Pharm 1 Pituitary Flashcards Preview

Test 9 > Pharm 1 Pituitary > Flashcards

Flashcards in Pharm 1 Pituitary Deck (69):
1

Growth Hormone regulation

++ GRH
-- Somatostatin (SRIF, somatotropin release-inhibiting factor)

2

Somatostatin functions (GI, brain)

-Suppress basically every GI hormone
-Inhibit GH, TSH secretion (not synthesis)

3

Somatostatin regulation

++ low pH

4

Posterior pituitary hormones

Vasopressin (ADH)

5

Growth hormone synonym

Somatotropin

6

Growth hormone replacement

Species specific (only human)
-Risk of CJD
-Use synthetic (recombinant rhGH)

7

Growth hormone feedback mechanism

Liver IGF-1 (insulin-like growth factor)

8

2 ways to induce SRIF

IGF-1
B-agonist

9

GH actions

-Synthesize chondroitin and collagen
-Grow bone and soft tissue
-Renal retain N, K, PO4

10

GH MOA (important)

Cytokine membrane receptors ->
a) IGF-1 (mitogen & antiapoptogen)
b) + triglyceride hydrolysis, insulin resistance, protein synthesis

11

IGF-1 v IGF-2

Adult vs infant

12

GH interaction with diabetes

Causes more problems in morning (GH secreted at night)

13

Most common pituitary tumor

Prolactinoma

14

Age associated GH pathology

Up to 1/3 of elderly

15

Gigantism

GH hypersecretion before fusion of epiphysis

16

Acromegaly enlargements

Head, face, hands, feet, thorax

17

Acromegaly clinical

-Carpal tunnel syndrome
-Hypogonadism
-Glucose intolerance and hyperinsulinemia
-Heat intolerance, sweating, fatigue, lethargy

18

rhGH therapeutic uses

-GH deficient patients
-Very short children with normal GH
-HIV related wasting or cachexia

19

Prader-Willi syndrome

Parental allele not expressed (chromosome 15 unbalanced)
-Retardation, obesity, hypogonadism, hypotonia

20

AngelMan's syndrome

Maternal allele not expressed (15)
-Retardation, inappropriate laughter, ataxic gait, seizures

21

Prader-willi and AngelMan's pathology

Disorder of genomic Imprinting (silencing of paternal/maternal alleles)

22

-rhGH-
administration
adverse effects

-Subcutaneous
-Carpal tunnel, arthralgia in adults
-few AE in children
-NO hyperglycemia

23

-rhIGH-1-
receptor

Tetrameric receptor autophosphorylation (like insulin)

24

-rhIGH-1-
indication
administration
contraindications

-Children who don't respond to GH
-Subcutaneously before or after meal (prevent hypoglycemia)
-Neoplasia; closed Epiphyses

25

Somatostatin drug

Octreotide

26

Octreotide advantages over somatostatin

Increased half life (1.7 hours v 1-3 minutes)

27

Somatostatin production

-Hypothalamic anterior periventricular nucleus
-Pancreas Delta cells

28

Somatostatin (octreotide) MOA

Gi-protein -> decrease cAMP -> decrease GH, TSH secretion

29

Octreotide indications

-Acromegaly after surgery
-Carcinoid tumors
-VIPomas (pancreas)

30

VIPoma pathology

WDHA syndrome
-Watery Diarrhea (dehydration)
-Hypokalemia
-Achlorhydria

31

Octreotide AE

GI disturbances
Reduced bile, gallbladder contractility

32

-Pegvisomant-
indication
MOA
Cindication

-Acromegaly (most effective Tx)
-Prevent GH-R dimerization and signaling (rhGH analog)
-Liver dysfunciton

33

Measure effectiveness of acromegaly Tx

-Normalize IGF-1 levels

34

3 Tx for acromegaly

Somatostatin
GH analog (receptor antagonist)
Dopamine agonist (Bromocriptine)

35

Prolactinoma hypogonadism mechanism

hyperprolactinemia inhibits pulsatile GnRH secretion

36

Prolactinoma Tx

Cabergoline (more effective than bromo)
-Also helps GH hypersecretion

37

Drug for LH

hCG (human chorionic gonadotropin)

38

Drug for LH & FSH

hMG; menotropin (human menopausal gonadotropin)

39

Drug for FSH

rFSH (recombinant FSH)
uFSH (Urofollitropin; menotropin with LH removed)

40

FSH action (female, male)

-Stimulate ovarian follicle development
-Stimulate androgen-binding globulin (maintain T levels in testes)

41

LH action (female, male)

-Stimulate production of estrogen and progesterone
-induce ovulation
-Stimulate production of testosterone

42

Ovarian stimulation routine

FSH for 6-12 days followed by LH for 1 day

43

OHSS - Ovarian hyperstimulation syndrome

Increase in vascular permeability -> rapid fluid accumulation in peritoneum, thorax, pericardium

44

-Clomiphene-
indication
MOA

Estrogen receptor competitive inhibitor
-infertility (non hormonal)
-Decrease estrogen negative feedback -> increase pulsatile LH, FSH

45

Clomiphene similar drug

Tamoxifen

46

-Leuprolide Acetate-
MOA
indication

Synthetic GnRH -> downregulate GnRH-R -> suppress LH/FSH release
-Precocious puberty, ovarian cyst, prostate cancer
-suppress endogenous LH surges during menotropin Tx

47

-Leuprolide Acetate-
t1/2
AE

-3 hours (normal GnRH is 5 minutes)
-Early menopause - hypogonadism, osteoporosis, hyperglycemia

48

-Ganirelix Acetate-
indication

GnRH-R antagonist (analog)
-inhibit premature LH surges during controlled ovulation

49

Posterior pituitary

Nerve endings from
-Supraoptic hypothalamus (oxytocin)
-Paraventricular hypothalamus (vasopressin)

50

Vasopressin synonyms

AVP (arginine vasopressin)
ADH

51

AVP inhibitor

Ethanol
Phenytoin

52

AVP stimulator

Nicotine
Epinephrine
Angiotensin II

53

AVP MOA

V1a - contract vascular and GI smooth muscle
V1b - ACTH secretion by a.pituitary
V2 -> cAMP -> collecting duct aquaporins

54

AVP dosing

V2 effects at much lower concentrations than V1
(V1 probably for extreme hypovolemia & hypotension)
-both circulate plasma unbound

55

-Desmopressin-
indication

Synthetic AVP
-Tx Diabetes Insipidus (central, not nephrogenic)
-differentiate btwn central and nephrogenic DI

56

-Desmopressin-
t1/2
administration

-12-24 hours (AVP is 15 minutes)
-Oral or subcutaneous

57

-Desmopressin-
AE

Primarily due to V1 effects
-Vessel constriction
-GI stimulation
-Uterine contraction (oxytocin cross-rxn)

58

Uses for Vasopressin (not desmopressin)

-Post-operative Ileus, dispel abd. gas before imaging
-Emergency Tx of hemorrhagic varices/gastritis

59

SIADH Tx (non drug)

-Water restriction
-IV hypertonic saline
-Loop diuretics

60

-Demeclocycline-

Antibiotic
-Reduces renal AVP sensitivity (Tx SIADH)
-SE nephrotoxicity

61

SIADH Tx (drug)

-Conivaptan (V-R antagonist)
-Tolvaptan (V2-R selective antagonist)

62

Oxytocin main stimulation

-Parturition (distention), suckling
-Plasma hypertonicity, hemorrhage

63

Oxytocin inhibition

Opioids
Pain
Heat

64

Oxytocin action

-Uterine contraction
-Mammary myoepithelial contraction

65

Oxytocin MOA

G-protein (phospholipase C)

66

-Oxytocin-
indication

-Induction of term labor
-Control of postpartum bleeding
-Increasing milk ejection

67

-Oxytocin-
AE

-Uterine rupture, infant trauma (monitor closely)

68

Other uterine stimulators

-Methylergonovine (2nd line for bleeding; CI in HTN)
-Dinoprostone (PGE - for abortion)
-Carboprost (PGF - for bleeding and abortion)

69

-Terbutaline-

B2-agonist (asthma)
-used to delay pre-term labor