Term
| ALL are peptides that bind to specific hormones |
|
Definition
| hypothalmic and anterior pituitary hormones |
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Term
| ____ produces vasopressin & oxytocin |
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Definition
|
|
Term
| where is vasopressin & oxytocin stored? |
|
Definition
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Term
| Hypothalmic regulatory hormones |
|
Definition
releasing/inhibiting factors
act on the anterior pituitary - control synthesis and release of specific hormones
limited therapeutic use |
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Term
| Where to the hypothalamic regulatory hormones pass through |
|
Definition
| hypophysial portal system |
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Term
| Not given orally because they are peptides |
|
Definition
hypothalmic and anterior pituitary hormones
given IM, SC, intra-nasally |
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Term
|
Definition
corticotropin-releasing hormone (CRH)
growth hormone releasing hormone (GHRH)
Gonadotropin/luteinizing-releasing hormone (GnRH/LHRH)
Prolactin inhibiting hormone (Dopamine) |
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|
Term
| Anterior pituitary hormones |
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Definition
adrenocorticotropic hormone (ACTH)
growth hormone (somatotropin)
follicular-stimulating (FSH) and Luteinizing hormone (LH)
prolactin |
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Term
| target organ of the adrenocorticotropic hormone (ACTH or corticotropic) is.. |
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Definition
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Term
| increases release of the adrenal corticosteriods and adrenal androgens |
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Definition
| adrenocoticotropic hormone (ACTH or corticotropin) |
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Term
| used for differential diagnosis of primary adrenal insufficiency (Addison's disease) versus secondary adrenal insufficiency |
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Definition
| adrenocoticotropic hormone (ACTH or corticotropin) |
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|
Term
| Primary adrenal insuffiency |
|
Definition
Addison's disease
caused by adrenal atrophy |
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Term
| Secondary adrenal insufficiency |
|
Definition
| caused by inadequate ACTH |
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Term
|
Definition
|
|
Term
| ACTH derived from animal sources- problem with antibody formation |
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Definition
|
|
Term
| Growth hormone (somatotropin) is released by |
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Definition
|
|
Term
| Growth hormone is stimulated by |
|
Definition
GHRH
(Growth hormone releasing hormone) (Sermorelin) |
|
|
Term
influences a variety of biochemical processes
cell proliferation, cartilage & bone growth |
|
Definition
| growth hormone (somatotropin) |
|
|
Term
causes release of somatomedin (IGF-I&II) from liver
(Acromegaly - increases IGF-I) |
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Definition
|
|
Term
| Somatotropin (Nutropin); Somatrem (Protropin) |
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Definition
| ther are now 9 recombinant-growth-hormone products available |
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Term
| Growth hormones place in therapy |
|
Definition
growth-hormone deficient growth failure
not with closed epiphyses |
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|
Term
| Where is growth hormone-inhibiting hormone (Somatostatin) found? |
|
Definition
| in the hypothalamus and in neurons throughout the body, intestine, and pancreas |
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Term
| Octreotide (Sandostatin) is a synthetic analog used to treat.. |
|
Definition
hormone-secreting tumors (Acromegaly)
secretory diarrhea cause by tumors secreting vasoactive intestinal peptides (VIP) |
|
|
Term
|
Definition
| GI receptor antagonist used to treat acromegaly |
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|
Term
| Pulsatile release of GnRH stimulates.. |
|
Definition
release of FSH and LH
used to treat hypogonadism |
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|
Term
| Adverse effects of GnRH/LHRH |
|
Definition
headache
decreased libido
depression |
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|
Term
| acts as agonist/desensitizers of GnRH-receptors |
|
Definition
synthetic analogs of GnRH
Leuprolide, Goserlin, Nararelin, Histrelin |
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Term
| Synthetic analogs of GnRH are used to treat.. |
|
Definition
prostate cancer
endometriosis
precocious puberty |
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|
Term
|
Definition
|
|
Term
|
Definition
continuous dosing leads to decreased LH and FSH in all patients
in males testosterone reduced to castrate levels
females - simlar, reduced to postmenopausal levels |
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|
Term
| used as fertility treatment for both males and females |
|
Definition
|
|
Term
| human chorionic gonadotropin (hCG) |
|
Definition
| LH agonist is a placental hormone |
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|
Term
|
Definition
contains both FSH and LH
urine of menopausal women |
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|
Term
Gonadotropins are given IM to cause
in females |
|
Definition
ovarian follicular growth and maturation (hMG) and ovulation (hCG)
can cause multiple births |
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|
Term
Gonadotropins are given IM to cause
in males |
|
Definition
external sex maturation (hCG) and spermatogenesis (hMG)
can cause gynecomastia |
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|
Term
| prolactin stimulates... and depresses... |
|
Definition
lactation
decreases sexual drive, and reproductive function |
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|
Term
| Secretion inhibited by dopamine |
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Definition
|
|
Term
| Typical (high potency) Neuroleptics |
|
Definition
haloperidol, flufenazine
amenorrhea, galactorrhea, infertility, impotence |
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|
Term
| Hyperprolactinemia - associated w/ galactorrhea and hypogonadism is treated with.. |
|
Definition
dopamine agonists
bromocriptine or cabergoline |
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|
Term
|
Definition
urterine contraction
increased frequency, force, and duration |
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|
Term
| Metoclopramide is now used to (but not approved).. |
|
Definition
stimualte lactation in women
dopamine- antagonists that increases prolactin secretion
considered safe but still a concern over AE CNS in infants |
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|
Term
| Vasopressin MOA: Antidiuretic action |
|
Definition
increased water resorption in collecting tubules
(V2 receptor)
Diabetes insipidus (Slide 14)
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|
|
Term
| Vasopressin MOA : Vasopressor Action |
|
Definition
powerful nonspecific vasoconstrictor that reduces blood flow (V1 receptor)
caution in CAD, asthma
bleeding control in esophageal varices and colonic diverticula |
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|
Term
| derivative of vasopressin |
|
Definition
|
|
Term
| Desmopressin has more/less pressor (V1) effect than vasopressin |
|
Definition
less pressor
but longer duration of action |
|
|
Term
| Preferred for neurogenic diabetes inspidus (V2) |
|
Definition
|
|
Term
| ___ tablets and nasal solution are used to treat noctural enuresis in children |
|
Definition
|
|
Term
| What is the really the only hormone that isnt a peptide |
|
Definition
prolactin inhibiting hormone
just dopamine - biogenic amine |
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|
Term
| How can cosyntropin be used to determine if it is primary or secondary adrenal insufficiency? |
|
Definition
if secondary (problem from ant. pituitary) then it will work
if primary (adrenal gland isn't working) it wont work |
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|
Term
| Why does it have to be a pulsatile release of GnRH |
|
Definition
| because if you give it continuous then you override the ability to stimulate release of FSH and LH and you actally inhibit them which can cause chemical castration |
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|
Term
| Synthetic analogs of GnRH are given with continuous action which... |
|
Definition
| basically acting as inhibitors even through they are stimulators because they overstimulate which causes the shut down of FSH and LH |
|
|
Term
|
Definition
dopamine 2 antagonist
result in an increase in prolactin release, interfere with inhibitor effect of dopamine |
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|
Term
| Dopamine 2 antagonist - prolactin levels go up and it stimulates lactation |
|
Definition
|
|
Term
| Oxytocin used to be used to stop bleeding after delivery but.. |
|
Definition
| caused massive contraction of the uterus which will squeeze off the vasculature but negative side is that this can cause a uterine rupture |
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Term
| Central or Neurogenic Diabetes insipidus |
|
Definition
reduced secretion of ADH by pituitary
resulting in large volumes of dilute urine causing dehydration and leading to thirst |
|
|
Term
| nephrogenic diabetes inspidus |
|
Definition
failure of kidney to respond to ADH
resulting in large volumes of dilute urine causing dehydration and leading to thirst |
|
|
Term
| How does Desmopressin help noctural enuresis in children? |
|
Definition
| stimulates water channels in the kidneys so more water reabsorbed and less delivered to the bladder so will take longer for the bladder to fill overnight |
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|
Term
| facilitates normal growth and maturation |
|
Definition
|
|
Term
| affect almost every organ system (essential for life) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
bradycardia
poor resistance to cold
mental and physical slowing |
|
|
Term
|
Definition
tachycardia
cardiac arrhythmias
body wasting
nervousness
tremor
excess heat production |
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|
Term
| Which hormones causes hypo-calcemia |
|
Definition
|
|
Term
| smal gland located in the neck near the larynx |
|
Definition
|
|
Term
enlargement of the thyroid gland
can occur in either hypo or hyperthyroidism |
|
Definition
|
|
Term
| All T4 produced in the body is produced by... |
|
Definition
| thyroid gland but less than 20% of T3 is produced here |
|
|
Term
| the amount of thyroid hormones are controlled by 2 systems |
|
Definition
hypothalamus-pituitary-thyroid axis
peripheral converison of T4 to T3 |
|
|
Term
| what releases thyroglobulin releasing hormone (TRH)? |
|
Definition
|
|
Term
| TRH stimulates the anterior pituitary to release? |
|
Definition
| thyroglobulin stimulating hormone (TSH) |
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|
Term
| TSH stimulate thyroid to... |
|
Definition
| iodinize the thyroglobulin which is then converted into T3 and T4 depending on how many iodines are incorporated |
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|
Term
| After being converted to T3 and T4 they are then... |
|
Definition
bound to proteins in the plasma in order to be transported throughout the body
(99% bound) |
|
|
Term
| Effects of thyroid hormones |
|
Definition
•Stimulate fetal neural and skeletal development
•Stimulate oxygen consumption at rest
•Stimulate bone turnover by increasing bone formation and resorption
•Promote chronotropic and inotropic effects on the heart
•Increase basal body temperature
•Increase the production of RBC’s
•Increase metabolism and clearance of steroid hormones
•Alter the metabolism of carbohydrates, fat and proteins |
|
|
Term
| multiple types of hypothyroidism but the most common type is... |
|
Definition
chronic autoimmune thyroiditis (Hashimoto's disease)
antibodies attack the thyroid
patients are typically middle-aged (45-65) women |
|
|
Term
| Drugs used to treat hypothyroidism |
|
Definition
thyroid U.S.P
levothyroxine (T4) - DOC
liothyronine (T3)
liotrix (thyrolar) (T3-T4) |
|
|
Term
| derived from pork, beef, or sheep thyroid glands |
|
Definition
|
|
Term
| use is no longer recommended because potency may vary and risk of allergic reactions |
|
Definition
|
|
Term
|
Definition
|
|
Term
| encourage patients to change to levothyroxine if they are taking |
|
Definition
|
|
Term
| thyroid replacement of choice |
|
Definition
|
|
Term
|
Definition
|
|
Term
| once a day dosing and a long half life of 7 days |
|
Definition
|
|
Term
| absorption is best on an empty stomach @ least 60 min before meals |
|
Definition
|
|
Term
| Levothyroxine sodium is available as.... |
|
Definition
| oral and parenteral forms |
|
|
Term
| Adverse reactions (Thyroid supplements) |
|
Definition
tachycardia
angina, heart failure and MI
nervousness
insomnia
diarrhea
intolerance to heat |
|
|
Term
Hyperthyroidism (thyrotoxicosis)
Multiple disease states |
|
Definition
graves disease
toxic adenoma
goiter
thyroiditis |
|
|
Term
| Exposure of tissues to excessive levels of T4 or T3 or both |
|
Definition
|
|
Term
| Clinical presentation of hyperthyroidism |
|
Definition
nervousness
easy fatigability
heat intolerance
loss of weight w/ increase in appetite
heart palpations |
|
|
Term
| used to determine hyperthyroidism |
|
Definition
radioactive iodine uptake
normal RAIU is 10-30% |
|
|
Term
|
Definition
propylthiouracil
methimazole
|
|
|
Term
| Propylthiouracil dosing... |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
prevent oxidation of iodide to iodine required for iodination of tyrosyl groups
prevent coupling of iodotyrosines
PTU also blocks conversion of T4 to T3 |
|
|
Term
| used in maintenance to control hyperthyroidism |
|
Definition
|
|
Term
| Which thioamide is preferred in pregnancy? |
|
Definition
| PTU because it is less likely to cross the placenta |
|
|
Term
| Adverse reactions of thioamides |
|
Definition
rash
agranulocytosis
edema |
|
|
Term
|
Definition
acutely blocks thyroid hormone release
block the synthesis of T3 and T4 precursors |
|
|
Term
|
Definition
rarely used as sole therapy
not useful for long term therapy - tolerance to effect within a few weeks |
|
|
Term
| Which drugs are used prior to surgery to decrease the vascularity of the thyroid gland |
|
Definition
|
|
Term
| Which drugs do the thyroid storm? |
|
Definition
iodides
used while awaiting the onset of the thioamides because iodides promptly inhibit thyroid hormones release |
|
|
Term
|
Definition
All b- blockers rapidly decrease nervousness, palpitations, and tremor associated with hyperthyroidism. These are all mediated by Beta adrenergic receptors
All b- blockers will reduce the widespread sympathetic stimulations that occurs in hyperthyroidism but Propranolol is the only one with an FDA approved indication of Thyrotoxicosis |
|
|
Term
| Clinical uses of propranolol |
|
Definition
cardiac manifestations of thyrotoxicosis
prophylaxis/treatment of thyroid storm |
|
|
Term
|
Definition
| diltiazem for thyroid storm with concomitant HF/asthma |
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|
