Pituitary hormones

Question 1

What are the physiological actions of growth hormone?

Answer 1

Growth, nitrogen retention, promote lipids as an energy source instead of carbohydrates

Question 2

What is the action of somatostatin?

Answer 2

Inhibits growth hormone (GHIH), glucagon and insulin

Question 3

What is somatostatin used for?

Answer 3

Treatment of acute haemorrhage from esophageal varices

Question 4

What is the somatostatin analogue?

Answer 4

Octreotide

Question 5

T or F - Octreotide is less effective in inhibiting GH and insulin than somatostatin?

Answer 5

False. It is 45x more effective at inhibiting GH and 2x more effective at inhibiting insulin

Question 6

What are the uses for octreotide?

Answer 6

• Acromegaly (and Gigantism)
• Upper GI haemorrhage
• Insulin secreting tumours
• Oesophageal varices

Question 7

What are the A/E of octreotide?

Answer 7

• Nausea, vomiting, flatulence
• Local reactions
• Hyperglycaemia – chronic
  administration
• Pancreatitis, hepatitis

Question 8

What is the role of GHRH?

Answer 8

Stimulate the release of GH

Question 9

What is the name of GHRH peptide?

Answer 9

sermorelin

Question 10

What is the therapeutic use of sermorelin?

Answer 10

stimulates GH in GH-deficient
children

Question 11

Up until what point can sermorelin be used?

Answer 11

Until aprox 8 yrs old. Used until epiphyseal plates are closed

Question 12

What are the A/E of GHRH and sermorelin?

Answer 12

• Acute and transient
• Headache, flushing, injection
  site reactions

Question 13

What is the synthetic human growth hormone?

Answer 13

Somatropin

Question 14

What is the action of somatropin?

Answer 14

Promotes the growth of long bones, ↑ protein synthesis, stimulate synthesis of IGF-I and IGF-II
↑ sulfate uptake into cartilage

Question 15

What are the adverse effects of somatropin?

Answer 15

• arthralgias,
• fluid retention
• lipodystrophy

Question 16

What is a risk in pt receiving Tx with somatropin?

Answer 16

Hypocalcemia

Question 17

What is the function of TRH?

Answer 17

Stimulate TSH secretion

Question 18

What effect does TRH have in a pituitary tumor?

Answer 18

With pituitary tumour, TRH
release stimulates the
release of GH
(acromegaly) and ACTH
(cushings disease)

Question 19

What is the function of TSH?

Answer 19

Stimulate thyroid to
produceT4, T3 and
thyroglobulin

Question 20

What is the recombinant form of TSH and what it is used for?

Answer 20

Thyrotopin alfa (rhTSH)
* (Diagnostic tool)
* - used with or without radioactive
iodine imaging to test the presence
of Tg in patients with thyroid cancer

Question 21

How is thyrotropin alfa administered?

Answer 21

IM only

Question 22

What are the A/E of thyrotropin alfa?

Answer 22

nausea, headache,
hyperthyroidism

Question 23

What is the action of corticotropen releasing hormone?

Answer 23

Stimulates release of ACTH and β-endorphins

Question 24

What is the diagnostic use of CRH?

Answer 24

Distinguish Cushings disease from ectopic
ACTH secretion

Question 25

What are the A/E of CRH?

Answer 25

transient facial flushing

Question 26

What is the action of ACTH?

Answer 26

Stimulates synthesis and release of cortisol, adrenal androgens, glucocorticoids

Question 27

What is the ACTH analogue?

Answer 27

Tetracosactide

Question 28

What is the use of Tetracosactide?

Answer 28

Diagnostic agent (assess adrenocortical responsiveness)

Question 29

What are the A/E of tetracosactide?

Answer 29

Hyperandrogenism in females, hyperpigmentation, allergic reactions, Na+/H20 retention, ↑ BP, hyperglycaemia and osteoporosis

Question 30

What is the function of GnRH?

Answer 30

Controls the release of FSH and LH

Question 31

What are the GnRH analogues?

Answer 31

Leuprorelin Goserelin Buserelin Triptorelin

Question 32

What effect is achieved when GnRH analogues are administered in a pulsatile manner?

Answer 32

Used to treat infertility

Question 33

What effect is achieved when GnRH analogues are administered in a sustained, non-pulsatile manner?

Answer 33

Used to suppress LH and FSH in a tumor

Question 34

What drug is the synthetic form of hCG?

Answer 34

Choriogonadotropin alfa

Question 35

What is the use of Choriogonadotropin alfa?

Answer 35

Tx of infertility in females. Causes the ovulation

Question 36

What is Choriogonadotropin alfa given in combination with?

Answer 36

FSH

Question 37

What are the A/E of Choriogonadotropin alfa?

Answer 37

Headache, fatigue, Nausea, vomiting, Abdominal pain, Ovarian hyperstimulation

Question 38

What is the FSH analogue?

Answer 38

follitropin-α

Question 39

What is the function of follitropin-α?

Answer 39

In females: stimulates gametogenisis and follicular development. Conversion of estrogens to androgens in granulosa cells In males: stimulates gametogenesis and spermatogenesis

Question 40

What are the A/E of follitropin-α?

Answer 40

Enlarged ovary, hyperstimulatory syndrome, gynaecomastia, ectopic pregnancy

Question 41

What is the analogue of LH?

Answer 41

Lutropin alfa

Question 42

What is Lutropin alfa used in combination with?

Answer 42

FSH

Question 43

What is the function of Lutropin alfa?

Answer 43

* Regulation of gonadal steroid production * Stimulate testosterone production and follicular development * Induces ovulation * Stimulate corpus luteum to produce progesterone and androgens

Question 44

What are the A/E of Lutropin alfa?

Answer 44

Headache, depression, oedema, skin rash, gynaecomastia, multiple pregnancy

Question 45

What drug is a LHRH antagonist?

Answer 45

Cetrorelix

Question 46

What is the function of cetrorelix?

Answer 46

Inhibits secretion of LH and FSH

Question 47

When is cetrorelix indicated?

Answer 47

Prevention of premature ovulation in patients undergoing fertility treatment

Question 48

What are the A/E of cetrorelix?

Answer 48

Nausea, headache, pain at injection site

Question 49

What are the C/I for cetrorelix?

Answer 49

Renal, Hepatic Impairment

Question 50

What is the Tx for Hyperprolactinemia?

Answer 50

prolactin secretion inhibited by dopamine agonists → shrink prolactin secreting tumours

Question 51

What drugs are used in hyperprolactinemia?

Answer 51

Cabergoline, bromocriptine, quinagolide

Question 52

What are the uses of dopamine agonists?

Answer 52

Amenorrhea, galactorrhoea, infertility assoc with hyperprolactinaemia

Question 53

What are the A/E of dopamine agonists?

Answer 53

N, H, lightheadedness, postural hypotension, fatigue Cabergoline < nausea than bromocriptine

Question 54

What are the DI of dopamine agonists?

Answer 54

Antipsychotics and TCAD - ↑ prolactin levels

Question 55

What is the function of oxytocin?

Answer 55

* Milk ejection * Induce uterine contraction / maintain labour with uterine dysfunction * Prevent / control bleeding after birth / abortion

Question 56

How is oxytocin administered?

Answer 56

* IM → uterine response 3-5 min * Slow IV → immediate response * Nasal spray → induce postpartum lactation

Question 57

What are the CI for oxytocin?

Answer 57

Ø Fetal distress, predisposition to uterine rupture Ø Vaginal delivery contraintraindicated Ø Intranasal administration during pregnancy

Question 58

What are the A/E of oxytocin?

Answer 58

Nausea, vomiting, uterine rupture, water intoxication (high dose of oxytocin), fetal death

Question 59

What are the DI of oxytocin?

Answer 59

Prostaglandins potentiate the effects

Question 60

What is the function of vasopressin (ADH)?

Answer 60

Has antidiuretic and vasopressor activities Short-term management of bleeding oesophageal varices

Question 61

What drug has potent vasoconstrictive activity and lacks antidiuretic activity?

Answer 61

Ornipressin

Question 62

What is the MOA of vasopressin?

Answer 62

V1 → vascular smooth muscle → vasoconstriction ♦ V2 → renal tubule cells → antidiuresis by ↑ H20 permeability and collecting tubule H20 resorption Ornipressin binds only to V1

Question 63

What are the signs of desmopressin/ADH toxicity?

Answer 63

* Headache, nausea, abdominal cramps, agitation, allergic reactions * Avoid in , < 5 years, > 65 years * Limit fluid intake to a minimum Excess intake → hyponatremia * Discontinue if vomiting and diarrhoea * Avoid drugs that release vasopressin * E.g. tricyclic antidepressants

Question 64

What drug is a synthetic vasopressin analogue?

Answer 64

Desmopressin

Question 65

T or F - Desmopression is longer acting than vasopressin?

Answer 65

True

Question 66

What is the indication for desmopressin?

Answer 66

Used in the treatment of diabetes insipidus, nocturnal enuresis, mild haemophilia A and von Willebrands disease

Question 67

What is the MOA for desmopressin?

Answer 67

V 2 activity only → negligible vasoconstriction

Question 68

How is desmopressin administered?

Answer 68

IN / IV / subcut / oral ♦ IN → less effective if congestion present ♦ Bedtime desmopressin IN → ↓ nocturnal enuresis ♦ Has Factor VIII releasing activity → ↑ levels in von Willebrands and mild haemophilia A