PHARM Chapter 26 - Hypothalamus and Pituitary Gland

Question 1

3 Drugs for Growth hormone and insulin like growth factor replacement

Answer 1

Somatorpin (GH)/Somatrem
Semorelin (GRRH)/Tesamorelin
Mecasermine

Question 2

ME of Growth Hormone and Insulin LIke Growth Factor Replacement

Answer 2

stimulate release of or replace growth hormone or insulin like growth hormone

Question 3

Use of Somatorpin (GH) and Somatrem

Answer 3

Growth failure in children w/ GH deficiency
Turners syndrom
Prader Willi syndrome
Chronic kidney disease
Idiopathic short stature
Replacement of endogenous GH in adults w/ GH deficiency

Question 4

Use of Sermorelin (GHRH) and Tesamorelin

Answer 4

Diagnostic evaluation of decreased plasma growth hormone (sermorelin)
HIV lipodystrophy (tesamorelin)

Question 5

Use of Mecasermin

Answer 5

Laron dwarfism, DH deficiency w/ neutralizing antibodies

Question 6

Contraindication for Growth Hormone and Insulin-like growth replacement

Answer 6

active malignancy

Question 7

Recombinant IGF-1

Answer 7

mecasermin

Question 8

Why does IGF-1 serve as better measurement

Answer 8

bound and stable in the circulation for longer peroids of time at steady concentrations

Question 9

Endogenous biological inputs that promote GH release include

Answer 9

GHRH, sex steroids, dopamine, ghrelin

Question 10

Ghrelin acts w/ ___ to prommote GH release

Answer 10

GHRH

Question 11

What is the most common cause of GH deficiency

Answer 11

defective hypothalamic release of GHRH, pituitary insufficiency, failure of IGF-1 secretion in response to GH

Question 12

Alternative exogenous agents used to stimulate GH release

Answer 12

glucagon, arginine, clonide, and insulin

Question 13

What is the main treatment for growth hormone excess

Answer 13

somatostatin receptor ligands

Question 14

2 agnts that decrease growth horone secretion or action

Answer 14

Octreotide and pegvisomant

Question 15

ME of octreotide and pegvisomant

Answer 15

inhibit GH release (octreotide)

antagonize GH receptor (pegvisomant)

Question 16

Uses of Octreotide

Answer 16

acromegaly
able to control GI bleeding and reduce secretory diarrhea
flushing and diarrhea from carcinoid tumors
carcinoid crisis
diarrhea from vasoactive intestinal peptide-secreting tumors
TSH producing adenomas

Question 17

Uses of pegvisomant

Answer 17

acromegaly

Question 18

Contraindication for pegvisomant

Answer 18

known malignancy, pt. should have yearly MRI

Question 19

Works on lactotrophs to physiologically inhibit prolactin release

Answer 19

dopamine

Question 20

2 dopamine analogues

Answer 20

bromocriptine

cabergoline

Question 21

GH analogue modified at one site to bind to GH w/ higher affinity than native model, preventing receptor dimerization required for subsequent receptor activation

Answer 21

Pegvisomant

Question 22

How are lactotrophs unlike other cells of anterior pituitary

Answer 22

under tonic inhibition by the hypothalamus, mediated by dopamine - therefore in disease states, while other hormones will be decreased, prolactin will increase

Question 23

What stimulates lactotrophs to secrete increasing quantities of prolactin

Answer 23

estrogen - although prolactin negatively feedbacks to suppress estrogen

Question 24

How does prolactin negatively feedback to suppress estrogen

Answer 24

antagonizes hypothalamic release of GnRH and by decreasing gonadotroph sensitivity to GNRH

Question 25

Agents that decrease prolactin levels

Answer 25

bromocriptine | cabergoline

Question 26

Uses of bromocriptine

Answer 26

amenorrhea and galactorrhea from hyperprolactinemia acromegaly Parkinson's Premenstrual syndrome

Question 27

Uses of cabergoline

Answer 27

hyperprolactinemia

Question 28

Benefit to using cabergoline over bromocriptine

Answer 28

produces less nausea due to weekly or bi-weekly dosing interval and less frequent GI adverse effects

Question 29

Ergot alkaloid

Answer 29

Bromocriptine

Question 30

How can GI side effects be reduced in bromocriptine

Answer 30

intravaginal administration

Question 31

Agents that Test thyroid function or stimulate iodide uptake

Answer 31

Protirelin | Thyrotropin

Question 32

Uses of protirelin

Answer 32

diagnosis of thyroid function

Question 33

uses of thyrotropin

Answer 33

adjunctive treatment of malignant tumor of thyroid gland

Question 34

Contraindications for thyrotropin

Answer 34

adrenal insufficiency | coronary thrombosis

Question 35

SE of protirelin

Answer 35

``` amaurosis fugax (in pt. w/ pituitary tumors) seizures ```

Question 36

SE of thyrotropin

Answer 36

anaphylactoid reaction w/ repeated administration nausea, vomiting, asthenia, headache

Question 37

Used to stimlate radioactive iodide uptake in treatment of thyroid cancer

Answer 37

Thyrotropin

Question 38

What is the main test used in screening for primary thyroid disease

Answer 38

serum TSH

Question 39

Agent that test adrenal function

Answer 39

cosyntropin (ACTH 1-24)

Question 40

ME of cosyntropin

Answer 40

stimulates adrenal cortisol and androgen production

Question 41

Uses of cosyntropin

Answer 41

diagnosis of adrenocortical function

Question 42

POMC is split into

Answer 42

POMC, MSH, lipotropin, and B-endorphin

Question 43

ACTH has a trophic effect on the

Answer 43

zona fasciculata and zona reticularis of the adrenal cortex

Question 44

ME of Gonadorelin (GnRH analogue)

Answer 44

COntinuous form: inhibits LH and FSH release | Pulsatile: stimulates LH and FSH release

Question 45

Uses of Gonadoreline

Answer 45

Diagnosis of hypogonadism, stimulates ovulation

Question 46

Multiple applications of GOnadoreline

Answer 46

anaphylaxis

Question 47

``` ME of goserelin histrelin leuprolide nafarelin ```

Answer 47

Continous: inhibit LH and FSH release Pulsatile: stimulates LH and FSH release

Question 48

Uses for Goserelin Histrelin Leuprolide Nafarelin

Answer 48

``` breast cancer prostate cancer endometriosis precocious puberty acute intermittent porphyria ```

Question 49

SE of leuprolide

Answer 49

pituitary apoplexy

Question 50

ME of ganirelix and cetrorelix

Answer 50

GnRH receptor antagonist

Question 51

Uses of ganirelix and cetrorelix

Answer 51

inhibition of premature LH surges in women undergoing controlled ovarian hyperstimulation

Question 52

SE of ganirelix and cetrorelix

Answer 52

ectopic pregnancy, thrombotic disorder, spontaneous abortion (Ganirelix) and anaphylaxis (cetrolix)

Question 53

ME of Follitropin (rFSH) and Urofollitropin (FSH)

Answer 53

Stimulate gonadal maturation and steroid production

Question 54

Uses of rFSH and FSH

Answer 54

ovulation induction | male hypogonadotropic hyogonadism

Question 55

ME of conivaptan and tolvaptan

Answer 55

Mixed V1/V2 receptor antagonists

Question 56

Uses of conivaptan and tolvaptan

Answer 56

``` Euvolemic and hypervolemic hyponatremmia Heart failure (tolvaptan) ```

Question 57

Conivaptan is a ___ substrate

Answer 57

P450-3A4 substrate, contraindicated w/ other P450-3A4 drugs (clarithromycin and indinavir)

Question 58

Tolvaptan is ___ antagonist

Answer 58

Vasopressin V2 receptor

Question 59

inhibitin is produced in ___ and effects ___ secretion

Answer 59

gonads, GSH

Question 60

activiin

Answer 60

paracrine factor produced and acts locally in pituitary and gonads to stimulate FSH

Question 61

V2 receptors

Answer 61

located in nephron, stimulate cell surface expression of water channels in order to increase water reabsorption

Question 62

ADH maintains vascular tone by

Answer 62

increasing blood pressure and increasing water reabsorption

Question 63

Disruption of ADH can lead to

Answer 63

SIADH or diabetes inspidus

Question 64

Demeclocylcine and ltihium

Answer 64

tetracycline antibiotic can treat SIADH

Question 65

Administration of ADH analogue ____ results in stimulation of V2 receptors in neurogenic diabetes inspidus

Answer 65

desmopressin

Question 66

Patients w/ diabetes inspidus can be treated with diuretics such as

Answer 66

amiloride or hydrochlorothiazide - prevents excessive loss of free water - induce volume contracted state to promote enhanced absorption of wtaer