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Pharmacology > Hypothalamic and Pituitary Hormones > Flashcards

Hypothalamic and Pituitary Hormones Flashcards

1
Q

What hormones are released by the posterior pituitary?

A

ADH
Oxytocin

Both are made in hypothalamus, then stored and released in post pituitary

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2
Q

What hormones are released by the anterior pituitary?

A 
TSH
ACTH
LH
FSH
GH
Prolactin
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3
Q

What is the main target organ for GH?

A

Liver (stimulates production of IGF-1)

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4
Q

What inhibits GH production in anterior pituitary?

A

Somatostatin, released by hypothalamus, inhibits GH production in ant pituitary

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5
Q

What inhibits prolactin production in anterior pituitary?

A

Dopamine from the hypothalamus inhibits prolactin production in the anterior pituitary

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6
Q

How does GH affect both muscle cells and adipose tissue?

A

Muscle cells – increase glucose and AAs uptake, stimulating production of proteins

Adipose tissue – decrease glucose uptake; Lipolysis is stimulated

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7
Q

GH Physiological Actions in Children and Adults

A

Children: promotes linear growth of long bones, cartilage, muscles, organs

Adults: Increase protein synthesis in muscle, Lipolysis, opposes glucose uptake into adipose tissue

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8
Q

Features of GH Deficiency in Children and Adults

A

Children: Short stature, adiposity, hypoglycemia

Adults: Adiposity, Decreased skeletal muscle mass, decreased bone density, CV changes, Fatigue

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9
Q

Sermorelin

MOA and Indication

A

Synthetic GHRH

Used when there is defective release of GHRH but normally functioning ant pituitary somatotrophs

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10
Q

Somatotropin and Somatrem

MOA

A

Recombinant human GH

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11
Q

Mecasermin

MOA and Indication

A

Recombinant IGF-1

Used in children where IGF-1 deficiency is caused by mutation of GH receptor (Laron dwarfism or development of Abs against GH)

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12
Q

Somatotropin and Somatrem

Indications

A

Documented growth failure in patients with GH deficiency

Prader-Willi Syndrome (mutation in GH)

Turner Syndrome (XO)

GH deficiency in adults

Wasting in AIDs pts

Short bowel syndrome

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13
Q

Somatotropin and Somatrem

Adverse Effects

A 
Leukemia, rapid growth of melanocytic lesions
Hypothyroidism
Insulin resistance
Arthralgia
Increase in CYP450 activity
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14
Q

Somatotropin and Somatrem

Contraindications

A

Pediatric pts with closed epiphyses
Active underlying intracranial lesion
Active malignancy
Progressive diabetic retinopathy

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15
Q

Features of GH Excess in Children and Adults

A

Children: Gigantism

Adults: Acromegaly
Large facial structures, thickened bones, macroglossia, hepatomegaly, increased risk of CV disease and GI cancers

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16
Q

Octreotide

MOA

A

Somatostatin analog, inhibits GH secretion

Lanreotide is another somatostatin analog used in Europe

17
Q

Octreotide

Indications

A

Controlling pituitary adenoma growth in acromegaly pts

Carcinoid crisis

secretory diarrhea from VIP secreting tumors

Control acute bleeding

18
Q

Octreotide

Adverse Effects

A

GI effects (nausea, vomiting, abd cramp)

Sinus bradycardia and conduction disturbances

Hypoglycemia

Gallstones

19
Q

Pegvisomant

MOA

A

GH receptor antagonist

Prevents dimerization of the GH receptors, cuaisng competitive inhibition of the GH receptor

Has many polyethylene glycol residues to prolong its half life

20
Q

Pegvisomant

Indications

A

Tx of acromegaly that is refractory to other surgical, radiologic, and pharm intervention

21
Q

Pegvisomant

Side Effects

A

Increased pituitary adenoma size (need annual MRI to ensure the adenoma does not grow)

Elevated serum aminotransferase levels (MUST monitor the patient’s LFTs on this drug)

22
Q

Describe the relationship of half lives with GnRH analogues and their ultimate effects on the Gonadal axis

A

GnRH analogs with short half lives are used to stimulate the reproductive axis

GnRH analogs with long half lives are used to inhibit the reproductive axis

23
Q

What drugs may be used to stimulate the gonadal axis?

A

Human menopausal gonadotropins or menotropins

hCG

Urofollitropin (purified FSH from urine)

Follitropin (recombinant FSH)

GnRH or its analogue Gonadorelin with SHORT half life

24
Q

What drugs may be used to inhibit the gonadal axis?

A

Synthetic analogs of GnRH with LONG half lives (Goserelin)

GnRH receptor antagonists (Ganirelix, Cetrorelix, Abarelix)

25
Q

Indications for drugs to stimulate the gonadal axis

A

Hypogonadotropic hypogonadism (anovulation in females, infertility in males)

PCOS

Obesity

Controlled ovarian hyperstimulation in IVF

26
Q

Drugs to stimulate the gonadal axis

Side effects

A

Ovarian hyperstimulation syndrome

Increase in multiple pregnancies

Gynecomastia in men

Ovarian cancer and ovarian cysts

27
Q

Drugs to stimulate the gonadal axis

Contraindications

A

Endocrine disorders other than anovulation

Primary gonadal failure

Ovarian cysts or enlargement

Pregnancy

28
Q 
GnRH Agonists (GnRH or Gonadorelin)
MOA and Indications
A

Both have short half lives and are used to stimulate release of LH and FSH

Indications: Hypogonadism
Stimulating Ovulation
Infertility in men with hypogonadotrophic hypogonadism

29
Q

Goserelin

MOA

A

Sustained, nonpulsatile inhibition of release of LH and FSH in men and women

Desensitizes GnRH receptors

Get an agonist effect for 7-10 days, then long term antagonist effect

30
Q

Goserelin

Indications

A

Keep LH surge low in controlled ovarian hypersimtulation

Endometriosis and Uterine fibroids

Adjunct in prostate cancer

Central precocious puberty

31
Q

Goserelin

Adverse Effects

A

Hot flashes (lack of estrogen, like menopause)

Osteoporosis

Urogenital atrophy

Worsening of precocious puberty during initial week of treatment

32
Q

What are the GnRH receptor antagonists?

A

Ganirelix, Cetrorelix, Abarelix

33
Q

GnRH Receptor antagonists

Indications

A

Keep LH surge low in controlled ovarian hyperstimulation

Metastatic prostate cancer

Pharmacology (67 decks)

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