Pituitary Gland

Question 1

GH secretion is regulated by?

Answer 1

• Hypothalamic GH releasing factor (GHRF)
• Somatostatin
• Insulin-like growth factor (IGF)-1

Question 2

physiological effects of GH

Answer 2

1) Anabolic effects
* Bone growth
* Bone mineral density increase after the epiphyses have closed
* Increased muscle mass
* Protein synthesis

2) Metabolic Effects
* Increased lipolysis
* Gluconeogenesis stimulation

Question 3

Drug of choice to treat GH deficiency

Answer 3

Somatropin
(Recombinant GH)

Question 4

Adm of Somatropin

Answer 4

SC

Question 5

CU of Somatropin

Answer 5

1) Pituitary dwarfism
2) Turner’s syndrome
3) AIDS-associated wasting
4) Used illicitly by athletes

Question 6

Pituitary Dwarfism is caused by lack of?

Answer 6

GH, GHRF and IGF-1 generation/action

Question 7

AE of Somatoropin

Answer 7

• Few side effects in children

Adults:
* Peripheral edema
* Carpel tunnel syndrome
* Arthalgias (joint stiffness)
* Myalgia
* Insulin resistance

Question 8

Recombinant IGF-1

Answer 8

Mecasermin

Question 9

CU of Mecasermin

Answer 9

Treatment of growth failure in children
caused by
- Lack adequate amounts of IGF
- GH deficiency alternative to recombinant GH
* note: GH is more effective

Question 10

Adm of Mecasermin

Answer 10

SC injection

Question 11

Excessive production of GH
* Children -> ——–
* Adults –> ——-

Answer 11

• Children –> Gigantism
• Adults –> Acromegaly

Question 12

Tx of excessive GH production

Answer 12

Pegvisomant
Bromocriptine

Question 13

MoA of Pegvisomant

Answer 13

Recombinant modified version of GH –> Highly selective antagonist of GH actions

Question 14

CU of Pegvisomant

Answer 14

2nd line tx in Excessive GH production
(when somatostain have failed)

Question 15

CU of Bromocriptin

Answer 15

3rd line tx of execcive GH production

Question 16

MoA of Bromocriptine

Answer 16

Dopamine agonist –> decreases production of GH from pituitary gland (AP)

Question 17

1st line tx of Excessive GH production

Answer 17

Somatostatin

Question 18

MoA of Somatostatin in the Anterior pituitary

Answer 18

Inhibits release of GH and TSH

Question 19

MoA of Somatostatin in the pancreas

Answer 19

Inhibits insulin and glucagon release

Question 20

MoA of Somatostain in the GI tract

Answer 20

Reduces gastric acid and pancreatic
secretions

Question 21

Somatostain analogues

Answer 21

Octreotide
Lanreotide

Question 22

Favoured tx of Acromegaly?

Answer 22

Somatostain analogue
(Octreotide, lanreotide)

Question 23

CU of Octreotide

Answer 23

1) Oesophageal Varices
2) Acromegaly due Excessive GH
3) Carcinoid and other hormone-secreting tumours

Question 24

AE of Somatostain Analogues

Answer 24

1) Injection site pain (SC injection),
2) GI disturbances,
3) gallstones,
4) postprandial hyperglycemia (due to insulin inhibition in the pancrease)
5) hypothyroidism (due to inhibition of TSH)

Question 25

Fxn of Prolactin

Answer 25

Lactation

Question 26

What is used in the prevention of lactation?

Answer 26

Bromocriptine (Dopamine agonist)

Question 27

What is used to stimulate lactation

Answer 27

Dopamine antagonsits

Question 28

MoA of Dopamine Antagonists in terms of lactation

Answer 28

Stimulate prolactine release --> increase lactatin

Question 29

MoA of Dopamine Agonists in terms of lactation

Answer 29

Supress prolactine release --> inhibit lactation

Question 30

CU of Bromocriptine

Answer 30

**1) Prevent lactation** **2) Galactorrhoea** **3) Prolactinoma** 4) Tx of Parkinsonism and acromegaly

Question 31

AE of Bromocriptine

Answer 31

1) Nausea/vomiting 2) Headache 3) **Postural hypotension** 4) Less frequent : **Psychosis/hallucinations**, Insomnia

Question 32

Dopamine anatgonists

Answer 32

Metoclopramide; domperidone

Question 33

Anti-psychotics may cause **----------------** as a side effect

Answer 33

Galactorrhea

Question 34

Physiological action Vasopressin receptor 1A **(V1A)**

Answer 34

Phospholipase **C/IP3** system activation --> **Contraction of smooth muscle**

Question 35

Physiological effect og Vasopressin receptor 1B **[V1B (v3)]**

Answer 35

Phospholipase **C/IP3** system activation -> **Release** of adrenocorticotropic hormone **(ACTH)** from anterior pituitary

Question 36

Physiological action of V2 receptor

Answer 36

* Stimulation of **adenylyl cyclase** * Action in **collecting ducts of the nephron** --> Increases permeability to water (aquaporin insertion) * **Release of blood coagulation factors**

Question 37

V2 receptor acts on?

Answer 37

Collecting ducts of the nephron --> increases permeabilty to water ( aqaporin insertion)

Question 38

Vasopressin analogues

Answer 38

1) **Terlipressin** (V1 selective) 2) **Desmopressin** (V2 selective) | - pressin

Question 39

CU of Terlipressin

Answer 39

tx of bleeding in Oesophageal varices

Question 40

CU of Desmopressin

Answer 40

1) Central diabetes insipidus (not nephrotic DI) 2) Persistent **nocturnal enuresis** 3) Prophylaxis against bleeding in haemophilia

Question 41

AE of Vasopressin Analogues **V1- mediated** AE

Answer 41

1) **Facial pallor** 2) Increased intestinal activity **(nausea/cramps)** 3) Spasm of coronary arteries **(angina)** 4) **Reduced CO** | - Terlipressin

Question 42

AE of vasopressin analouge, **V2-mediated** AE

Answer 42

Water intoxication (hyperhydration) | * Desmopressin

Question 43

Vasopressin Antagonists

Answer 43

1) T**o**lvaptan (oral) - selective V2 anatogonist 2) Con**iv**aptan (IV) - non-selective V1A/V2 antagonist | -aptan

Question 44

Adm of Tolvaptan

Answer 44

Oral

Question 45

Adm of Conivaptan

Answer 45

IV HINT: Con**iv**aptan

Question 46

MoA of Conivaptan

Answer 46

Non-selective V1A/V2 anatgonist

Question 47

MoA of Tolvaptan

Answer 47

Selective V2 antagonist

Question 48

CU of Tolvaptan

Answer 48

1) Treatment of syndrome of inappropriate ADH secretion **(‘SIADH’)** 2) Hypervolemic or euvolemic hyponatremia

Question 49

CU of Conivaptan

Answer 49

Hypervolemic or euvolemic hyponatremia in **hospitalized patients** | * Emergency tx (IV)

Question 50

AE of Tolvaptan

Answer 50

1) GI-related adverse effects, 2) **hyperglycemia,** 3) **pyrexia** (fever)

Question 51

AE of Conivaptan

Answer 51

1) Drug-drug interactions preclude chronic use 2) **Infusion-site reactions**

Question 52

A Tetracycline drug

Answer 52

**Demecolocycline**

Question 53

CU of Demeclocycline

Answer 53

SIADH

Question 54

AE of Demeclocycline

Answer 54

* Nephrogenic DI * Photosensitivity * **Abnormalities of bone and teeth**

Question 55

MoA of Demeclocycline

Answer 55

V2 antangonist

Question 56

Drugs used to test for ACTH production i Cushing's syndrome

Answer 56

**Metyrapone** (anti-adrenal CS -> inhibits the synthesis of endogenous adrenal glucocorticoids)

Question 57

# ** tx of Cushing's syndrome

Answer 57

**ketoconazole** (anti-glucocorticoid)