Pituitary Drugs

Question 1

GnRH Analogs (Inhibitors)

Answer 1

Leuprolide, Goserelin, Nafarelin

Drugs are full agonists and can cause receptor desensitization, which end result is inhibition

Question 2

Therapeutic uses of GnRH and analogs

Answer 2

1. replacement therapy in disorders from abnormal pulse generation
2. Promotion of pituitary desensitization

Question 3

Idiopathic Hypogonadotropic Hypogonadism (IHH)

Answer 3

Results from faulty GnRH secretion in men. Pituitary responds to GnRH by secreting LH, FSH.
Replacement therapy, every 2 hours via pump to induce puberty

Question 4

Induction of Ovulation in women with hypothalamic amenorrhea

Answer 4

treat with replacement therapy

Question 5

Central Precocious puberty

Answer 5

GnRH activation is the last step in puberty

Treated by pituitary desensitization, continuous infusion of GnRH analogs. Takes 4-6 weeks for desensitization

Question 6

Prostate Cancer

Answer 6

Treated by pituitary desensitization

Question 7

Gynecological Disease

Answer 7

GnRH analogs can be used to inhibit menstrual function and produce a hypoesterogenic state.
Do medical castration by induced GnRH analogs

Question 8

Chorionic gonadotropin (Pregnyl)

Answer 8

Derived from urine of pregnant women

Acts like LH

Question 9

Menotropins (Pergonal)

Answer 9

Obtained from the urine of postmenopausal women and are referred to as hMG
contains equal amounts of FSH and LH

Question 10

Urofollitropin (Braelle)

Answer 10

Menotropic preparation which most of LH has been removed. Primarily FSH

Question 11

Follitropic Alpha, Follitropin Beta

Answer 11

Contain human FSH

Produced by recombinant DNA technology

Question 12

Therapeutic Uses for FSH

Answer 12

Female infertility, to induce ovulation for women who still menstruate regularly but appear to have reduced fertility . NOT effective for women who don’t ovulate.

Question 13

Somatropin Recombinant (Humatrope)

Answer 13

Same Amino Acid sequence as GH isolated from human pituitaries

Question 14

Somatrem (Protropin)

Answer 14

growth hormone analog with an amino acid sequence identical to that of hormone isolated from human pituitaries, but with an additional methionine residue introduced as the amino-terminal amino acid

Question 15

Octerotide (Sandostatin)

Answer 15

Somatostatin analog, longer half life than somatostatin and is resistant to enzymatic degradation

Question 16

Therapeutic Use of Octerotide (Somatostatin analog)

Answer 16

approved in treatment of metastatic carcinoid tumors that secrete vasoactive peptides (secretory tumors). Octreotide is effective in inhibiting diarrhea and flushing as well as restarting electrolyte balance.
Used for Acromegaly.

Question 17

How is Dopamine an alternative treatment for Acromegaly?

Answer 17

Dopamine stimulates GH secretion in normal pituitary. It is believed that adenomas of stem cells express dopaminergic receptors that are inhibitory

Question 18

What inhibits prolactin?

Answer 18

PRL does not have any inhibitory feedback mechanisms.

It is inhibited by dopamine

Question 19

Cabergoline

Answer 19

Treatment for prolactin

D2 agonist with a long half life (65 hours)

Question 20

Bromocriptine

Answer 20

Dopamine agonist that activates lactotrope dopamine receptors leading to inhibition of spontaneous and TRH-induced release of prolactin

Question 21

Vasopressin

Answer 21

synthetic 8-L arginine vasopressin

given IM, SC, or nasal spray

Question 22

Lypressin

Answer 22

synthetic 8-L Lysine

Given as nasal spray

Question 23

Desmopressin

Answer 23

given IM, SC, nasal spray
preferred for diabetes insipidius b/c free of pressor effects and longer acting than vasopressin
Also effective by V2 receptor mechanism in pt that have type 1 von Willebrand disease- will elevate von Willebrand factor and shorten bleeding time

Question 24

8-L-arginine vasopressin

Answer 24

used for vasoconstriction effects (V1) for bleeding in esophageal varices

Question 25

Oxytocin

Answer 25

used to stimulate uterine contractions to induce labor
control post partum uterine atony and hemorrhage
promote milk ejection