Pituitary Adenoma Drugs

Question 1

first line for prolactinomas

Answer 1

medication (dopamine agonists like bromocriptine and cabergoline)

Question 2

first line for GH secreting pituitary adenomas

Answer 2

neurosurgical tumor resection

Question 3

suppress prolactin synthesis and secretion

Answer 3

bromocriptine

cabergoline

Question 4

can cause deprssion

Answer 4

bromocriptine (& less: cabergoline)

Question 5

what increases plasma levels of DA agonists

Answer 5

macrolide ATBs

Question 6

enhances ADRs of ergot derivatives

Answer 6

alph aand beta agonists

efavirenz

Question 7

meds for GH secreting pituitary adenoma

Answer 7

somatostatin analogs (octreotide, lanreotide)

dopamine agonists (bromocriptine, cabergoline)

GH receptor antagonist (pegvisomant)

Question 8

somatostatin analogs have effects on which organs

Answer 8

anterior pituitary (SSTR2 and 5)

pancreas (SSTR2 and 5)

Question 9

Rx what after sugary or radiation therapy to decrease GH and IGF-1

Answer 9

somatostatin analogs (octreotide, lanreotide)

Question 10

only given by SQ and IM

Answer 10

somatostatin analogues (octreotide, lanreotide)

Question 11

gallbladder abnormalities (biliary sludge, stones) due to decreased GB contractions

Answer 11

somatostatin analogues (octreotide, lanreotide) (for GH)

pasireotide (for ACTH)

Question 12

can cause sinus brady in acromegalics

Answer 12

somatostatin analogues (octreotide, lanreotide)

Question 13

drug adjustments if placed on somatostatin analogues (octreotide, lanreotide)

Answer 13

increase: insulin, cyclosporin
decrease: beta blockers, drugs metal by CYP3A4

Question 14

dopamine agonists can be used for what adenomas

Answer 14

prolactinoma

GH secreting adenomas

Question 15

competitive GH receptor antagonist

Answer 15

pegvisomant

Question 16

normalizes IGF-1, but elevates GH secretion

Answer 16

pegvisomant (GH rec antag)

Question 17

only given SQ

Answer 17

pegvisomant (for GH adenomas)

pasireotide (for ACTH adenomas)

Question 18

drug adjustments if placed on pegvisomant

Answer 18

decrease: insulin

if on opioids, need incr pegvisomant

Question 19

treatment of choice for cushing disease / ACTH secreting adenoma

Answer 19

transsphenoidal surgery

Question 20

meds for cushing disease

Answer 20

adrenolytics (ketoconazole, metyrapone, mitotane)

pituitary directed agents (pasireotide)

glucocorticoid receptor antagonists (mifepristone)

Question 21

indications for meds for cushing disease

Answer 21

before surgery to control hypercortisolism

if surgery doesn’t work

while waiting for complete effect of pituitary radiotherapy

Question 22

anti fungal used to treat cushing

Answer 22

ketoconazole

Question 23

inhibits 11 beta hydroxylase and 17,20 lyase

Answer 23

ketoconazole

Question 24

causes serious hepatic injury

Answer 24

ketoconazole

Question 25

gynecomastia, decreased libido

Answer 25

ketoconazole

Question 26

inhibits 11 beta hydroxylase

Answer 26

metyrapone

Question 27

causes hirsutism, acne, hypertension

Answer 27

metyrapone

Question 28

drug adjustments if taking metyrapone

Answer 28

decrease or don't use acetaminophen

Question 29

inhibits side chain cleavage enzyme, 3 beta hydroxysteroid dehydrogenase, 11 beta hydroxylase

Answer 29

mitotane

Question 30

mitotane drug interactions

Answer 30

enhances orthostatic hypotension of MAOis enhance effect of vitamin K antagonists

Question 31

highest binding affinity to SSTR5

Answer 31

pasireotide

Question 32

hyperglycemia

Answer 32

pasireotide

Question 33

pasireotide and drug adjustments

Answer 33

increase: insulin, cyclosporine decrease: beta blockers

Question 34

binds competitively to GR (cortisol) and PR (progesterone)

Answer 34

mifepristone

Question 35

CI during gestation

Answer 35

mifepristone

Question 36

used to control hyperglycemia 2ary to hypercortisolism

Answer 36

mifepristone

Question 37

ecreases hb A1c

Answer 37

mifepristone

Question 38

hypokalemia ADR

Answer 38

mifepristone