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D&T3 Exam 1 > Neuroendo Pharm > Flashcards

Neuroendo Pharm Flashcards

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1
Q

Releasing hormones from the hypothalamus and hormones from adenohypophysis

A

GHRH–GH

CRH–ACTH

TRH–TSH

GnRH–FSH

GnRH–LH

TRH–PRL

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2
Q

Hormones from the neurohypophysis (posterior pituitary)

A

ADH

oxytocin

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3
Q

Hypothalamic dwarfism

A

Treat with GH replacement

Doesn’t work in bone age >15 (closed epiphyses)

Doesn’t work in pts that cant make IGF1

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4
Q

GH preparations

Somatropin

A

Exact match with HGH

Administered in evening (1/day) mimics when GH is normally elevated

If GH is low and works then give recombinant to restore growth

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5
Q

Sermoreline

A

Synthetic GHRH

No longer used

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6
Q

Additional uses of GH

A

Reduced size or growth but not very sensitive to GH

Turner’s syndrome

Prayer-willi

Chronic renal insufficiency

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7
Q

GH therapy

Side effects

A

Inc ICP

Diabetogenic

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8
Q

Human recombinant IGF-1

A

Treat growth deficiency due to IGF-1 (cant use GH)

Laron Dwarfism! Mutation in GH receptor

ADR: hypoglycemia and lipohypertrophy: give before or after meal

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9
Q

Laron Dwarfism

A

Mutations in GH receptor

Rx: human recombinant IGF-1

GH doesnt work!!!

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10
Q

Xs GH

Due to

A

GH secreting adenoma

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11
Q

Xs GH

Can cause

A

acromegaly in adults and gigantism in children

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12
Q

Tx acromegaly in adults and gigantism in children

A

Somatostatin analog

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13
Q

Octreotide and lanreotide

A

Somatostatin analog

Longer acting

Inhibit GH secretion (red levels of IGF1)

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14
Q

Octreotide and lanreotide

ADR

A

GI: diarrhea, nausea, abdominal pain

Slow gall bladder–gallstones

Dec thyrotopin (used for thyrtrope adenoma)

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15
Q

Pegvisomant

A

Used when can’t handle somatostatin analog

Competitive GH receptor antagonis, reduces levels of IGF-1

2nd line

ADR: monitor liver fxn, lipohypertrophy at injection site

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16
Q

Hyperprolactinemia

Results in

A

Infertility

suppresses GnRH (and then FSH and LH)

Due to dec dopamine (lesion in hypothalamus)

Or pituitary adenoma

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17
Q

Hyperprolactinemia

Sx

A

Amenorrhea, galactorrhea and infertility and impotence

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18
Q

Hyperprolactinemia

Rx

A

Dopamine receptor agonists

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19
Q

Cabergoline and bromocriptine

A

Stimulate dopamine D2 receptors to inhibit spontaneous and TRY induced release of prolactin

Cabergoline: preferred, longer half life and greater D2 selectivity

Bromocriptine also for acromegaly

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20
Q

Cabergoline and bromocriptine

ADR

A

ADR more prominent in bromocriptine

Induce nausea

Hypotension and dizziness

cabergoline: linked to valvular disease

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21
Q

Protirelin

A

TRH analog synthetic

Diagnostic analog for hypothyroidism
(Tell what level lesion is at hypothalamus, pituitary, thyroid)

Low T4, T3

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22
Q

Cosyntropin

A

ACTH synthetic analog

Diagnostic: determine primary (adrenal gland doesn’t respond) vs secondary adrenal insufficiency

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23
Q

HCG

A

Gonadotropin mimic drug

Placental hormone

Mimics action of LH (promotes ovulation and ext sex development in males:: inc testosterone)

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24
Q

HCG

Use

A

Stimulate ovulation in anovulatory women and treat male infertility and cryptorchidism

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25
Menotropins
Gonadotropin mimic drugs Human menopausal gonadrotropins (urine extract) Equal amounts partially degraded FSH and LH For infertility to development of ovarian follicles Drives spermatogenesis
26
Urofollitropin
Gonadotropin mimic drugs Pull out LH leaving FSH (allows timing ovulation) Similar to mentropins
27
Follitropin beta and alpha
Recombinant FSH
28
Choriogonadotropin alpha
Recombinant LH
29
Gonadotropins ADR
Risk for multiple births Ovarian hyperstimulation syndrome: ovarian cysts, ascites, hypotension (sore abdomen, nausea, fever):: stop tx Males: gynecomastia
30
Clomiphene
Estrogen receptor antagonist Inc gonadotropin secretion and ovulation
31
Clomiphene Use
Infertility due to polycystic ovary syndrome, manifests with irregular menstrual periods, infertility, hirsutism, xs anadrogens
32
Clomiphene MOA
Inc levels of LH and FSH by inhibiting estrogen negative feedback at level of hypothalamus
33
Clomiphene ADR
Multiple births Antiestrogenic effects on developing follic, ovarian cysts endometrium and cervical region
34
Gonadorelin
LH and FSH stimulant Synthetic GnRH Given via pump to mimic endogenous GnRH release
35
Leuprolide, goserelin, nafarelin and histrelin
Anti estrogen and anti androgen drugs Long acting synthetic GnRH agonists Down regulates receptor (no pulses) Subs at pos 6 (resistance to proteolysis) and c terminus (for receptor binding)
36
Leuprolid, goserelin, nafarelin and histrelin What happens
Transient stimulation of gonadotropin secretion Then down regulate GnRH receptor and inhibit gonadotropin secretion Reduces estrogen and testosterone
37
Leuprolid, goserelin, nafarelin and histrelin Uses
Endometriosis uterine fibroids, advanced prostate cancer, breast cancer, central precocious puberty
38
Leuprolid, goserelin, nafarelin and histrelin ADR
Hot flashed, dec bone density, vaginal dryness, ED
39
Flutamide, bicalutamide
Androgen receptor antagonist Prevent testosterone and androgen binding Red effects of androgens at level of prostate tumor
40
Flutamide, bicalutamide Effect and Given with
Blocking receptor, inc LH, then inc testosterone Give with leuprolide to shut down feed back and block this
41
Flutamide, bicalutamide ADR
Liver damage
42
Finasteride
5a-reductase inhibitor Blocks conversion of testosterone to dihdrotestosterone Prostate tissue shrinks (BPH)
43
DI Due to
Central defect: low ADH Nephrogenic: kidney doesn't respond to ADH
44
Central DI Due to
Surgical or traumatic head injury near hypothalamus of pituitary Hypothalamic or pituitary tumors CNS ischemia Brain infxn
45
Nephrogenic DI Due to
Congenital or acq. Hypercalcemia, hypokalemia Postobstructive renal failure Li!!!! For bipolar. 1 in 3 gets this
46
DI Sx
Polyuria, polydipsia, dilute urine
47
DI Dx test
Administration of synthetic vasopressin If it induces inc in urine osmolality then central DI If no effect on urine osmolality then nephrogenic DI
48
Desmopressin
For central DI Synthetic analogue of ADH Reduced vasopressin activity, but enhanced anti diuretic activity
49
Desmopressin Other use
For Von willebrand disease type 1 (inc factor VIII and Von willebrand factor) Primary nocturnal enuresis
50
DI ADR
Vasopressin activity due to activation of V1 (facial pallor, inc in GI and nausea, constriction of coronary aa Overstimulation of V2 results in water intoxication V1 hit by vasopressin not so much by desmopressin
51
DI Drug interactions Chlorpropamide and carbamazepine
Inc the sensitivity of collecting duct to vasopressin
52
DI Drug interactions Li and demeclocycline
Inhibit action of vasopressin on collecting duct Li: AS MANY AS ONE IN 3 DEVELOP NEPROGENIC DI! Li: disrupts cAMP
53
Tx of nephrogenic DI
Adequate water intact: thiazide. Diuretics Front line therapy Reduce urine volume by 50%
54
Nephrogenic DI Tx Thiazide MOA
Water contraction sensed by nephron Shifts water reabsorption to PCT
55
Neprhogenic DI Amiloride
Blocks li uptake by na channel in collecting duct Counters li induced nephrogenic DI
56
SIADH
Malignancy (lung) CNS Drugs (ssri, tricyclics antidepressants, sulfonylureas
57
SIAH Sx
Plasma hypotonicity,letargy, anorexia, nausea
58
SIADH Rx
Fluid restriction! Demeclocyline: antagonizes xs ADH Conivaptan: V1 and V2 receptor antagonist Tolvaptan: V2 receptor antagonist
59
SIDH Other Rx
Hypertonic saline Loop diuretics
60
Oxytocin Uses
For hemorrhaging Facilitate Milk ejection Induction of child birth
61
Synthetic oxytocin ADR
Overstimulation: trauma to mother or fetus, uterine rupture, water intoxication and allergic runs
62
Oxytocin Preparations
Synthetic oxytocin IV: induce labor IM: control post abortion hemorrhage Intranasal: induce lactation
63
Nephrogenic DI Caused by what drug
Li
64
Li can cause what?
Nephrogenic DI

D&T3 Exam 1 (19 decks)

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