pituitary Flashcards
Posterior pituitary Hormones are synthesized in neurons that originate in _____.
hypothalamus
Anterior pituitary Hormones are synthesized in epithelial cells, but are under neural control via ______.
portal circulation
Pituitary Hormones and Drugs- Most require parenteral administration because of ?
proteolytic breakdown in the gut
routes of Pituitary Hormones and Drugs
IM, IV, SubQ, IN, PO
____ Controls the rate of water excretion in urine.
- Antidiuretic hormone (ADH) (vasopressin)
increased ADH increases permeability and ____ water loss in urine.
decreases
decreased ADH cause kidneys to be impermeable to water, so there is ___ reabsorption
decreased
hormone that Elicits uterine contractions during labor
oxytocin
hormone that allows for Milk expression in lactation
oxytocin
in diabetes insipidus, what hormone is of major use?
vasopressin
In kidney, vasopressin binds to V2 receptor to increase ______ in the collecting tubules
water permeability and reabsorption
In liver, vascular smooth muscle, other tissue, vasopressin binds to V1 receptors for a variety of actions such as ______.
vasoconstriction
uses for Vasopressin (3)
o Diabetes insipidus
o Esophageal varices
o Cardiac arrest/shock
Vasopressin ADRs
o Water intoxication, hyponatremia
o HA, bronchoconstriction, tremor
use vasopressin with caution in what diseases?
o Coronary artery disease (CAD), epilepsy, asthma, vascular disease, elderly
desmopressin was modified to _________.
- Molecule modified to have minimal activity at the V1 receptor
what is the Preferred agent for diabetes insipidus and nocturnal enuresis
desmopressin
Also used to treat hemophilia A and vWF deficiency
in vWF deficiency, desmopressin does what?
o Increases plasma levels of vWF, factor VIII, and t-PA
desmopressin routes
- IM, IV, SubQ, IN, and PO forms
Oxytocin (Pitocin) uses
medical (not elective) induction of labor, adjunct in abortion, postpartum bleeding
Oxytocin (Pitocin) contraindications
fetal distress, abnormal fetal presentation, premature births
what are the anterior pituitary hormones?
- GHRH: growth hormone-releasing hormone
- TRH: thyrotropin-releasing hormone
- CRH: corticotropin-releasing hormone
- GnRH (LHRH): gonadotropin-releasing hormone (luteinizing hormone-releasing hormone)
- PIH: prolactin-inhibiting hormone (dopamine) and PRH: prolactin-releasing hormone
- ACTH: adrenocorticotropic hormone
- TSH: thyroid-stimulating hormone
- FSH: follicle-stimulating hormone
- LH: luteinizing hormone
Thyrotropin-releasing hormone (TRH) action on anterior pituitary
Stimulates secretion of TSH by thyrotropes
Gonadotropin-releasing hormone (GnRH) Action on Anterior Pituitary
Stimulates secretion of FSH and LH by gonadotropes
Corticotropin-releasing hormone (CRH) Action on Anterior Pituitary
Stimulates secretion of ACTH by corticotropes
Growth hormone-releasing hormone (GHRH) Action on Anterior Pituitary
Stimulates secretion of growth hormone by somatotropes
Growth hormone inhibitory hormone (somatostatin) Action on Anterior Pituitary
Inhibits secretion of growth hormone by somatotropes
Prolactin-inhibiting hormone (PIH) Action on Anterior Pituitary
Inhibits secretion of prolactin by lactotropes
ACTH (corticotropin) Diagnostic uses
Differentiate between Cushing syndrome and ectopic ACTH-producing cells Differentiate primary (Addison disease) from secondary adrenal insufficiency
ACTH (corticotropin) therapeutic uses
multiple sclerosis, infantile spasms, some other inflammatory conditions
ACTH (corticotropin) Synthetic agent
Cosyntropin: is preferred agent for diagnosis of adrenal insufficiency
what is preferred agent for diagnosis of adrenal insufficiency?
Cosyntropin
ACTH (corticotropin)/Cosyntropin ADRs
ADRs are like glucocorticoids (osteoporosis, hypertension, edema, hypokalemia, CNS stimulation, infection, etc.)
Name of the synthetic form used to treat Growth Hormone deficiencies
Somatropin
Somatropin ADRs
edema (HTN, intracranial HTN, etc.), neoplasms, bone malformations
Trend in recent years as the “anti-aging” drug but is not indicated for use to increase or maintain ______.
lean muscle mass
Somatropin has been abused by ______.
athletes
what do you use for IGF-1 deficiency
IGF-1 analogue: mecasermin (Increlex)
what do you use for HIV-associated lipodystrophy
GH secretagogue: tesamorelin (Egrifta)
GH Receptor Antagonist drug name
Pegvisomant (Somavert)
MOA of Pegvisomant (Somavert)
Binds to receptor and prevents endogenous binding
what is Pegvisomant (Somavert) used to treat?
treatment-resistant acromegaly
Somatostatin (GH inhibitor) Analogs drug names (3)
o Octreotide ( Sandostatin) o Lanreotide (Somatuline Depot) o Pasireotide (Signifor)
what Somatostatin (GH inhibitor) Analogs is used to treat Cushing’s?
Pasireotide (Signifor)
what Somatostatin (GH inhibitor) Analogs is used to treat refractory acromegaly
Lanreotide (Somatuline Depot)
what Somatostatin (GH inhibitor) Analogs is used to treat acromegaly, cancer( and also Off-label: diarrhea, esophageal varices)
Octreotide ( Sandostatin)
Gonadotropin-releasing Hormone (GnRH) Agonists
drug names
- Goserelin (Zoladex)
- Histrelin (Vantas)
- Leuprolide (Lupron)
- Nafarelin (Synarel)
- Triptorelin (Trelstar)
when using Gonadotropin-releasing Hormone (GnRH) Agonists continuously, we stimulate the receptors and causes release of _______ to be inhibited with chronic administration
FSH and LH
what is Gonadotropin-releasing Hormone (GnRH) used to treat?
prostate cancer, endometriosis, precocious puberty
what is Gonadotropin-releasing Hormone (GnRH) Contraindication?
pregnancy
Gonadotropin-releasing Hormone (GnRH) ADRs in women
hot flushes, sweating, decreased libido, depression and ovarian cysts
Gonadotropin-releasing Hormone (GnRH) ADRs in men
increased early in course of therapy testosterone causes bone pain; hot flushes, **gynecomastia, edema, diminished libido
GnRH Antagonists drug names
- Degarelix (Firmagon)
- Cetrorelix (Cetrotide)
what GnRH Antagonists is Used for advanced prostate cancer
- Degarelix (Firmagon)
what GnRH Antagonists is Used o to control ovulation by delaying LH surge until ovarian follicle is of adequate size
- Cetrorelix (Cetrotide)
GnRH Antagonists (Degarelix (Firmagon), Cetrorelix (Cetrotide)) are what pregnancy category?
x
Variety of FSH/LH agonists used for _____ treatment in women and men
infertility
prolactin Functions:
o Stimulate and maintain lactation
o Decrease sex drive and reproductive function
Hyperprolactinemia (often associated with tumors) is treated with D2 agonists like ______.
bromocriptine and cabergoline