HPA - bk Flashcards by Jerry Sojan

GH receptor

jak stat

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Criteria for dx of GH deficiency

growth rate of < 4 cm per year

no GH in serum despite bein g given to secretagogyes

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Name the recombiant Growth Hormone(s)

Somatropin - recombiant GH

Somatrem - GH analogue

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~*Effects of somatropin and somatrem in GH deficient adults

improved metabolic state
increased lean body mass
sense of well being

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~* Effects of somatropin and somatrem in HIV positive patients

increased lean body mass and weigh and physical endurance

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Use of somatropin and somatrem in short bowel syndrome

improved GI function when receiving specialized nutritional support

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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

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A/se of GH in adults

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

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Mecasermin = ?

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

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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)

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A/se mecasermin

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

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How to treat Gh secreting adenomas please

Gh receptor antagonists
Somatostatin analogs
DA receptor agonists

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What is pegvisomant?

GH receptor antagonist

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Ocreotide =

somatostatin

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Ocreotide MOA

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

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Advantage of Ocreotide acetate over ocretoide alone-zees

long acting suspension that you can give at 4 week itnervals

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~*~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 ****

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SHARK: provide acute control for bleeding from esophageal varices

ocreotide!!!

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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

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Name some DA agonists:

bromocriptine (shark flash back - parkinsons)

cabergoline

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Treat a pit adenoma that is secreting a bunch a prolactin

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

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Uses of Bromocriptine/cabergoline

hyperprolatinemia

acromegaly (alone or with surgery, radiation, ocreotide)

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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

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Name the analogs of FSH and LH

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

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

choriogonadotropin = recominant

how do you give choriogonadotropin?

SC or IM

Receptor of gonadotropins please :)

GPCRs

CLinical application of gonadotropins

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

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

Name the Gonadotropin releasing hormone analgos

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

If I say goserelin, you think?

leuprolide and nafarelin | GNRH analogs

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

Advantage of goserlin/leuprolide and nafenlin vrs gonadorelin

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

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

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)

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

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

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

~*~ DOC @ endometriosis

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

~*~ DOC @ uterine leiomyomata

leuprolide, goserelin, nafarelin

~*~ DOC @ prostate cancer

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

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

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

Name the GNRH receptor ANTAGONISTS

Cetrorelix Ganirelix COMPETITVE antags of GnRh receptors

Cxl app for cetrorelix and ganirelix

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

Name the adrenocorticotropic hormone analogs

corticotropin cosyntropin ACTH analogs

I say MC2R, you think?

a GPCR = icnreased cAMP

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!!

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

Uses of oxytocin

IV -- initation and augmentation of labour IM -- used to control postpartum bleeding

Control the uterine hemorrhage!!!

oxytocin. bamalam

Control the esophageal varice bleeding!

ocreotide!

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!)

What is Atosiban?

oxytocin antagonist

Uses of atosiban

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

Name the ADH agonists

vasopression | desmopressin

MOA and kinetic-y things of Desmopressin please

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

DOC @ diabetes insipiduse

vasopression | desmopression

uses for vasopression

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

uses for demsopressin

coagulopathy treatment in hemophilia A and vWF disease

Name a vasopressin antagonist and its love for what receptors

conivaptan loves V1 AND V2.

DOC @ hemophilia A and vWf

desmopressin

DOC @ colonic diverticular bleeding

vasopressin

`DOC @ patients with hypnatremia due to elevated vasopression

conivaptan