Hypothal and Pituitary Hormones, Drugs acting on the uterus, gonadal hormones,

Question 1

Mifepristone is classified as what type of drug

Answer 1

Anti progestin (only one we cover)

its works as part of a Two person team with Misoprostol (a PGE1 analogue) for medical abortion

MIFE and MISO!

but when combined==> INC RISK OF GI AE. *DIARRHEA*

Question 2

whats the treatment for Chronic (Addison’s disease)-Primary adrenal Insufficiency

• hyperpigmentation (due to: increased ACTH)
• hyponatremia (hypervolemic type)
• hypotension
• no H+ secretion–>metabolic acidosis (normal anion gap)
• High H+ in serum–> low bicarb
• no K+ secretion–> hyperkalemia

-

Answer 2

Daily hydrocortisone-short acting (increase dose during stress) +

mineralocorticoid (fludrocortisone)

***DO NOT administer glucocorticoids lacking salt- retaining effects or long acting ones either like (Triamcinolone or Dexamethasone)

Question 3

name the Androgen Receptor Antagonists

what the relationship between Bicalutamide, nilutamide & Flutamide?

Answer 3

Flutamide

• Bicalutamide*
• Nilutamide*

Cyproterone

Spironolactone

**Bicalutamide and Nilutamide are similar to flutamide butlower risk of hepatotoxicity

Question 4

whats the treatment for a Prolactinoma

Answer 4

• dopamine agonists (eg., ergot alkaloids such as bromocriptine, cabergoline)
• transsphenoidal resection.

Question 5

Can Methylprednisolone be given via Aerosol or topical admin?

Answer 5

NO! just oral, IM and iV

Question 6

what effect does a Pituitary prolactinoma have on GnRH?

Answer 6

it causes GnRH to ↓ —-> hypogonadism, amenorrhea, galactorrhea & osteoporosis

Question 7

what are expected lab values during Acute adrenal insufficiency, or Addisonian crisis?

Answer 7

Laboratory findings may include hyponatremia, hyperkalemia, metabolic acidosis, azotemia as a consequence of aldosterone deficiency; and hypoglycemia, and eosinophilia as a consequence of cortisol deficiency.

Question 8

how do you administer growth hormone

Answer 8

subcutaneously bc since its a protein it will be broken down too quickly if its given orally

Question 9

list all the ways Triamcinolone can be administered

Answer 9

Aerosol, IM, topical and Oral

not IV

Question 10

What adverse effects are commonly associated with mineralocorticoids?

Answer 10

Hypokalemia

metabolic alkalosis

increased plasma volume

hypertension

Question 11

whats the most common cause of Primary adrenal insufficiency (Addison disease) in the US and worldwide

Answer 11

The most common cause in the United States is autoimmune destruction of the adrenal glands.

The most common cause worldwide is tuberculous adrenalitis.

***In primary adrenal insufficiency, the glands themselves are destroyed so that the patient becomes deficient in cortisol and aldosterone.

Question 12

List the SERMs

TR-TC

Answer 12

Tamoxifen

Raloxifene

Toremifene

Clomiphene

Question 13

List the Competitive GnRH ANTAGONISTS (2)

-relix

Answer 13

Cetrorelix

Ganirelix

*prevents LG surge during controlled ovarian hyperstimulation

SUBCUTANEOUS injection

Question 14

list the Mineralocortocoids

Answer 14

• Aldosterone
Most important mineralocorticoid in humans

• Fludrocortisone

Synthetic corticosteroid. Most commonly prescribed salt-retaining hormone

Question 15

list the synthetic GCs

Answer 15

• Prednisone
• Methylprednisolone
• Dexamethasone
• Beclomethasone
• Triamcinolone

Question 16

a 1000-fold increase in estriol is an indicator of…

Answer 16

fetal well being.

Question 17

list the synthetic GCs that can be given via the aerosol route

Answer 17

Beclomethasone

Triamcinolone

Question 18

list the corticosteroid synthesis inhibitors

Answer 18

Ketoconazole

Aminoglutethimide

Metyrapone

Question 19

list Long-acting glucocorticoids

Answer 19

Dexamethasone

Question 20

Elevated ACTH with low cortisol is diagnostic of _________________

Low ACTH and low cortisol suggest__________

fill in the blank with

primary adrenal insufficiency or

secondary adrenal insufficiency.

Answer 20

primary adrenal insufficiency, particularly in patients who are severely stressed or in shock.

secondary adrenal insufficiency.

Question 21

is primary or secondary adrenal insufficiency being described below

patients are deficient in cortisol because of a lack of ACTH from the pituitary, but aldosterone production is maintained by the renin- angiotensin system. Therefore, volume depletion and hyperkalemia are not present and the patient will not manifest the typical hyperpigmentation.

Answer 21

secondary

Question 22

List the estrogens

MC DEEE

Answer 22

Mestranol

Conjugated estrogen

Diethylstilbestrol

Ethinyl estradiol,

Estrone

Estriol

Question 23

characteristic abnormalities of serum electrolytes in adrenal insufficiency are:

Answer 23

low sodium

high potassium

low bicarbonate

high BUN.

Question 24

What signaling pathway does GH use to mediate its effects via cell surface receptors

Answer 24

Mediates effects via cell surface receptors that activate JAK/STAT signaling cascades

Question 25

what is the name of the anti androgen drug that **inhibits 5α-reductase** **and what are its main clinical uses**

Answer 25

**Finasteride** **Benign prostatic hyperplasia (BPH)** **male- pattern hair loss**

Question 26

In secondary adrenal insufficiency are mineralocorticoids and cortisol levels deficient as in primary (addisons)?

Answer 26

nah, In secondary adrenal insufficiency, the renin-angiotensin system usually is able to maintain near-normal levels of aldosterone **so that the patient is deficient only in cortisol.**

Question 27

what are the 3 ways Cortisol (Hydrocortisone) evokes its antiimflamm effects

Answer 27

matory Effects 1. Inhibition of **phospholipase A2** (through induction & activation of **annexin I**) which blocks arachidonic acid release (major precursor of prostaglandins). 2. **Cyclooxygenase-2 synthesis** is reduced (through inhibition of NF-B) .3. **Induction of MAPK phosphatase I** (inhibits MAPK activated proinflammatory signaling pathways)

Question 28

List GCs that can be given via IV/IM route

Answer 28

Dexamethasone Hydrocortisone Methylprednisolone Prednisolone

Question 29

List the Short -medium acting GCs **"P-M-H"**

Answer 29

**P**rednisone **M**ethylprednisolone **H**ydrocortisone

Question 30

List all the **Androgens** **D(a)MN, SO FO!** (damn, so fo-ward!)

Answer 30

Danazol (a) Methyltestosterone, Nandrolone, Stanozolol Oxandrolone Fluoxymesterone, Oxymetholone

Question 31

list the gonadotropin analogues

Answer 31

Follitropin Urofollitropin hCG Menotropins

Question 32

what is **Secondary adrenal insufficiency and whats the most common cause of it**

Answer 32

**Secondary adrenal insufficiency** is adrenal failure caused by a lack of ACTH stimulation from the pituitary gland. It can be caused by an **autoimmune, infiltrative, metastatic disease of the pituitary.** The most common reason, however, is **chronic exogenous administration of corticosteroids,** *_which can suppress the entire hypothalamic-pituitary-adrenal axis._*

Question 33

List all the **Progestrins** @ PM NNN & DD [@ night, Nani and D get together]

Answer 33

Progesterone Medroxyprogesterone Norgestrel Norgestimate Norethindrone Desogestrel Drospirenone

Question 34

what are the physiological effects of **Growth Hormone (aka: somatotropin)**

Answer 34

* Stimulation of longitudinal growth of bones * Increased bone mineral density * Increased muscle mass (in GH deficient people) * Increased GFR * Stimulation of preadipocyte differentiation into adipocytes * Anti-insulin actions (decreased glucose utilization & increased lipolysis)--\> eventually leads to diabetes * Development & increased function of immune system

Question 35

Dopamine antagonists (eg., antipsychotics) can cause ____________ due to hyperprolactinemia

Answer 35

galactorrhea

Question 36

LIst Intermediate- acting glucocorticoids

Answer 36

**Triamcinolone** just one in this category!

Question 38

what are the two ways Beclomethasone can be admin

Answer 38

aerosol and topical not IV or IM

Question 39

list the corticosteroid antagonists

Answer 39

Mifepristone Spironolactone

Question 40

List GCs that can be given via Topical route

Answer 40

Beclomethasone Dexamethasone Hydrocortisone Triamcinolone

Question 41

List the aromatase inhibitors LAE Lance aux epines

Answer 41

Letrozole Anastrozole Exemestane