin II
53
AVP MOA
V1a - contract vascular and GI smooth muscle V1b - ACTH secretion by a.pituitary V2 -> cAMP -> collecting duct aquaporins
54
AVP dosing
V2 effects at much lower concentrations than V1 (V1 probably for extreme hypovolemia & hypotension) -both circulate plasma unbound
55
-Desmopressin- | indication
Synthetic AVP - Tx Diabetes Insipidus (central, not nephrogenic) - differentiate btwn central and nephrogenic DI
56
-Desmopressin- t1/2 administration
- 12-24 hours (AVP is 15 minutes) | - Oral or subcutaneous
57
-Desmopressin- | AE
Primarily due to V1 effects - Vessel constriction - GI stimulation - Uterine contraction (oxytocin cross-rxn)
58
Uses for Vasopressin (not desmopressin)
- Post-operative Ileus, dispel abd. gas before imaging | - Emergency Tx of hemorrhagic varices/gastritis
59
SIADH Tx (non drug)
- Water restriction - IV hypertonic saline - Loop diuretics
60
-Demeclocycline-
Antibiotic - Reduces renal AVP sensitivity (Tx SIADH) - SE nephrotoxicity
61
SIADH Tx (drug)
- Conivaptan (V-R antagonist) | - Tolvaptan (V2-R selective antagonist)
62
Oxytocin main stimulation
- Parturition (distention), suckling | - Plasma hypertonicity, hemorrhage
63
Oxytocin inhibition
Opioids Pain Heat
64
Oxytocin action
- Uterine contraction | - Mammary myoepithelial contraction
65
Oxytocin MOA
G-protein (phospholipase C)
66
-Oxytocin- | indication
- Induction of term labor - Control of postpartum bleeding - Increasing milk ejection
67
-Oxytocin- | AE
-Uterine rupture, infant trauma (monitor closely)
68
Other uterine stimulators
- Methylergonovine (2nd line for bleeding; CI in HTN) - Dinoprostone (PGE - for abortion) - Carboprost (PGF - for bleeding and abortion)
69
-Terbutaline-
B2-agonist (asthma) | -used to delay pre-term labor

Test 9 (17 decks)

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