Term
| goals of pharmacotherapy in endocrinology |
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Definition
-replacement for hormone deficiency states
-antagonists for diseases that result in excess production
-diagnostic tools for identification of endocrine abnormalities |
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Term
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Definition
thyroid stimulating hormone
thyrotropin
released by anterior pituitary |
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Term
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Definition
thyrotropin releasing hormone
released by hypothalamus |
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Term
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Definition
follicle stimulating hormone
released by anterior pituitary |
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Term
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Definition
gonadotropin releasing hormone
released by hypothalamus |
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Term
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Definition
leutenizing hormone
released by anterior pituitary |
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Term
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Definition
adrenocorticotropic hormone
released by anterior pituitary |
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Term
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Definition
corticotropin releasing hormone
released by hypothalamus |
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Term
| release of TRH causes release of ___ |
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Definition
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Term
| release of GnRH causes release of... |
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Definition
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Term
| release of CRH causes release of... |
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Definition
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Term
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Definition
growth hormone
released by anterior pituitary |
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Term
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Definition
growth hormone releasing hormone
released by hypothalamus |
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Term
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Definition
somatostatin
released by hypothalamus |
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Term
| GH is released when _______ is released. |
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Definition
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Term
| GH stops being released when _____ is released. |
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Definition
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Term
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Definition
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Term
| Prolactin is inhibited by ________. |
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Definition
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Term
| What is an absolue requirement in childhood and early adulthood for normal adult size and is involved in lipid metabolism and lean body mass? |
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Definition
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Term
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Definition
shortened analog of GHRH with full biological activity
does not work if GH deficiency is secondary to anterior pituitary defect
cheaper than GH, but may not be as effective |
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Term
| side effects of GH and sermorelin |
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Definition
very few in children (scoliosis, rarely intracranial HTN)
more in adults (peripheral edema, myalgias, arthralgias, carpal tunnel) |
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Term
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Definition
malignancy
(although no definitive link to increase in cancer risk) |
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Term
| For children with GH deficiency, the supplemented GH dose is ____________ than adults. |
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Definition
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Term
| excess GH before end of puberty |
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Definition
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Term
| excess GH after end of puberty |
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Definition
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Term
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Definition
| hypersecretion of GH by pituitary tumor |
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Term
| definitive treatment for excess GH |
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Definition
| surgical removal of pituitary tumor |
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Term
| pharmacologic treatment of excess GH |
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Definition
GHRH antagonists (somatostatin analog--octreotide)
D2 receptor agonist--bromocriptine |
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Term
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Definition
| treatment of acromegaly as well as other hormone secreting tumors |
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Term
| side effects of octreotide |
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Definition
GI problems
gall stones
bradycardia
conduction disturbances
vitamin B12 deficiency |
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Term
| How does prolactin exerts a negative feedback control? |
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Definition
| enhances dopamine synthesis in the hypothalamus which acts on the D2 receptors in the pituitary and stops production of more prolactin |
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Term
| release of prolactin is stimulated by... |
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Definition
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Term
| After birth, what hormones stimulate milk synthesis? |
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Definition
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Term
| During the nursing period, what hormones maintain milk secretion? |
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Definition
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Term
| causes of hyperprolactinemia |
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Definition
-hypothalamic or pituitary disease that interferes with dopamine
-renal failure
-primary hypothyroidism (increased TRH)
-pituitary adenoma |
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Term
| effects of hyperprolactinemia |
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Definition
galactorrhea in women
negative feedback of the H-P-G axis
-amenorrhea and infertility in women
-loss of libido and infertility in men |
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Term
| prototype agent used to treat hyperprolactinemia |
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Definition
| bromocriptine (D2 receptor agonist) |
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Term
| side effects of bromocriptine |
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Definition
| headache, nausea, vomiting, orthostatic hypotension, psychiatric problems |
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Term
| What drugs can cause hyperprolactinemia? |
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Definition
anti-psychotics that act on D2 receptors
(chlopromazine, haloperidol, resperidone) |
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Term
| D2 receptor agonists are discontinued in what population due to CV toxicity risk? |
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Definition
| post-partum women who do not want to nurse |
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Term
| oxytocin mechanism of action |
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Definition
direct contraction of uterine muscle via increase in Ca2+
increased production of prostaglandins and leukotrienes |
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Term
| two primary physiological actions of oxytocin |
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Definition
stimulation of frequency and force of uterine contractions during labor
milk ejection: contraction of myoepithelium that surrounds areolar channels in breast |
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Term
| oxytocin therapeutic uses |
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Definition
induction of labor
augmentation of labor
reduction of bleeding postpartum |
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Term
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Definition
| challenge test to determine fetal heart rate |
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Term
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Definition
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Term
| Oxytocin is eliminated by... |
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Definition
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Term
| Explain the concentration dependent effect of oxytocin. |
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Definition
Low dose increases force and frequency of contractions.
High dose causes a sustained contraction. |
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Term
| oxytocin contraindications |
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Definition
fetal distress
prematurity
abnormal fetal presentation
any predisposition for uterine rupture |
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Term
| What happens if the oxytocin dose is too high or the patient has an exaggerated response to a typical dose? |
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Definition
| excessive uterine contraction |
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Term
| High dose of oxytocin stimulates... |
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Definition
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Term
| What results from a high dose of oxytocin as a result of vasopressin receptor stimulation? |
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Definition
water intoxication
hyponatremia |
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Term
| oxytocin is released by... |
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Definition
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Term
| vasopressin (ADH) is released by... |
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Definition
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Term
| What causes the release of vasopressin (ADH)? |
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Definition
hyperosmolality
hypovolemia/hypotension |
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Term
| primary site of action for vasopressin (ADH) |
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Definition
| V2 receptors in renal collecting duct |
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Term
| vasoconstrictor receptor subtype found in the heart and vascular smooth muscle that acts as a vasopressin receptor |
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Definition
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Term
| receptor subtype that releases ACTH from anterior pituitary and vasopressin (ADH) from posterior pituitary |
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Definition
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Term
| drugs that enhance vasopressin's anti-diuretic response |
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Definition
chloropropramide
carbamazepine
NSAIDs, especially indomethacin |
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Term
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Definition
impaired renal conservation of water
large volume of urine
thirst, polydipsia |
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Term
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Definition
neurogenic: inadequate secretion of ADH
nephrogenic: inadequate renal response to ADH |
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Term
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Definition
head injury
pituitary tumors
infections
genetics |
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Term
| treatment for neurogenic DI |
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Definition
| replacement therapy (desmopressin) |
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Term
| Why is desmopressin preferred to vasopressin in the treatment of neurogenic DI? |
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Definition
| 3000x more selective at V2 than V1 receptors |
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Term
| What distinguishes between neurogenic and nephrogenic DI? |
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Definition
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Term
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Definition
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Term
| What drugs can cause nephrogenic DI? |
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Definition
lithium (33% of patients)
demeclocycline |
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Term
| treatment of nephrogenic DI |
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Definition
adequate water intake
amiloride for lithium-induced
thiazide diuretics |
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Term
| syndrome of inappropriate secretion of ADH (SIADH) |
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Definition
too much secretion
water intoxication, hyponatremia, hypoosmolality
fatigue and lethargy--convulsions and death |
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Term
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Definition
demeclocycline
loop diuretics
water restriction |
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Term
| What is demeclocycline used to treat SIADH instead of lithium? |
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Definition
| lithium has a low therapeutic efficacy and is more toxic |
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Term
| What happens if vasopressin is given PO? |
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Definition
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Term
| drug of choice for V1 receptor mediated therapeutic applications |
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Definition
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Term
| drug of choice for bleeding esophageal varices (vasoconstriction of splanchnic arterial vessels to the portal system) |
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Definition
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Term
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Definition
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Term
| Vasopressin is given IV/IM for esophageal varices. |
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Definition
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Term
| Why must large doses of PO and intranasal desmopressin be given? |
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Definition
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Term
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Definition
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Term
| drug of choice for anti-diuretic related disorders |
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Definition
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Term
| drug of choice for neurogenic DI |
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Definition
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Term
| drug of choice for type I von Willebrand's disease |
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Definition
desmopressin
will increase the factor and shorten bleeding time |
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Term
| sex steroid critical for development of fetal male genital tract |
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Definition
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Term
| sex steroids cricial for growth and development during puberty |
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Definition
| testosterone and estrogen |
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Term
| sex steroids critical for reproduction |
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Definition
| estrogen, testosterone, and progesterone |
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Term
| GnRH stimulates the release of ____ and _____, which in turn stimulate _____ _________ production and release at the level of the gonad. |
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Definition
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Term
| areas of hypothalamus that produce GnRH |
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Definition
arcuate nuclei
preoptic acrea |
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Term
| What hormone is responsible for stimulation of immature follicle and estrogen synthesis? |
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Definition
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Term
| What hormone(s) surge at ovulation? |
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Definition
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Term
| What secretes progesterone for implantation? |
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Definition
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Term
| What directs progesterone and estrogen production if implantation occurs? |
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Definition
human chorionic gonadotropin (hCG)
hCG is very similar to LH |
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Term
| What drives progesterone and estrogen production if implantation does not occur? |
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Definition
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Term
| LH acts on _______ cells in the ovaries. |
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Definition
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Term
| FSH acts on ________ cells in the ovaries. |
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Definition
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Term
| LH acts on ______ cells in the testes to release ________. |
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Definition
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Term
| FSH acts on _______ cells in the testes to release _________. |
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Definition
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Term
| GnRH release is increased by... |
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Definition
| norepinephrine and pheromones |
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Term
| GnRH release is inhibited by... |
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Definition
| dopamine, endorphins, and stress |
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Term
| H-P-G axis has a _________ type of secretion. |
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Definition
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Term
| There are greater concentrations of LH and FSH in women/men. |
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Definition
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Term
| Is the concentration of LH or FSH higher? |
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Definition
| LH, but they track together |
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Term
| During the menstrual cycle, LH and FSH are greater in the first/second half. |
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Definition
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Term
| When do LH and FSH make a sharp peak in a woman's menstrual cycle? |
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Definition
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Term
| treatment of infertility in women |
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Definition
simulate ovulation
controlled ovulation hyperstimulation for assisted reproductive techniques (IVF) |
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Term
| causes of infertility in women |
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Definition
hypogonadotropic hypogonadism
polycystic ovary syndrome (PCOS)
obesity |
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Term
| treatment of infertility in men |
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Definition
| stimulate spermatogenesis |
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Term
| Hypogonadal men require treatment with ____ and _____. |
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Definition
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Term
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Definition
| LH (recombinant), given with recombinant FSH |
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Term
| Which hormones have both extracted and recombinant forms? |
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Definition
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Term
| side effects of LH, FSH, and hCG |
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Definition
ovarian overstimulation
multiple pregnancies
ovarian cancer risk increases
men--gynecomastia |
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Term
| hyperstimulation syndrome |
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Definition
| ovarian overstimulation, causing ovarian enlargement, rupture, hypovolemia, shock, arterial thromboembolism |
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Term
| What risks do multiple pregnancies raise? |
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Definition
pre-eclampsia
diabetes
pre-term labor |
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Term
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Definition
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Term
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Definition
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Term
| How is GnRH agonist therapy administered? |
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Definition
IV pump (intermittent administration)
about 6 months of treatment for men |
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Term
| Which infertility treatment is less likely to cause multiple ova to be released? |
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Definition
| GnRH agonists (gonadorelin, leuprolide) |
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Term
| What happens with continuous administration of GnRH agonists? |
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Definition
| suppression of gonadotropin formation |
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Term
| What is continuously administered GnRH agnoist used to treat? |
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Definition
endometriosis (suppression of cyclical hormone changes reduces symtpoms)
uterine fibroid reduction
precocious puberty (rule out tumors first!) |
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Term
| treatment of prostate cancer |
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Definition
GnRH agonist and androgen antagonist (flutamide)
reduces testosterone levels to hypogonadal levels within two weeks |
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Term
| other androgen antagonists |
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Definition
spironalactone (competitive inhibitor)
finasteride (reduces dihydrotestosterone production) |
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Term
| side effects of GnRH agonists |
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Definition
hot flashes, sweating, HA, loss of libido
reduced bone density, osteoporosis
headaches
depression
vaginal dryness and breast atrophy in women
gynecomastia in men |
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Term
| Where is testosterone and dihydrotestosterone produced? |
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Definition
| Leydig cells in testes (95%) and adrenals (5%) |
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Term
| What is the major form of testosterone in the prostate, seminal vesicles, and epididymis? |
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Definition
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Term
| various forms of testosterone |
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Definition
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Term
| What is androgen therapy not useful in? |
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Definition
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Term
| side effects of androgen therapy |
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Definition
masculinization in women
synthetic agents:
-hepatic dysfunction
-prostatic hyperplasia
supraphysiologic doses
-azoospermia
-decreased testicular size
-hepatic failure/cancer
-aggressiveness/psychosis |
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