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139 Cards in this Set
- Front
- Back
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what hormones does the hypothalamus release? |
GHRH CRH TRH GnRH PIH PRH |
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the anterior pituitary releases what hormones? |
GH ACTH TSH FSH/LH Prolactin |
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what hormones does the posterior pituitary release? |
oxytocin ADH |
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Octreotide (Sandostatin) is what type of drug? |
anterior pituitary hormone |
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what is the MOA of Octreotide? |
analog of somatostatin GH inhibitng hormone |
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what are the advantages of using Ocretotide? |
half-life longer than natural (once given every month) -vasoconstrict to prevent GI bleeding like esophageal varices -GOOD FOR CIRRHOSIS! |
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what is Ocreotide used for? |
Acromegaly tx when tumor cause |
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what are characteristics of acromegaly? |
asymmetrical frontal bossing increase in shoe size enlarged hands and feet
increase in size even after puberty or the closure of plates |
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SE of Ocreotide? |
Diarrhea from VIPomas short term |
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Pegvisomant: _____ receptor antagonist |
GH
**it does not ↓ the amount of GH but blocks the receptor.** |
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when do you use Pegivosmant? |
when patients do not respond to octreotide → used in refractory cases of growth hormone excess |
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______ and ______ are long acting forms of somatostatin. they ______ release of ______ from the anterior pituitary |
Octreotide, Lanreotide inhibit release of GHRH from anterior pituitary |
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growth hormone is considered as ____- ________ med b/c ↑ lean body mass, ↓ fat, ↑ QOL. therefore it has the potential for ______- |
anti-aging abuse |
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______ is a growth hormone that you have to be human for its' use. |
Somatropin |
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what are indications for somatropin and when is it released? |
-used in growth hormone deficiency -naturally released during sleep/night |
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GH defciency is considered as less than ______ in children. how is defined in adults? |
children- <2.5 SD→ short stature
adults: ↓ lean body mass, BMD, QOL, ↑ fat mass, cardiovascular dz and mortality |
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how many inches are expected to grow w/ somatropin? |
only 1 inch |
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how is Somatropin administered and what are SE? |
IM or SC injection 3x weekly DO NOT GIVE IF PLATES HAVE ALREADY CLOSED
-may cause insulin resistance→ hyperglycemic→ diabetes so must measure Hb1Ac ONCE A YEAR
potential for abuse. |
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what are alternative uses for Somatropin? |
AIDs wasting short bowel syndrome |
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the release of CRH causes secretion of _______ from the adrenal cortex |
corticosteroids |
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T or F: ACTH is both diagnostic and therapeutic |
false. it's only diagnostic. |
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what is the difference between primary and secondary adrenal insufficiency? |
primary- defciency in production of hormone from the target gland itself→ no negative feedback→ ↑ ACTH levels
secondary- something wrong w/ hypothalamus or pituitary→ ↓ ACTH levels |
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what is characteristic about cortisol? |
it's diurnal variation: AM > PM
feed mostly thru 6-9 am
if checked cortisol levels later in the day→ ↓ cortisol levels and could falsely label someone as adrenal insufficient |
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what affects the release of cortisol? |
stress trauma tumor fever hypoglycemia pain infection |
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what other special receptor does CRH exert its affect on? what effects does it show? |
proopio-melanocortin receptor→ hyperpigmentation
similar activity as melanocytes |
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what does cortisol do? |
anti-inflammatory actions increased gluconeogenesis increased protein breakdown |
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what is preferred for diagnosis of adrenal insuffiency? |
Cosyntropin (ACTH) |
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what else can cosyntropin (ACTH) be therapeutic for? |
MS Infantile spasm (West syndrome) |
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what is collected from the urine of pregnant women? |
HCG (human chorionic gonadotropin) |
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what are signs of hypogonadism? |
obese loss of hair breast mass loss of muscle mass
you're losing testosterone.... |
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HCG has similar action to _____ w/ slight _____ activiity |
LH, FSH
LH→ ↑ testosterone→ tx hypogonadism |
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what are indications for HCG? |
prepubertal cryptorichidism hypogonadism ovulation induction (infertility) |
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when is it given? |
13th day of menstrual cycle after the release of ovum from the ovary |
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what are SE of HCG? |
HA edema fatigue depression |
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what is used to tx fertility? |
HCG and FSH |
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When and how is FSH given? |
5-12 days to stimulate follicle growth → ↑ FSH and LH
given IM or SQ |
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SE of FSH |
hyperstimulation→ multiple gestations
STOP TX IF YOU SEE THIS OCCURS |
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how does fertility tx work? |
follicular enlargement w/ FSH then ovulation w/ HCG |
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what is pulsatile secretion? continuous release? |
pulsatile- release of FSH and LH continuous= inhibition of FSH and LH |
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is prostate cancer pulsatile or continuous release? |
continuous release |
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what are inhibitors of GnRH? |
Leuprolide (lupron) goserelin Nafarelin Histrelin |
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what's the MOA of Lupron? |
occupies and desensitizes LHRH receptors inhibiting gonadotropin secretion |
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what is Lupron used to treat? |
prostate ca |
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what are other potential treatments of lupron? |
endometriosis precocious puberty PCOS uterine fibroids |
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what are SE of lupron? |
edema hot flashes impotence decreased libido
you are ↓ estrogen and testosterone so menopausal symptoms! |
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what NT inhibits prolactin? |
dopamine |
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what does prolactin do? |
milk lactation |
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how do you tx hyperprolactinemia? |
bromocriptine and cabergoline
cabergoline better tolerated** |
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what's the MOA of bromocriptine and cabergoline? |
dopamine agonists |
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which patients are more likely to have hyperprolactinemia? why? |
ppl are antipsychotics like Risperidone b/c they are dopamine antagonists so ↓ dopamine→↑ prolactiemia→ ↓ FSH and LH |
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what is the drug that can cause juvenile seizures from nasal spray? what is used for? |
DDAVP bedwetting |
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what characteristic does DDAVP have? |
non-pressor properties of vasopressin so doesn't vasoconstrict nasal or oral
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whats the MOA of DDAVP? |
ADH affect |
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what is used to tx diabetes insipidus and works on the kidneys to reasborb water? where does it reabsorb water at? |
vasopressin
collecting tubule |
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when do you use vasopressin? |
hemorrhage shock to ↑ BP ACLS |
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vasopressin is a form of _______ |
ADH |
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Vasopressin is limited due to _______ |
short action |
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T or F: Vasopressin most uses off label. |
True |
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what are SE of vasopressin? |
water intoxication hyponatremia facial pallor nausea abd. distention
FLUID OVERLOAD |
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what is the "hormone of love" released during orgasm? |
Pitocin |
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Pitocin is a form of what? |
oxytocin |
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what are indications for pitocin? |
uterine contractions → induce labor milk ejection |
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what are SE of pitocin? |
rupture of uterus fetal death HTN |
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what is T4 and T3? |
T4- inactive form but more stable form- 80% of thyroid hormones produced
T3- active form- 20% produced |
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if you have hyperthyroidism, you have ____ TSH levels. hypothyroidism means you have _____ TSH levels |
hyperthyroidism-decrease hypothyroidism- increase |
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antibodies to thyroid peroxidase means you ahve ____ hx of thyroidism such as _______ |
familial hx Hasimoto thyroiditis |
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what are signs of hypothyroidism? |
dry skin sallow complexion periorbital myxedma loss of lateral aspect of brow cold intolerance weight gain hair loss constipation puffy face cold clammy hands |
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what is used to tx hypothyroidism? |
Levothyroxine
FYI: 4th most prescribed generic drug in 2010 |
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what do you not take w/ levothyroxine? |
don't take w/ Maalox food 30-45 min before calcium (↓ absorbption) antacids multi-vitamins (primarily iron- inhibits reabsorption) protonix zantac calcium |
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do you switch brands w/ levothyroxine? |
NO. otherwise the levels will be abnormal |
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what is the drug that has pig thyroid? |
Armour thyroid |
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what is so special about armour thyroid? |
both T4 and T3 so pts say they feel better b/c T3 gives them the extra boost for a short amount of time b/c it's the active form and has a short half-life |
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what drugs accelerate metabolism of thyroid hormones (Phenytoin)? |
P450 drugs |
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what's the progression of the drugs? |
start w/ levothyroxine first. see if they get better within 2-3 months. if not, give them armour thyroid. |
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how long do patients take levothyroxine for? |
for life. constantly adjust the dose. |
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what's the drug that contains T3? |
liothyronine (triiodothyronine) |
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what are SE of levothyroxine? |
paplitations jittery fingers osteoporosis? |
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which disease has the goiter? |
hyperthyroidism |
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goiters can cause compression of the SVC causing redness in the face which is also called? |
Pemberton's sign |
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what are signs of hyperthyroidism? |
palpitations goiter sweating diarrhea hot flashes tachycardia tremors heat intolerance weight loss exopathlamos pretibial myxedema anorexia, muscle wasting |
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what's 1st line of tx for Grave's dz? second? |
1. methimazole 2. PTU |
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what are the only 2 indications for PTU over methimazole? |
1st trimester of PG then afterwards, switch back to methimaozle
thyroid storm- PTU is more effective |
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PTU or Methimazole: which one has more liver toxicity? |
PTU |
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PTU or methimazole: which one takes longer to become euthyroid? |
PTU- 50 weeks Methimazole- 20 weeks |
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how often is PTU administered? Methimazole? |
PTU- dosed mutliple times daily Methimazole- 3 equal doses @ 8h intervals= most preferred |
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what are SE of both? |
skin rash, leukopenia, AGRANULOCYTOSIS- monitor closely for 3 months
if have fever, sore throat→ order CBC→ WBC→↓ neutrophils |
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what's an absolute CI of methimazole/PTU? |
<500 of neutrophils |
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when is potassium iodine used for? |
short-term for thyroid storm |
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what's the MOA of KI? |
it releases thyroid hormone from the thyroid gland |
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what must you give before giving KI to block iodine synthesis? |
methiamazole or PTU
**giving KI before giving methimazole or PTU, the iodide will be taken up by the gland and ↑ secretion of thyroid hormone so makes it worse |
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what is thyroid storm? |
aggressive form of hyperthyroidism acutely sick N/V Afib hyperthermia CHF |
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how do you tx thyroid storm? |
high doses of PTU 200 mg every 4 hrs beta blockers- propranolol- slow down the heart, palpitations, tremors, anxiety ↓ T4 to T3 |
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adrenal cortex secretes what? |
glomerulosa→ aldosterone fasciculata→ cortisol reticularis→ androgens |
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adrenal medulla secretes what? |
catecholamines- EPI and NRE |
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if you have a tumor of the medulla, you have excess catecholamines which is called what? |
pheochromocytoma |
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low cortisol levels is called ________. high cortisol levels is called ________. |
low- Addison's high- cushing's dz |
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primary addison's dz has _____ cortisol, _____ ACTH. it can be caused by what?
Secondary has _____ ACTH, ______ cortisol |
primary- ↓ cortisol, ↑ ACTH caused by dz in adrenal gland, autoimmune, TB, fungal infections, CMV
secondary- ↓ cortisol, ↓ ACTH |
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in primary adrenal insufficiency, you have hypo or hyper pigmentation? |
hyperpigmentation- interacts w/ melanocytes - knees, arms, axilla, knuckles
hyperpigmentation does not occur in secondary adrenal insufficiency |
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what are signs of addison's dz? |
fatigue anorexia weight loss N/V/Dizziness abdominal pain muscle or joint pains salt craving HYPOTENSION HYPOGLYCEMIA HYPONATREMIA hyperkalemia metabolic acidosis adrenal crisis- shock, low BP |
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remember, what are the 3 functions of cortisol mentioned earlier? what effect does it have on sodium and potassium? |
anti-inflammatory gluconeogensis increased protein breakdown
cortisol also retains sodium→ excretes potassium and hydrogen ion in urine |
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cortisol is a _________ and aldosterone is ________ |
glucocorticoids mineralcorticoids |
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what's the MOA of corticosteroids? |
it stimulates or inhibits the promoter, which initiates or inhibits transcription of a gene |
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cortisol: what secretes it? when are levels most accurate? what affects it? |
-secreted by adrenal cortex ~ 20 mg majority in am hours -circulating cortisol exerts a direct neg. feedback effect on hypothalamus
-sx, infection, stress, hypothermia, increase secretion causes a ↑ in cortisol |
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what overrides the neg. feedback loop in cortisol? |
stress |
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effects of glucocorticoids? |
gluconeogenesis- prod. from amino acids→ ↑ glucose→ diabetes protein catabolism- ↓ muscle mass, thin skin, osteolysis → check for BMD if using longer than 3 months anti-inflammatory effects immunosuppression fatty acid mobilization- redistribution of fat "cushingoid habitus" |
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s/s of cushing's disease? |
loss of muscle mass thin skin easy bruisability obesity in trunk buffalo hump - 2 sticks on lemon facial plethora hirsuitism striae- bluish, and raised compared to normal stretch marks in PG proximal weakness |
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name a mineralcorticoids? do they retain sodium? |
fludrocortisone yes retain sodium→ hypernatremia and metabolic alkalosis→ loss K and hydrogen ions in the urine |
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what glucorticoids are short acting? which one has the same anti-inflammatory and salt-retaining effect? |
hydrocortisone- same effects 1:1 ratio cortisone
short acting 1-12 hrs |
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which drugs are intermediate glucocorticoids? which one of them has no salt retaining effect? |
prednisone prednisolone methylprednisolone triamcinolone - no salt retaining effect
12-36 hrs |
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which drugs have long acting effects? do they have salt-retaining effects? |
Betamethasone dexamethasone |
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in primary adrenal insufficiency, dexamethasone won't work b/c ______ so you need fludrocortisone + glucocorticoids together |
you need salt in primary adrenal insufficiency |
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if it's a secondary insufficiency, normal adrenal gland, defect in pituitary, you only need _______ |
glucocorticoids |
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ACTH mainly regulates ______ and ______. it does not regulate ________. so even if there was a deficiency of ACTH, it won't effect ______ b/c it is not regulated by ACTH so replace w/ _______ |
regulates cortisol and androgens. not mineralcorticosteroids. won't effect mineralocorticoids. replace w/ glucocorticoids. |
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you give hydrocortisone ______ and prednisone ____. dosage of each? |
hydrocortisone- 20 mg twice daily prednisone 5 mg once morning
Prednisone is 4 times more potent that hydrocortisone so reduce the dosage by 4 times. |
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T or F: all corticosteroids can be given PO |
true |
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which steroids are given IV and IM? |
dexamethasone hydrocortisone methylprednisolone prednisolone |
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which steroids can be given topically? |
dexamethasone hydrocortisone triamcinolone |
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what are alternate forms of steroids? |
enemas nebulized dose packs (allergies) gel joint eye ear |
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T or F: hydrocortisone is cheaper than prednisolone |
false. it's more expensive. |
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so if they don't have insurance, which steroid do you give them? |
prendisolone but more potent |
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if insured, prefer using ________ |
hydrocortisone |
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what's the most important thing about dosing steroids? |
WEANING THEM OFF. TAPER DOWN
IF STOPPED ABRUPTLY, CAUSE ACUTE ADRENAL CRISIS. |
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prolonged use of steroids can cause _______ |
Cushing's dz |
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what are indications for steroids? |
Cerebral edema spinal disc dz- epidural injections organ transplantation asthma rheumatologic conditions cancer skin problems eye problems allergy UC/Crohn's Arthritis Collagen d/o myasthenia gravis |
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what are SE of steroids? |
P-UD R-rash E-ezcema D-diabetes N- no sleep I-increase hair growth S- suppression of adrenal gland (↓ ACTH) O- osteoporosis N- nocturia E-edema (excess weight gain) |
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long term SE of corticosteroid therapy |
decreased growth in children osteoporosis increased appetite HTN GLAUCOMA increased risk of infection emotional disturbances peripheral edema centripetal distribution of body fat hirsutism peptic ulcer hypokalemia |
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what is congenital adrenohydroplasia? |
deficiency in 21- of hydrooxyprogesterone or progesterone? can't produce aldosterone or cortisol excess production of androgens precocious puberty tx: give them glucocorticosteroids and aldosterone |
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↑ coritsol→ ↓ ACTH→ ↓ androgens |
just extra info |
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what are the 3 inhibitors of adrenocorticoid biosynthesis? |
ketoconazole spironolactone eplerenone |
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which one can be used in refractory cushings? |
ketoconazole |
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what is a SE of ketoconazole? |
liver toxicity |
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tell me about spironolactone? |
it's a mineralcorticoid used for adrenal alderonoma (excess aldosterone), gynecomastia b/c of antiandrogen effect, and hyperkalemia esp. if on ACEIs |
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which drug does not have androgen receptor effect on gynecomastia but has anti-mineralcorticoids receptor? |
Eplerenone |
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know each of these pairs |
Pegvisomant- tx acromegaly cabergoline- tx prolactinoma HCG- tx infertility Vasopressin- tx diabetes mellitus Somatropin- tx GH deficiency DDAVP- bedwetting |
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s/s of hypothyroidism include all of the following except:
bradycardia cold intolerance weight gain fatigue tremors |
tremors |
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all of the following can be used to tx thyroid storm except PTU iodide triiodothyronine glucocorticoids propranolol |
triiodothyronine |
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symptoms of adrenal insufficiency include all of the following except: weight loss hypotension N/V hypoglycemia easy bruisability |
easy bruisability- Cushing's |
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all of the following adverse effects commonly occur in glucocorticoid therapy except: pU cataracts hypertension immunosuppression hypoglycemia |
hypoglycemia |
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what steroid drug is specifically used in PG? |
prednisone |
