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pharm 2 > Parathyroid, Pituitary, Adrenal disorders > Flashcards

Parathyroid, Pituitary, Adrenal disorders Flashcards

1
Q

Medications for parathyroid

A

Hypoparathyroidism
-Vitamin D
-Calcitriol

Hyperparathyroidism
-Bisphosphonates
-Calcimimetics

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2
Q

Medications for Pituitary

A

Hypothalamic/Anterior Pituitary Hormones
-Corticotropin (H.P Acthar)
-Cosyntropin (Cortrosyn)
-Follitropin alfa (Gonal-F)
-Follitropin beta (Follistim AQ)
-Goserelin (Zoladex)
-Histrelin (Supprelin LA, Vantas)
-Lanreotide (Somatuline Depot)
-Leuprolide (Lupron)
-Menotropins (Menopur)
-Nafarelin (Synarel)
-Octreotide (Sandostatin)
-Somatotropin (Humatrope, Genotropin)
-Urofollitropin (Bravelle)

Posterior pituitary
-Desmopressin (DDAVP)
-Oxytocin (Pitocin)
-Vasopressin (ADH)(Vasostrict)

Dopamine agonists
-Bromocriptine (Cycloset, Parlodel)
-Cabergoline

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3
Q

Medications-Adrenal

A

Corticosteroids
-Betamethasone (Celestone, Diprolene)
-Cortisone
-Dexamethasone (Decadron)
-Fludrocortisone
-Hydrocortisone (Corteg)
-Methylprednisolone (Medrol)
-Prednisolone (Orapred, Pediapred)
-Prednisone (Deltasone)
-Triamcinolone (Kenalog, Nasacort, Aristrospan)

Inhibitors of Adrenocorticoid Biosynth or fxn
-Eplerenone (Inspra)
-Ketoconazole (Nizoral)
-Spironolactone (Aldactone)

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4
Q

Hypoparathyroidism tx

A

*1. Oral calcium carbonate
-increases serum calcium, cheap
-high dose= constipation (bc heavy metals)
*2. Vitamin D (Calcitriol)
-increases calcium absorption and phosphorus excretion in GI tract
3. Recombinant human parathyroid hormone (Natpara)-> for pts failing multiple things

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5
Q

Hyperparathyroidism

A

1st line: Surgery (parathyroidectomy)
2nd line: meds if surgery not possible, symptoms, severe Hypercalcemia, Osteoporosis
1. Bisphosphonates (-onate)
-MOA: bind to active sites of bone remodeling-> decrease bone resorption and inhibit osteoclasts-> residual benefits when stopped
-indications: any condition from excess bone resorption
–alendronate, ibandronate, risedronate, zoledronic acid– familiar w/ names
-AE: OSTEONECROSIS OF THE JAW (chornic use), hypocalcemia, fragility fractures
-AVOID IN RENAL INSUFF (BC HOW ELIM) AND HYPOCALCEMIA- if cant be upright for 30 min or swallowing disorders-> TAKE WITH FULL GLASS OF WATER
2. Calcimimetics (dont need to know)
3. Combination therapy

KNOW exists:
Sevelamer (Renagel, Renvela)= phosphate binder
-tx high phos and 2ndary hyperparathyroidism

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6
Q

Glossary

A

-tropin = stimulating effect of a hormone or target organ

-statin = stops others from being secreted

-medin = to intercede/middle of

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7
Q

Pituitary hormones- ACTH

A

preps specific to hormonal def: IM, SQ, Intranasal
Oral= susceptible to proteolytic degradation by GI

Anterior pituitary:
ACTH
- diurnal rhythm conc highest in early AM
-stress-> secretion which cortisol then feedback mech to suppress release

MOA: Stim Adrenal Cortex to secrete Adrenal steroids (including cortisol)

Therapeutic uses: DIAG TOOL TO DIFF PRIMARY (ADDISONS= DESTRUCTION) VS SECONDARY ADRENAL INSUFF (NO ACTH FROM PITUITARY)

Synthetic human ACTH= Cosyntropin
-DIAG TOOL AND TX INFANTILE SPASMS AND MULTIPLE SCLEROSIS

AE: SHORT TERM IS FINE
LONG TERM= LIKE GLUCOCORT= HTN, EDEMA, HYPOK, EMOTINOAL DISTURB

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8
Q

Growth Hormone or Somatotropin

A

Hypoth: GHRH
Pituit: GH
Inhibition: Somatostatin
released in pulsatile manner-> highest during sleep-> GH decreases with less muscle mass in elderly

Synthetic GH= recombinant DNA tech
MOA: EFFECTS DIRECTLY AT TARGETS OR THROUGH SOMATOMEDINS (INSULIN LIKE GROWTH FACTORS 1 AND 2)
-acromegaly
-gigantism

Therapeutic uses:
TX OF GH DEFICIENCY
GROWTH FAILURE IN KIDS
HIV W/ CACHEXIA (WASTING SYND)
REPLACE GH IN ADULTS W/ DEFICIENCY

AE: pain at injxn site, edema, arthral

Contraind:
1. NO KIDS W/ CLOSED EPIPHYSES
2. PTS W/ DIABETIC RETINOPATHY
3. OBESE W/ PRADER WILLI SYND (mc obesity syndrome)

Adults lead to : increased muscle mass, higher bone density, increased skin thickness, lower adipose tissue
OFF LABEL USE BY ATHLETES PERFORMANCE ENHANCEMENT

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9
Q

Growth Hormone Inhibiting Hormone (Somatostatin)

A

Suppress GH and TSH release (insulin, glucagon, and gastrin too)
receptors w/in neurons in hypoth, intest, stomach, pancreas

Octreotide and Lanreotide:
tx of : ACROMEGALY
octreotide= IV USE FOR ESOPHAGEAL VARICES

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10
Q

Gonadotropin-releasing hormone agonists/Analogs

A

stim FSH and LH from the anterior pituitary

Leuprolide (Lupron)
-synthetic GnRH analong
-suppresses production of FSH and LH
Indications:
-ADVANCED PROSTATE CANCER
-ENDOMETRIOSIS
-PRECOCIOUS PUBERTY
-SUPPRESS LH SUG AND PREMATURE OVULATION IN WOMEN IN CONTROLLED OVARIAN STIMULATION PROTOCOLS FOR TX OF FERT

AE: hot flushes, low libido

Contra:
PREGNANCY
BREASTFEEDING

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11
Q

Gonadotropins

A

FSH and LH
long list-> dont mem (menotropins, urofollitropin, hcg)
IM OR SQ
AE: OVARIAN ENLARGEMENT
OVARIAN HYPERSTIMULATION SYNDROME-> CAUSING MULTIPLE BIRTHS

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12
Q

Prolactin

A

peptide hormone secreted by anterior pituitary
PRIMARY FXN TO STIM AND CONTINUE LACTATION
-DRUGS ACTING AS DOPAMINE ANTAGONISTS -> INCREASE PROLACTIN SECRETION BC DOPAMINE INHIBIT SECRETION

Hyperprolactinemia: galactorrh and hypogonadism
-TX W/ DOPAMINE 2 RECEPTOR AGONISTS
1. BROMOCRIPTINE- alt tx for T2DM
2. CABERGOLINE
both tx PITUITARY MICROADENOMAS

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13
Q

Posterior pituitary

A

Vasopressin and Oxytocin w/ no releasing hormones (synth in hypoth and released in response to physio)=
HIGH PLASMA OSMOLARITY AND PARTURITION (DELIVERY)

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14
Q

Oxytocin (Pitocin)

A

love hormone
-IN OBSTETRICS TO STIM UTERINE CONTRACTIONS AND INDUCE LABOR + MILK EJECTION
-AE: htn, uterine rupture, water retention, fetal death

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15
Q

Vasopressin

A

aka ADH antidiuretic hormone
BOTH AN ANTIDIURETIC AND VASOPRESSOR
-KIDNEY-> INCREASES WATER PERMEABILITY AND RESORPTION IN COLLECTING TUBULES
-TISSUES-> VASCULAR SMOOTH MUSCLE CONSTRICTION

Uses:
-MAJOR ENDOCRINOLOGIC USE IN DIABETES INSIPIDUS
-septic shock

AE:
-WATER RETENTION
-HYPONATREMIA

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16
Q

Desmopressin

A

MINIMAL PRESSOR EFFECTS
PREFERRED OVER VASOPRESSIN IN TX FOR DIABETES INSIPIDUS AND NOCTURNAL ENURESIS (bed wetting)

CAUSING SEIZURES IN KIDS IF USED IN NASAL SPRAY FORM

17
Q

regulation of corticosteroid secretion

A

Zona glomerulosa-> Aldosterone (mineralcorticoid- electrolyte regulating)
Zona Fasiculata -> Cortisol (glucocorticoid- metabolic activity)
Zona Reticularis -> Androgens (Corticosteroid)
Medulla-> Epi and Norepi

18
Q

corticosteroid activity

A

MECHANISM MEANS EFFECTS TAKE HOURS TO DAYS TO OCCUR

binds to receptor-> dimerizes- recruits coactivator-> translocates in to the nucleus-> attaches to gene promoter elements

19
Q

Activity of ALL glucocorticoids

A
  1. Promote normal intermediary metabolism
  2. increase resistance to stress
  3. Alter blood cell levels in plasma
  4. possess antiinflammatory action
  5. affect other systems
20
Q

Adrenal hormones

A

Corticosteroids:
-betamethasone
-cortisone
-dexamethasone
-fludrocortisone
-hydrocortisone
-methylprednisolone
-prednisolone
-prednisone
-triamcinolone

inhibitors:
-eplerenone
-ketoconazole
-spironolactonve

21
Q

Corticosteroids uses

A

replacement therapy
tx: allergic rxns
-asthma, RA, inflamm disorders

Effects:
ANTI INFLAMM EFFECTS
SALT RETAINING EFFECTS

22
Q

Hydrocortisone in addisons

A

Addisons= Primary Adrenocortical Insufficiency
tx: hydrocortisone-> 0 tx = DEATH
DOSED TO MIMIC DIURNAL VARIATION OF CORTISOL (2/3 DOSE IN AM 1/3 DOSE EVENING)

may need FLUDROCORTISONE to correct mineralcorticoid deficiency

2ndary-> defect in ACTH production by pituitary-> tx hydrocortisone

3rd-> defect in CRH production by hypothalamus-> tx hydrocortisone

23
Q

Dexamethasone in Diagnosing Cushing Syndrome

A

Cushing syndrome: hypersecretion of glucocorticoids-> excess ACTH by anterior pituitary or adrenal tumor

cortisol levels + deamethasone suppression test= diagnose cushings

DEXAMETHASONE SUPPRESSES CORTISOL RELEASE IN NORMAL BUT NOT IN CUSHINGS-> CHRONIC HIGH DOSES OF GLUCOCORTICOIDS CAN CAUSE CUSHING SYNDROME

24
Q

Replacement therapy for Congenital Adrenal Hyperplasia

A

enzyme defect in synth of adrenal steroid hormones

CHOICE OF REPLACEMENT DEPENDS ON SPECIFIC ENZYME DEFECT

25
Q

Corticosteroids for relief of inflammatory sxs

A

high reduction w/ RA and skin conditions-> persistent or exacerbation of asthma or IBD

INTRAARTICULAR CORTICOSTEROIDS USED FOR TX OF OSTEOARTHRITIC FLARE
NEVER CURATIVE

26
Q

Corticosteroids in tx of allergies

A

beneficial in tx of allergic rhinitis, drug, serum, transfusion allergic rxns

fluticasone-> MDI for allergic rhinitis and asthma
inhalation minimizes systemic effects

27
Q

Acceleration of Lung maturation

A

fetal cortisol is a regulator of lung maturation
BETAMETHASONE OR DEXAMETHASONE IM to MOTHER W/IN 48 HRS PRIOR TO PREMATURE DELIVERY CAN ACCELERATE LUNG MATURATION IN FETUS AND PREVENT RESPIRATORY DISTRESS SYNDROME

28
Q

PHARMACOKINETICS OF CORTICOSTEROIDS

A

oral readily absorbed
ALL FORMS ARE SYSTEMICALLY ABSORBED TO SOME EXTENT AND HAVE THE POTENTIAL TO SUPPRESS THE HYPOTHALAMIC-PITUITARY-ADRENAL (HPA) AXIS

PREDNISONE PREFERRED IN PREGNANCY bc fetal liver cannot convert it to an active compound

4 STEROID INJECTIONS PER YEAR MAXIMUM

29
Q

Routes of administration and elimination of corticosteroids

A

admin: IM, IV, inhaled, oral, intra articular, topical

ELIM THROUGH URINE

30
Q

Dosing of corticosteroids and AE

A

IF LARGE DOSES OF CORTICOSTEROID ARE USED FOR >2 WEEKS = HPA suppression occurs

AE: OSTEOPOROSIS bc suppress intestinal Ca absorption, inhibit bone formation, decrease synthesis of sex hormones

GIVE CALCIUM ADN VITAMIN D SUPPLEMENTS

BISPHOSPHONATES TO TX GLUCOCORTICOID INDUCED OSTEOPOROSIS

INCREASED APPETITE IS DESIRABLE EFFECT IN CA CHEMO PTS

HYPERGLYCEMIA-> MASK BS IN DM PTS

CLASSIC CUSHING LIKE SIGNS= EXCESS CORTICOSTEROID REPLACEMENT

CATARACTS= LONG TERM USE

topical: skin atrophy, eccymosis, purple striae

31
Q

Discontinuation of corticosteroids

A

IF HPA AXIS IS SUPPRESSED> SUDDEN DISC = SERIOUS CONSEQUENCES= DEATH

ABRUPT DISCONTINUATION OF CORTICOSTEROIDS-> ACUTE ADRENAL INSUFFICIENCY THAT CAN BE FATAL= DOSE MUST BE TAPERED SLOWLY TO INDIVIDUAL TOLERANCE AND MONITOR CAREFULLY

32
Q

Inhibitors of Adrenocorticoid biosynthesis or fxn

A
  1. KETOCONAZOLE-> NONSTEROIDAL ANDROGEN ANTAGONIST
    MOA: inhibits synthesis of gonadal and adrenal
    TX CUSHINGS
  2. EPLERENONE-> binds mineralcort receptor= ALDOSTERONE ANTAGONIST
    tx htn and HFref w/out gynecomastia
  3. SPIRONOLACTONE-> htn med= competes for mineralcorticoid receptor which inhibits Na resorption by kidney= NONSTEROIDAL ANDROGEN ANTAGONIST
    - TX : HYPERALDOSTERONISM
    PCOS
    HEPATIC CIRRHOSIS
    HFref
    HIRSUTISM IN WOMEN= ANTIANDROGEN ACTIVITY ON THE HAIR FOLLICLE

pharm 2 (15 decks)

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