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Pharm II
Endocrine..Pituitary...Thyroid
102
Pharmacology
Graduate
10/19/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
ALL are peptides that bind to specific hormones
Definition
hypothalmic and anterior pituitary hormones
Term
____ produces vasopressin & oxytocin
Definition
hypothalamus
Term
where is vasopressin & oxytocin stored?
Definition
posterior pituitary
Term
Hypothalmic regulatory hormones
Definition

releasing/inhibiting factors

act on the anterior pituitary - control synthesis and release of specific hormones

limited therapeutic use

Term
Where to the hypothalamic regulatory hormones pass through
Definition
hypophysial portal system
Term
Not given orally because they are peptides
Definition

hypothalmic and anterior pituitary hormones

given IM, SC, intra-nasally

Term
Hypothalmic hormones
Definition

corticotropin-releasing hormone (CRH)

growth hormone releasing hormone (GHRH)

Gonadotropin/luteinizing-releasing hormone (GnRH/LHRH)

Prolactin inhibiting hormone (Dopamine)

Term
Anterior pituitary hormones
Definition

adrenocorticotropic hormone (ACTH)

growth hormone (somatotropin)

follicular-stimulating (FSH) and Luteinizing hormone (LH)

prolactin

Term
target organ of the adrenocorticotropic hormone (ACTH or corticotropic) is..
Definition
adrenal cortex
Term
increases release of the adrenal corticosteriods and adrenal androgens
Definition
adrenocoticotropic hormone (ACTH or corticotropin)
Term
used for differential diagnosis of primary adrenal insufficiency (Addison's disease) versus secondary adrenal insufficiency
Definition
adrenocoticotropic hormone (ACTH or corticotropin)
Term
Primary adrenal insuffiency
Definition

Addison's disease

caused by adrenal atrophy

Term
Secondary adrenal insufficiency
Definition
caused by inadequate ACTH
Term
synthetic human ACTH
Definition
cosyntropin (Cortosyn)
Term
ACTH derived from animal sources- problem with antibody formation
Definition
Corticotropin (Acthar)
Term
Growth hormone (somatotropin) is released by
Definition
anterior pituitary
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)

Definition
growth hormone
Term
Somatotropin (Nutropin); Somatrem (Protropin)
Definition
ther are now 9 recombinant-growth-hormone products available
Term
Growth hormones place in therapy
Definition

growth-hormone deficient growth failure

not with closed epiphyses

Term
Where is growth hormone-inhibiting hormone (Somatostatin) found?
Definition
in the hypothalamus and in neurons throughout the body, intestine, and pancreas
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
Pegvisomant (Somavert)
Definition
GI receptor antagonist used to treat acromegaly
Term
Pulsatile release of GnRH stimulates..
Definition

release of FSH and LH

used to treat hypogonadism

Term
Adverse effects of GnRH/LHRH
Definition

headache

decreased libido

depression

Term
acts as agonist/desensitizers of GnRH-receptors
Definition

synthetic analogs of GnRH

Leuprolide, Goserlin, Nararelin, Histrelin

Term
Synthetic analogs of GnRH are used to treat..
Definition

prostate cancer

endometriosis

precocious puberty

Term
Leuprolide admin
Definition
multiple injections
Term
MOA of leuprolide
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

Term
used as fertility treatment for both males and females
Definition
gonadotropins
Term
human chorionic gonadotropin (hCG)
Definition
LH agonist is a placental hormone
Term
Mentropin (hMG)
Definition

contains both FSH and LH

urine of menopausal women

Term

Gonadotropins are given IM to cause 

in females

Definition

ovarian follicular growth and maturation (hMG) and ovulation (hCG) 

can cause multiple births

Term

Gonadotropins are given IM to cause 

in males

Definition

external sex maturation (hCG) and spermatogenesis (hMG) 

can cause gynecomastia

Term
prolactin stimulates... and depresses...
Definition

 lactation

decreases sexual drive, and reproductive function

Term
Secretion inhibited by dopamine
Definition
prolactin
Term
Typical (high potency) Neuroleptics
Definition

haloperidol, flufenazine

amenorrhea, galactorrhea, infertility, impotence

Term
Hyperprolactinemia - associated w/ galactorrhea and hypogonadism is treated with..
Definition

dopamine agonists

bromocriptine or cabergoline

Term
Oxytocin stimulates
Definition

urterine contraction

increased frequency, force, and duration

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

Term
Vasopressin MOA: Antidiuretic action
Definition

increased water resorption in collecting tubules

(V2 receptor)

Diabetes insipidus (Slide 14)

 
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

Term
derivative of vasopressin
Definition
desmopressin (DDAVP)
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
desmopressin
Term
___ tablets and nasal solution are used to treat noctural enuresis in children
Definition
desmopressin (DDAVP)
Term
What is the really the only hormone that isnt a peptide
Definition

prolactin inhibiting hormone

just dopamine - biogenic amine

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

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
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
Haloperidol
Definition

dopamine 2 antagonist

result in an increase in prolactin release, interfere with inhibitor effect of dopamine

Term
Dopamine 2 antagonist - prolactin levels go up and it stimulates lactation
Definition
metoclopromaide
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
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
Term
facilitates normal growth and maturation
Definition
thyroid hormones
Term
affect almost every organ system (essential for life)
Definition
thyroid hormones
Term
2 major thyroid hormones
Definition

T3 - most active

T4

Term
Hypothyroidism symptoms
Definition

bradycardia

poor resistance to cold

mental and physical slowing

Term
hyperthyroidism symptoms
Definition

tachycardia

cardiac arrhythmias

body wasting

nervousness

tremor

excess heat production

Term
Which hormones causes hypo-calcemia
Definition
calcitonin
Term
smal gland located in the neck near the larynx
Definition
thyroid gland
Term

enlargement of the thyroid gland

can occur in either hypo or hyperthyroidism

Definition
goiter
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
hypothalamus
Term
TRH stimulates the anterior pituitary to release?
Definition
thyroglobulin stimulating hormone (TSH)
Term
TSH stimulate thyroid to...
Definition
iodinize the thyroglobulin which is then converted into T3 and T4 depending on how many iodines are incorporated
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
thyroid U.S.P
Term
use is no longer recommended because potency may vary and risk of allergic reactions
Definition
thyroid U.S.P
Term
contains both T3 and T4
Definition
thyroid U.S.P
Term
encourage patients to change to levothyroxine if they are taking
Definition
thyroid U.S.P
Term
thyroid replacement of choice
Definition
levothyroxine sodium
Term
contains T4 only
Definition
levothyroxine sodium
Term
once a day dosing and a long half life of 7 days
Definition
levothyroxine sodium
Term
absorption is best on an empty stomach @ least 60 min before meals
Definition
levothyroxine sodium
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
thyrotoxicosis
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
Thioamides
Definition

propylthiouracil

methimazole

 

Term
Propylthiouracil dosing...
Definition
multiple daily dosing
Term
Methimazole dosing
Definition
once a day is possible
Term
MOA of thioamides
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
thioamides
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
MOA of iodides
Definition

acutely blocks thyroid hormone release

block the synthesis of T3 and T4 precursors

Term
Iodides clinical uses
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
iodides
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
MOA of propranolol
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
Propranolol
Definition
diltiazem for thyroid storm with concomitant HF/asthma
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