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83 Cards in this Set
- Front
- Back
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what system synchronizes body fxns by conveying messages b/w specific tissues and cells?
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the neuroendocrine system
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what is the neuroendocrine system regulated by?
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the hypothalamus and pituitary
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what is the difference in time b/w genomic and non genomic effects?
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genomic takes hours to days
while non genomic takes seconds |
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what is the neuroendocrine systemis responsible for controlling in the body?
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*growth
*metabolism *reproduction |
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what horomones are made in the hypothalamus and then transported to post pituitary?
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vasopressin and oxytocin
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what are most hypothalamic hormones made of?
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small proterins (peptides)
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how do hypothalamic hormones and pituitary hormones exhibit there effects?
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through a specific membrane receptor
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what controls the sythesis and release of ant. pit hormones?
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the hypothtalmaic releasing or inhibitng hormones
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what are the hypothalamic regulatory hormones largely used for in medicine?
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as diagnostic tools to deteremine different states of pituitary insufficiency
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what are the pituitary hormone preparations used clinically for?
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as replacement therapy for certain hormone deficient states and in treatment of certain hormorn related disorders
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what is the only hypothalamicor pituitary hormone that is NOT a peptide
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dopamine
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how does being a peptide influence the method of administration?
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they must be administered either sub q or intramuscularly or intranasally since they are rapidly degraded within the GI tract
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describe the receptors for growth hormone and prolactin
what does hormone binding to these receptors cause? |
they are similar single transmembrane peptides
binding activates an intracellular tyrosine kinase (JAK2) that causes phosphoyrlation of intracellular proteins thereby influencing gene regulation |
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what are all other hypothalamic and pituitary hormone receptors like? (not GH or prolactin)
what is activated |
seven transmembrane domain serpentine peptides involved in the activation of G proteins
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what does the activation of G proteins lead to?
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*activation of adenylyl cyclase
*synthesis of cAMP, *activation of protein kinases *phosphorylation of intracellular proteins such as enzymes |
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what are the hypothalamic hormones?
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1. Growth hormone releasing hormone-GHRH
2. Somatostatin (somatrotropin release inhibiting hormone) 3. Thyrotropin releasing hormone-TRH 4. Corticotropin releasing hormone (CRH) 5. GOnadotropin releasing hormone (GnRH or LHRH) 6. Dopamine(prolactin inhibiting hormone) 7. Oxytocin 8. Vasopressin |
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what is the natrual GHRH?
what is the synthetic? how are these administered? |
somatorelin is natural
sermorelin is synthetic iv, sc, nasally |
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what is the clinical use of somatorelin/sermorelin?
what are adverse effects? |
the cause of GH deficiency and to promote GH releease in GH deficient kids
facial flushing, injection pain, HA, n/v |
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what is does TRH do?
how many peptides is it? what regulates the release or TRH |
stimulates TSH from ant pituit. and also increases prolactin release
it is a tripeptide it is regulated by thyroxine |
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what is the drug used as TSH?
what is it's clinical usefulness? what are adverse effects? |
Protirelin is drug
administered IV but rarely used in dx of hypo/hyper thyroid states effects include nausea, flushign, light headed |
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what does CRH stimulate?
what is the drug used? |
CRH stimulates ACTH and beta endorphin secretion from ant. pituitary
(ACTH leads to production of cortisol and androgens by adrneal cortex) the drugs used is corticorelin |
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what is the clinical use of corticorelin
(hint: CRH) |
diff. dx of Cushing syndrome and other adrenal disorders
*cushings has high levels of cortisol usually due to pituitary tumor *adrenal disorders have ectopic secretion of cortisol (usually in lung |
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will acth release increase following CRH stimulation in is cause of excess cortisol is from nonpit tumor?
will ACTH increase if excess is due to pit. tumor (cushings) |
NO
YES w/ cushings there is no neg feedback to pituitary |
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how is corticorelin administered and waht are side effects?
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IV, facial flushing, midl dyspena and hypotension
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what does gonadotropin releasing hormone stimulate?
what is natural drug used clinically? |
GnRH stim. Gonadotropins from ant pit. (LH and FSH)
drug used clinically is Gonadorelin |
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why is gonadorelin administered in pulsatile doses and not continuously
what are clinical uses? |
pulsed doses resemble physiologic cycle. if given continuously then then gonadotropin release is actually inhibited
clinical uses include infertility, amenorrhea, delayued puberty and cryptorchidism due to 1st degree hypothalamic hypogonadism |
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what are the GnRH analongs?
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*Leuprolide
*Nafarelin(synarel) *Histrelin *Goserelin *Triptorelin |
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how doe the GnRH analogs compare to gonadorelin in terms of potency and time of action?
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they are more potent and longer acting
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what are some clinical uses for the GnRH analogs?
(hint: they are administered conintuously) |
continuous inhibition inhibits relase of LH and FSH from pit.
this suppression can be used to tx prostatic carcinoma, breast cancer in premenopausal females, ovarian cancer, uterine fibroids, endometriosis, precocious puberty, mastalgia and hirsutism also in femles undergoing controlled ovarian hyperstim and in assisted reproduction tech |
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what are the GnRH adverese effects?
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OSTEOPOROSIS, sweats, hot flashes, HA, depression, decresed libido and vag dryness
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what are the GnRH antagonists?
what do they inhibit what is the clinical use? |
Cetrorelix and Ganirelix
they inhibit LH clinically they inhibit premature LH surges in females undergoin CONTROLLED OVARIAN HYPERSTIM |
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what is the other name for Somatostatin release Inhibitng hormone?
why is somatostatin clinically worthless? |
also called GH inhibiting hormone.
*also inhibits insulin it is cliniclally worthelss due to the really short half life |
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what is the clinically used Somatostatin?
what is this drug used to tx? what is the major adverse effect |
Octreotide***(Sandostatin, Sandostatin LAR DEPOT)
used to treat: -acromegaly -carcinoid tumor -bleeding due to esophageal varices *DOES NOT provoke hyperglycemia adverse effect is biliary disorders suc =ha s gallstones and bile sludge |
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what is is the prolactin inhibiting horomone?
why is this not a practical managment for hyper prolactinemia? |
dopamine
is not practical b/c of it's peripheral actions and requirements of parenteral administration |
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what are the drugs used clinically that are D2 receptor agonists?
how are these drugs administered? |
Bromocriptine and Cabergoline
administered PO |
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what are bromocriptine and cabergoline used to tx?
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HYPERPROLACTINEMIA due to galactorrhea, amenorrhea, hypogonadism,infertility and breast tenderness
also tx prolactin secreting adenomas (prolactinomas) |
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what are drugs that can cause hyperprolactinemia (b/c they are D2 receptor antagonists)
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older antipsychotic drugs such as phenothoazine and haloperidol
also drugs that deplete CNAS amine NT's such as RESERPINE |
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what are the anterior pituitary hormones
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1. GH
2. TSH 3. Adrenocorticotropin ACTH 4. FSH 5, LH 6. Menotropins 7. Prolactin |
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what is the naturally occuring GH?
what are the synthetic? |
Somatotropin is natural
Somatrem and Somatropin are synthetic |
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what is the mech of action of GH?
what is the target organ |
Gh stimulates sythesis and relese of SOMATOMEDINS and promote cell proliferation, bone growth and cartilage synthesis
they also induce an insulin like effect followed by a peripheral insulin antagonistic effect liver is target organ |
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what are the synthetic GH's (Somatrem and Somatropin) used clinically for?
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tx GH deficiency
*hypopituitary dwarfism *turners syndrome *Prader-willi syndrome (short stature) *AIDS assoc wasting/cachexia |
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what are the adverse effects and contraindications of Somatrem and somatropin?
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adverse=intracranial HTN, pancreatitis, gynecomastia and myalgia
contraindicated in kids with closed epiphysis |
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what are two newer drugs used to tx GH failure, GH gene deletion or primary IGF-1 deficiency?
which is better and Y |
Inrelex and Iplex
Iplex is better b/c is only needs to be administered once a day |
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what are adverse effects of iplex and increlex?
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HYPOGLYCEMIA (less w/ iplex)
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what is a GH antagonist?
wat is is used to tx? what are adverse effects? |
GH antagonist is Somavert
used to tx acromegaly adverse is elevated hepatic enzymes |
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what is the natural thyroid stim horm drugs?
what is target organ what does it regulate? what is the release of this drug inhibited by |
thyrotropin is naturally occuring glycoprotein hormone
target organ is thyroid it regulates the thyroid fxn by stimulating adenlyl clclsae and prod of cAMP it also increases iodine uptkae intho thyroid to controll sythesis and release of thyroid hormones T4 and T3 |
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what is the main thyroid hormone? T3 or T4
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T4 is main
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what is the clinical use of thyrotropin?
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as a diagnostic tool b/w primary and secondary hypothyroidism
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if you give someon thyrotorpin and there is no effect on thyroid hormone release what does this indicate?
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primary hypothyroidism due to hypothyroid glad itself not working
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if you give thyrotropin and thryoid hormone increses what does this indicate?
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it indicates secondary hypothyroidism due to pit not releasing TSH
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what is thyrotropin alph used for?
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a diagnostic tool for determining the recurrency of thryoid carcinoma
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when is TSH (thyrotropin) contraindicated?
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if person hs heart dz or adrenocortical insufficiency
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what is target organ of ACTH?
what is teh mechanism of action? what is the rate limiting step of adrneocorticoid sythsis? |
the adrenal cortex
this peptid ehromone regulates release of glucorcorticoids and mineralocorticoids and androgens through the G protein/cAMP mechanism cholesterol esterase |
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what are the ACTH drugs?
what is the clinical use? |
*corticotropin-natural
*cosyntroprin is synthetic COSYNTROPIN used to distinguish primary and secondary addison's dz |
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if cosyntropin is given and there is no effect on corticosteroid release what does this indicate?
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that this is primary addison's due to adrenal gland not producing
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if you give cosyntropin and there is increased relesae of corticosteroid what does this indicate?
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that the pituitary is not making ACTH and is secondary Addison's disease
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what what is the target organ of FSH?
what does is mechanism of action what does it cause in females? what does it cause in males? |
gonads
Controls gonadal fxn through cAMP females=gametogenesis and foliclar maturation males=spermatogenesis |
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what are adverse effectes of FSH drugs?
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females=ovarian enlargment
males=gynecomastia |
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what other hormone does FSH work with?
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LH
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what FSH drug is extracted from urine of postmenopausal women?
which FSH drugs are made through recom DNA? what are the FSH drugs used to tx clinically? |
from urin=Urofollitropin
from DNA=Follitropin alfa and beta tx infertility |
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what is LH a major stimulant of?
what is the target organ? |
major stimulant of gonadal steroid biosynthesis
target organ is gonads |
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what effect does LH have in females
in males? |
in females reulates follicular development and induces ovulation, sythesis of pregesterone and androgens in corpus luteum
in males promotes biosythesis of testosterone |
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what are the three drugs used as clinical LH?
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1. hCG(Pregnyl and Novarel)
2. hCG alfa (Ovidrel) 3. Lutropin alfa (Luveris) |
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what are the hCG's and Lutropin used to tx?
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1. hypogonadism
2. infertility 3. cryptorchidism |
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what are adverse effects?
what are contraindications? |
adverse=ovarian enlargement, gynecomastia, Prostate cancer
contraindicated in presence of adnrogen dependent neoplasms |
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what are menotropins?
where are they acquired from? what is effect in males? in females? |
menotropins are partly degreaded FSH and LH
acquired from postmenopausal women females=promote follicular growth and maturation males=spermatogenesis |
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what are menotropin drugs used clinically?
what do they treat? what are adverse effects? |
drugs are Repronex and Menopur
treat infertility adverse effects are ovarian enlargement and gynecomastia |
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what is prolactin responsible for?
what is target organ? what can a deficiency of prolactin cause? is there any current therapy for prolactin deficient patients? |
primary hormone of lactation
target organ is breast deficiency can cause hyporprolactinemia NO |
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what can hyperprolactinemia lead to?
what is secretion of prolactin inhibited by? |
galactorrhea and hyopgonadism
dopamine(dopamine blockers can cause hyperprolactinemia) |
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what are the Prolactin inhibiting drugs?
which is better? what receptor do these drugs act on? what are the active derivatives? |
Bromocriptine and Cabergoline
Cabergoline is better b/c fewer side effects act on dopamine D2 agonists orally active ergot derivatives |
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what are clinical uses of bromocriptine and cabegoline?
which of these two drugs in not a hormone? |
tx hyperprolactinemia and its manifestations
tx prolactin secreting adenomas, acromegaly and parkinsons bromocriptine |
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what are the post pituitary drugs?
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1. Vasopressin
2. Desmopressin 3. Oxytocin |
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how are post pit drugs administered?
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parenterally since they aren'te peptides
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what is vasopressin?
what does a deficiency result in? what causes a release of vasopressen? |
it is ADH, nonapeptide hormone
deficiency results in diabetes insipidis released due to incresed plamsa tonicity or decreased blood pressure |
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what is synthetic ADH?
what effects does this drug exhibit |
ARGIPRESSIN
exhibits both antidiureticV2 and vasopressor V1 effects |
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what are the the three types or receptrs and resulting effects that argipressin activates?
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1. renal V2=increased water permeability in kidney
2. extrarenal V2=von willebrand factor and coag factor VIII release 3. V1 receptr=vascular smooth muscle vasoconstriction |
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what is the clinical use of argipressin?
what are contraindications? |
tx pituitary diabetes insipidus
control bleeding from esophageal varices and colonic divertiula C/I=CAD (b/c hyponatremia and vasoconstrtiction) asthma(b/c bronchoconstriciton and epilepsy b/c tremor, hyponatrmia, water intoxication |
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what is a a vasopressin antagonist?
what are clinical uses? what is adverse effect? |
conivaptan
tx hyponatrmic states and SIADH adverse effect in hypernatremia |
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what is desmopressing?
what are drug names? |
desmopressin is a selective V2 receptor agonist that is a long acting synthetic VASOPRESSIN DERIV
drugs are DDAVP, stimate and minirin clinically used to tx von willebrand dz and doag wih hemophilia A tx also diabetes insipidus and nocturnal enuresis |
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what are clinical used of DDAVP, Stimate, Minirin ?
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1. pit diabetes insipidus
2. von Willebrand dz and coag assoc with hemophilia A 3. nocturnal enuresis (bedwetting) |
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what does oxytocin do?
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promote milk ejection
stimulant of uterine contraction initiate labor |
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what are clinical uses?
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*induce labor
*reinforce mild let down and releif of post partum breast engorgement *control postpartum and postaboraiton utrerin hemorrhage *induce therapeutic abortion |
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what are adverse effects?
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(HTN crisis
H2o retention uterine rupture and fetal death |
