L32- Hypothalamic and Pituitary Hormones (gonadotropins) Flashcards Preview

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Flashcards in L32- Hypothalamic and Pituitary Hormones (gonadotropins) Deck (25)
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1

list the gonadotropins

-FSH
-LH
-hCG

2

describe function of FSH, LH in women

FSH --> ovarian follicle development

FSH + LH --> ovarian steroidogenesis

3

describe function of FSH, LH in men

FSH --> i) spermatogenesis, ii) conversion of Testosterone to Estrogen, iii) maintains high local [androgen] in area of developing cells

LH --> stimulates testosterone production

4

what are the clinical applications of gonadotropins

Men --> stimulate spermatogenesis

Women --> induce ovulation (IVF)

5

list the FSH analogs used (explain where they came from)

Follitropin α and β (rFSH) = recombinant FSH

Urofollitropin (uFSH) = purified human FSH extract

6

list the LH analogs used (explain where they came from)

Lutropin alfa = recombinant LH (rLH)

7

_____ = purified extract of FSH and LH

Menotropins or human menopausal gonadotropins (hMG)

8

hCG is extracted / purified from (1) and is administered via (2)

(3) = recombinant hCG, administered via (4)

1- urine
2- IM

3- Choriogonadotropin α (rhCG)
4- SQ

9

describe the different types of male infertility Tx

1) both FSH and LH
2) hCG alone
3) urofollitropin (uFSH), Follitropin α/β (rFSH ), Lutropin alfa (rLH)

10

AEs of gonadotropins in women

-ovarian hyperstimulation syndrome
-multiple pregnancies (15-20%)

-HA, depression, edema, precocious puberty

11

AEs of gonadotropins in men

gynecomastia

12

GnRH agent = (1)
GnRH analog = (2)

-indicate the advantage one has over the other

1- gonadorelin (IV, SQ)

2- goserelin, leuprolide, nafarelin (SQ, IM, nasal spray, SQ implant)

**analogs are more potent, last longer

13

GnRH is released in a (1) fashion in order to release FSH/LH. Gonadotropins stimulate (2) type receptors on target cells. (3) is the result if gonadotropins are released in opposite manner of (2).

1- pulsatile

2- G protein coupled receptors

3- (sustained / non-pulsatile) GnRH inhibits FSH/LH release => hypogonadism in men and women

14

what are the 2 general uses of GnRH and its analogs

Stimulation
Suppression (mostly)

15

list the stimulatory functions of GnRH and its analogs

-female infertility (uncommon, inconvenient, costly)

-male infertility, men w. hypothalamic hypogonadotropic hypogonadism (pulsatile gonadorelin)

-Dx of LH responsiveness: is puberty delayed b/c of constitutional delay or by hypogonadotropic hypogonadism

16

Controlled ovarian hyperstimulartion:
-(1) are used for suppression
-critical to suppress (2) because of (3)

1- leuprolide, nafarelin (GnRH analogs)

2- endogenous LH surge

3- prevent premature ovulation

17

Endometriosis:
-(1) are used for suppression
-suppression will abolish cyclical changes to (2) in order to decrease (3)
-Tx is limited to (4) amount of time

1- goserelin, leuprolide, nafarelin (GnRH analogs)

2- estrogen, progesterone (during menstrual cycle)

3- pain (during menstrual cycle)

4- 6 mos

18

Fibroids = (1):
-(2) agent has (3) function
-combined with (4) supplement administration to improve (5)

1- uterine leiomyomata
2- goserelin, leuprolide, nafarelin (GnRH analogs)
3- reduce fibroid size
4- Fe
5- anemia

19

Prostate Cancer:
-(1) and (2) are the main agents used in Tx
-this regimen is just as effective as (3) in terms of reducing serum testosterone

1- leuprolide, nafarelin (GnRH analogs)
2- androgen receptor antagonist
3- castration

20

(1) are used to treat precocious puberty; (2) is very important before starting (1) treatment

1- leuprolide, nafarelin (GnRH analogs)

2- confirming diagnosis

21

GnRH analogs are used to:
-treat (1) cancer
-treat (2) in women with PCOS
-prepares women for (3) procedure

1- advanced breast cancer, advanced ovarian cancer, prostate cancer

2- amenorrhea

3- endometrial ablation
for women with thinning of endometrial lining and dysfunctional uterine bleeding

22

Gonadorelin = _____, + AEs

GnRH agent (not analog)
-HAs, lightheaded ness, nausea, flushing

-swelling at injection site
-generalized hypersensitivity rxn --> dermatitis (long-term use)
-acute hypersensitivity rxns (rare)

-sudden pituitary apoplexy / blindness in Pts with gonadotropin secreting pituitary tumor

23

GnRH analogs women AEs + contraindication

-Menopausal Sxs: hot flushes, sweats, HAs
-depression, dec libido, generalized pain, vaginal dryness, breast atrophy

-ovarian cyst (generally resolves)
-reduced bone density / osteoporosis (long term use)

Contraindication- pregnant and breast feeding women

24

GnRH analogs men AEs

-hot flashes, sweats, edema
-gynecomastia, dec libido
-reduced bone density
-asthenia
-injection site rxns

25

GnRH receptor antagonists = (1):
-(2) MOA
-(3) use

1- cetrorelix, ganirelix

2- competitive antagonists of GnRH receptor

3- suppresses gonadotropin production --> prevents LH surge during controlled ovarian hyperstimulation