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Flashcards in HPA - bk Deck (63):
1

GH receptor

jak stat

2

Criteria for dx of GH deficiency

growth rate of < 4 cm per year
no GH in serum despite bein g given to secretagogyes

3

Name the recombiant Growth Hormone(s)

Somatropin - recombiant GH
Somatrem - GH analogue

4

~*Effects of somatropin and somatrem in GH deficient adults

improved metabolic state
increased lean body mass
sense of well being

5

~* Effects of somatropin and somatrem in HIV positive patients

increased lean body mass and weigh and physical endurance

6

Use of somatropin and somatrem in short bowel syndrome

improved GI function when receiving specialized nutritional support

7

A/se of somatropin and somatrem

generally well tolerated BUT
* scoliosis (due to rapid growth)
* hypothyroidism
* intracranail hypertension - rare
* otitis media (increased risk at turners)
* pancreatitis
* gynecomastia
* nevus growth
* diabetic syndrome (opposes insulin) at chronic used

8

A/se of GH in adults

peripheral odema
myalgia
arthralgia @ hand and wrists
carpal tunnel syndrome
proliferative retinopathy
**ie think acromegaly symtpoms

9

Mecasermin = ?

recombinant IGF-1 analog and recombinant IGF-binding protein 3

10

use of Mecasermin?

children wtih growth faiure that have an IGF-1 deficiency (due to mutations in GH receptor and development of neutralizing Gh abs)

11

A/se mecasermin

** opposite of what you would think = hypglycemia
intracranial hypertension
asymptomatic elevation fo lvier enzymes

12

How to treat Gh secreting adenomas please

Gh receptor antagonists
Somatostatin analogs
DA receptor agonists

13

What is pegvisomant?

GH receptor antagonist

14

Ocreotide =

somatostatin

15

Ocreotide MOA

inhibits release of GH, TSH, glucagon, insulin and gastrin

16

Advantage of Ocreotide acetate over ocretoide alone-zees

long acting suspension that you can give at 4 week itnervals

17

~*~Use of Ocreotide

1) reduce symptoms caused by all the lil hormone secreting tumours (acro, carcinoid, gastrinoma etc)
2) localizing neuroendocrine tumours
3) acute control of esophageal varices ******

18

SHARK: provide acute control for bleeding from esophageal varices

ocreotide!!!

19

A/se for DOC @ gastrinoma

n/v, ab cramps, flatulence, steatorrhea
constipation
biliary sludge and gallstones
sinus bradycardia and conduction disturbaces
vitamin B 12 deficiency@ long term use

20

Name some DA agonists:

bromocriptine (shark flash back - parkinsons)
cabergoline

21

Treat a pit adenoma that is secreting a bunch a prolactin

bromocriptine or cabergoline
DA agonists (inhibi of prolactin @ pti)

22

Uses of Bromocriptine/cabergoline

hyperprolatinemia
acromegaly (alone or with surgery, radiation, ocreotide)

23

A/se bromocriptine/cabergoline

nausea (worse with B over C), h/a light headedness, orthostatic hypotension, fatigue
psych manifestations
high dose = cold induced peripheral digital vasosapsm
pulmonary infiltirares - chronic high doages terapy **repeat from parkinson lecture = pulmoanry infiltrates with ergot derviatives

24

Name the analogs of FSH and LH

menotropins - FSH and LH
follitropin - recombinant FSH
urofollitropin - purified human FSH extract

25

Name the human chorionic gonadotropin extract and where we get it from

choriogonadotropin = recominant

26

how do you give choriogonadotropin?

SC or IM

27

Receptor of gonadotropins please :)

GPCRs

28

CLinical application of gonadotropins

1) ovluation induction
2) male infertility (FSH and LH required; can give choriogonadotropin alone or with urofollitropin, rFHS and rLH)

29

A/se of gonadotropins in a) women and b) men

WOMEN - ovarion hyperstimulation syndrome + multiple pregnancies (ie mom getting jerm and jerm <3), headache, depression, oedema, precocious pubery
MEN - gyneCOmastiaaa

30

Name the Gonadotropin releasing hormone analgos

gonadorelin - GnRH
goserelin - GNRH analog
leuprolide - GnRH analog
nafarelin - GnRH analog

31

If I say goserelin, you think?

leuprolide and nafarelin
GNRH analogs

32

Describe the differences in the effects of PULSATILE and SUSTAINED NONPULSATILE administration of GnRH (gonadorelin, goserelin, leuprolide, nafarelin)

pulsatlie - stimulats release of LH and FSH ie jsut liek real physiology time

sustained non pulsatile - inhibits FSh and LH --> hypogonadism

33

Advantage of goserlin/leuprolide and nafenlin vrs gonadorelin

analogs (goserelin, leuprolide and nafenelin) are more potent and longer lasting than gonadarelin

34

Describe the PK of the gonadtropin releasing hormone and analogs

gonadorelin - IV or Sc
analongs (goserelin ,leuprolide, naferelin) --> SC, IM , nasal (naferlin), Sc implant NOT IV!!! makes sense bc of long t1/2 - wont be used in emergent sitautions

35

If I give a patient a continuous administartion of gonadorelin what would I expect to see?

a BIPHASIC response
a) first 7 days get a reponse flare
b) chronic effects - inhibitory (downregulation and changes in signalling pathways)

36

Clinical applications of the GNRh and analogues

1) Female infertility - UNCOMMON

2) Male infertility - with hypothalamic hypogonagotropic hypogonadism @ pulsatile gonadorelin

3) diagnosis of LH responsiveness - differentiates between pubtery due to constitutional delay of hypogonadotropic hypogonadism

37

~*~ DOC @ controlled ovarian hyperstimulation (SHARK: side effect of mentropins/follitropin and urofollitropin)

Leuprolide and nafarelin (GnRh analgoues) (same treatment as prostate cancer - no nafarelin)

38

~*~ DOC @ endometriosis

leuprolide, goserelin, nafarelin - pain decreased due to cyclical changes of e and p stopped.

39

~*~ DOC @ uterine leiomyomata

leuprolide, goserelin, nafarelin

40

~*~ DOC @ prostate cancer

leuprolide, goserelin ( ovariona hyperstimulation same meds, no nafarelin)

41

Other uses of suppresion by GnRH analogs: times four

a) central precocious puberty with leuprolide and nafarelin (opp prostate cancer and ovarian hyperstimulation - leuprolie and goserelin)
b) advanced breast and ovarian cancer
c) treatmetn of amenorrhoea and infertilty in women wtih PCOD
d) thinning of endometrial lining

42

A/se Gonadorelin

h/a, lightheadedness, n, glusing
swelling at injection site
generalized hypersensitivity dermatitis @ long term administration
rate acute hypersensitivy reactions
**sudden pituitary apoplexy and blindness

43

Name the GNRH receptor ANTAGONISTS

Cetrorelix
Ganirelix
COMPETITVE antags of GnRh receptors

44

Cxl app for cetrorelix and ganirelix

suppression of gonadotropin production - prevent LH surge @ controled ovarian hyperstimulation

45

Name the adrenocorticotropic hormone analogs

corticotropin
cosyntropin
ACTH analogs

46

I say MC2R, you think?

a GPCR = icnreased cAMP

47

Uhoh. Im not sure if the patient has primary adrenal insufficiency/addisons disease or secondary adrenal insufficiency/not enough ACTH around, what do i do?

give em an adrenocorticotropic hormone analog ie coticotropin or cosyntropin hurrah! one day for real!!

48

Effects of small vrs higher doses of oxytocin

1) small dose - increases force and frequency of contractions

2) higher dose - evokes sustained contractions and weak ADH and aldoseterone activitin

3) milk ejection

49

Uses of oxytocin

IV -- initation and augmentation of labour

IM -- used to control postpartum bleeding

50

Control the uterine hemorrhage!!!

oxytocin. bamalam

51

Control the esophageal varice bleeding!

ocreotide!

52

A/se oxytocin

1) excessive uterin contractions
2) inadvertent activation of vasopressin receptors
3) bolus causing HYPOTENSION (opposite of what you'd think from the whole mimicks vasopression/ADH weak activity thing, hurrayy!)

53

What is Atosiban?

oxytocin antagonist

54

Uses of atosiban

preterm labout, jk. not in the US.. canada?

55

Name the ADH agonists

vasopression
desmopressin

56

MOA and kinetic-y things of Desmopressin please

long acting
minimal V1 (vasoconstrictive) effects
antidiuretic : pressin activity - 4000x

57

DOC @ diabetes insipiduse

vasopression
desmopression

58

uses for vasopression

esophageal variceal bleeding (with ocreotide), colonic diverticular bleeding ** vasoconstriction

59

uses for demsopressin

coagulopathy treatment in hemophilia A and vWF disease

60

Name a vasopressin antagonist and its love for what receptors

conivaptan loves V1 AND V2.

61

DOC @ hemophilia A and vWf

desmopressin

62

DOC @ colonic diverticular bleeding

vasopressin

63

`DOC @ patients with hypnatremia due to elevated vasopression

conivaptan