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🄼💊MSY2 Pharm (Endocrine/Repro/Thyroid) > Hypothalamus / Pituitary > Flashcards

Hypothalamus / Pituitary Flashcards

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1
Q

Long loop negative feedback

A

1° Hormone inhibits Pituitary and/or Hypothalamus

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2
Q

short loop negative feedback

A

2° Hormone inhibits Hypothalamus

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3
Q

ultra short loop negative feedback

A

3° Hormone inhibits Hypothalamus

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4
Q

Which pituitary hormones function through [G protein coupled receptors] (4)

A

FAT Lacy was a G!

TSH, ACTH, FSH, LH

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5
Q

Which pitutiary hormones function through [JAK/STAT receptors] (2)

A

GH and Prolactin

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6
Q

Physiological action of GH in children (5)

A

Linear Growth of

  • long bones
  • cartilage
  • muscle
  • organ systems

+ [Blood Glucose promoter]

primary determinant of adolescent growth spurt

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7
Q

Physiological Action of GH in Adults (3)

A
  1. Catabolic for Fat
  2. Anabolic for Muscle & Bone
  3. Blood Glucose Promoter (INC Blood Glucose)
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8
Q

When are GH pulses generated

A

During sleep

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9
Q

Mechanism of GH pulsation

A

Interplay of GHRH and Somatostatin

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10
Q

GH tends to ____[DEC/INC] with age

A

DEC

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11
Q

Effects of GH are mostly mediated by _____, which is released from the ____ in response to ___

A

Effects of GH are mostly mediated by IGF1, which is released from the liver in response to GH

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12
Q

In addition to Musculoskeletal changes, what other changes occur in Adults with GH deficiency (3)

A
  • Hyperlipidemia
  • Cardiac Muscle Atrophy
  • [Fatigue / Depression / Malaise]
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13
Q

Adult onset GH deficiency is typically due to what?

A

Pituitary problem

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14
Q

Drugs for GH deficiency (4)

A

Sermorelin

Somatropin

Somatrem

Mecasermin

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15
Q

Name a Synthetic GHRH

A

Sermorelin

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16
Q

Somatropin Drug Class

A

Recombinant Human GH

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17
Q

Name 2 [Recombinant Human GH]

A
  1. Somatropin
  2. Somatrem
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18
Q

Mecasermin Drug Class

A

Recombinant IGF1

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19
Q

Sermorelin Indication

A

Defective hypothalamic GHRH release

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20
Q

Somatropin Indication (5)

A

SPAWN

  1. Pediatric growth failure (associated w/GH/chronic Renal Failure/Prader Willi/Turner)
  2. No idea: Idiopathic short stature (>2.25 SD below mean height)
  3. Adult GH deficiency
  4. Wasting in AIDS pts
  5. Short Bowel Syndrome in pts receiving nutritional support (it INC SA for digestion)
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21
Q

Somatrem Indication (5)

A

SPAWN

  1. Pediatric growth failure (associated w/GH/chronic Renal Failure/Prader Willi/Turner)
  2. No idea: Idiopathic short stature (>2.25 SD below mean height)
  3. Adult GH deficiency
  4. Wasting in AIDS pts
  5. Short Bowel Syndrome in pts receiving nutritional support (it INC SA for digestion)
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22
Q

Structure of Somatropin

A

Synthetic GH identical to native hGH

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23
Q

Structure of Somatrem

A

Synthetic GH that contains an extra methionine at N-terminus –> INC stability and less hypersensitivity

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24
Q

Somatropin SE (5)

A
  1. Leukemia (rapid melanocytic lesions)
  2. hypOthyroidism
  3. Insulin Resistance
  4. Arthralgia
  5. INC Cytochrome P450
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25
Somatrem SE (5)
1. Leukemia (rapid melanocytic lesions) 2. hypOthyroidism 3. Insulin Resistance 4. Arthralgia 5. INC Cytochrome P450
26
Somatropin Contraindications (4)
- Pedatrics with closed epiphyses - Active intracranial lesion - Malignancy - Diabetic Retinopathy
27
Somatrem Contraindications (4)
- Pedatrics with closed epiphyses - Active intracranial lesion - Malignancy - Diabetic Retinopathy
28
Mecasermin Indication
Pediatric IGF1 deficiency from [Laron GH receptor Dwarfism] vs. [Ab against GH]
29
Tx for GH microadenoma (3)
1. Octreotide/Lantreotide 2. Pegvisomant 3. Bromocriptine ## Footnote *MACROAdenomas are surgically removed*
30
Octreotide [Drug Class and MOA]
Somatostatin Analogue (45x more potent and long lasting) --\> blocks GH secretion
31
Why isn't somatostatin used clinically?
short half-life
32
Octreotide Indications (4)
* Pitutiary microadenoma * Carcinoid Crisis (flushing/diarrhea/Cyanosis) * Secretory Diarrhea 2° to VIP tumors * Acute GI Bleeding
33
Octreotide SE (4)
"8 sums **C**an **B**e **H**airy & **G**ross" ## Footnote - GI sx (NV / GI discomfort) - Bradycardia & Conduction problems - hypOglycemia - Cholelithiasis
34
Octreotide Contrainidcations
Hypersensitivity
35
Pegvisomant [Drug Class and MOA]
[GH R Blocker] **and** does not appropriately bind to second GH receptor --\> Blocks dimerization and signal transduction --\> DEC IGF1
36
**P**EGvisomant Structure
Recombinant with [multiple **P**EG (PolyEthylene Glycol)] residues --\> prolongs half life
37
Pegvisomant Indications (2)
Refractory Acromegaly Pituitary microadenoma
38
Pegvisomant SE (2)
* INC Pitutiary Adenoma Size (pts being treated with Pegvisomant should have yearly MRI to exclude enlarging adenoma) * INC Aminotransferase levels
39
Pegvisomant Contraindication
Hypersensitivity
40
Successful tx of infertility due to neuroendocrine factors depends on \_\_\_\_\_
Competent Gonads
41
Source of Menotrophins (FSH & LH)
Urine of Menopausal Women
42
Source of Urofollitrophin
Urine of **Post**Menopausal Women
43
Name the Gonadotropins (4) and what their MOA is
Replaces FSH and LH - Menotrophins (FSH and LH) - hCG - Urofollitropin (FSH from menopausal women urine) - Follitropin
44
Gonadotropins Indication (3)
1. Ovulation in [women with hypOgonadotropic hypOgonadism] vs. IVF 2. PCOS/Obesity 3. Infertility in [Men with hypogonadotropic hypOgonadism]
45
Gonadotropin SE (4)
* Ovarian hyperstimulation syndrome (ovarian enlargement/Ascities/Hydrothorax/Shock) * Multiple Pregnancies * Gynecomastia * [Ovarian CA / cyst / Hypertrophy]
46
Gonadotropin Contraindications (5)
- Use in any endocrine DO other than anovulation - 1° gonadal failure - [Pituitary vs. Sex-hormone dependent] Tumors - [Ovarian CA/Cyst/Hypertrophy] - Pregnancy
47
How does GnRH or [short half life GnRH analog] affect gonadal axis
Stimulates Gonadtroph cells to make/secrete LH & FSH
48
Gonadorelin SE (4)
Anaphylaxis with multiple administration Lightheadedness Flushing Generalized Hypersensitivity Dermatitis
49
List [**long half life/HIGH potency**] GnRH analogs (5)
**G**o **L**earn **H**x **N**' **T**rip **G**oserelin **L**euprolide **H**isterelin **N**afarelin **T**riptorelin *3 hour Half life*
50
[GnRH analog] MOA
**Desensitizes** GnRH receptors and **inhibits** FSH and LH release | (i.e. Leuprolide, Triptorelin)
51
Biphasic Effect of [GnRH analogs]
1st: Flare = Transient (7-10 days) INC in gonadal hormone levels from agonist effect 2nd: Long-lasting suppresion of Gonadotropins and gonadal hormones from inhibition
52
Triptorelin Indication
[Androgen dependent Prostate CA] adjunct
53
Histerelin Indication
[Androgen dependent Prostate CA] adjunct
54
Goserelin Indication (2)
1. [Androgen dependent Prostate CA] adjunct 2. Endometriosis & Uterine Fibroids
55
Nafarelin Indication (3)
1. Endometriosis & Uterine Fibroids 2. Central Precocious Puberty 3. Keeps LH surge low --\> multiple mature oocytes for reproductive technology
56
Leuprolide Indication (4)
1. Endometriosis & Uterine Fibroids 2. Central Precocious Puberty 3. Keeps LH surge low --\> multiple mature oocytes for reproductive technology 4. [Androgen dependent Prostate CA] adjunct
57
[GnRH synthetic analogs] general indication (4)
Advanced Breast CA Advanced Ovarian CA Amenorrhea Infertility in Women with PCOS
58
[GnRH synthetic analog] SE (4)
* [Hot flashes/sweats/HA] * Osteoporosis * Urogenital atrophy * Exacerbation of Precocious Puberty during inital weeks
59
[GnRH synthetic analog] Contraindications (3)
* Hypersensitivity * Pregnancy * Breast Feeding
60
List the [GnRH R Blockers] (3)
"Don't Block me from getting my *Rolex*" 1. Ganirelix 2. Cetrorelix 3. Abarelix *These are Dose-Dependent*
61
How is administration between [GnRH synthetic analogs] and [GnRH R Blockers] different (2)
1. [GnRH R Blockers] produce immediate Blocking effect = Duration of Admin is shorter during IVF 2. [GnRH R Blockers] **don't produce Flare Effect**
62
Ganirelix Indication
Keeps LH surge low in IVF --\> Improved implantation/pregnancy
63
Cetrorelix Indication
Keeps LH surge low in IVF --\> Improved implantation/pregnancy
64
Abarelix Indication (2)
1. Metastatic Prostate CA *(PEE)* 2. Tumor encroaching Spinal Cord *(NERVES)* Abby has no PEE NERVES!
65
Cetrorelix SE (2)
1. Ovarian Hyperstimulation Syndrome 2. Anaphylaxis
66
Abarelix SE (2)
1. Ovarian Hyperstimulation Syndrome 2. QT prolongation ## Footnote *A for Arrhythmia*
67
Ganirelix SE (4)
1. Ovarian Hyperstimulation Syndrome 2. Ectopic Pregnancy 3. Thrombotic DO 4. Spontaneous Abortion
68
[Ganirelix, Cetrorelix, Abarelix] Contraindications (6)
" Don't **PLOT** to kill the **VP** with a rolex" 1. **P**regnancy 2. **L**actation 3. [**O**varian cyst/enlargement **not from PCOS**] 4. **T**hyroid/Adrenal dysfunction 5. **V**aginal Bleeding that's idiopathic 6. **P**rimary Ovarian Failure
69
Drugs given during [Follicular Proliferative Phase] during IVF (2)
* Gonadotropin injection is given 3 days after menses to develop Follicles. * [GnRH analogs or GnRH Blockers] are given to prevent premature LH
70
Drug Given when transitioning into [Luteal Secretory Phase] during IVF. How do you know mensturation is transitioning into [Luteal Secretory phase]
**hCG injection** is given when [oocyte follicles are mature] (assesed with serum estrogen & US) --\> Ovulation
71
Physiologic Actions of Prolactin (3)
1. Mammogenesis 2. Milk production and secretion 3. Suppresses Ovulation by inhibiting GnRH release
72
Most common cause of Hyperprolactinemia
Prolactinoma
73
Hyperprolactinemia Tx and why (3)
1. Bromocriptine 2. Cabergoline 3. Pergolide These are [D2 Dopamine Agonist]
74
Prolactin Deficiency Tx
None
75
Bromocriptine Indication (5)
1. Pituitary Prolactinoma 2. PMS 3. Acromegaly (Use High Doses and only if tumor secretes both Prolactin & GH) 4. Parkinson's Dz 5. Type2DM
76
Pergolide Indication
Parkinson's Dz
77
Cabergoline Indication (3)
1. Pituitary Prolactinoma 2. PMS 3. Parkinson's Dz
78
Bromocriptine SE (3)
1. Orthostatic hypOtension 2. Vascular Dz (CVA vs. MI) 3. Seizure
79
Cabergoline SE (3)
1. Orthostatic hypOtension 2. Pulmonary Fibrosis 3. Pleural Effusion
80
Pergolide SE (2)
1. Orthostatic hypOtension 2. **Heart** Vascular Dz (Arrhythmia/MI/HF)
81
[Bromocriptine, Cabergoline, Pergolide] Contraindications (3)
* Ergot Derivative Hypersensitivity * Uncontrolled HTN * Pregnancy Toxemia

🄼💊MSY2 Pharm (Endocrine/Repro/Thyroid) (6 decks)

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