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62 Cards in this Set
- Front
- Back
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What is the connection of the hypothalamus to the ant pit? To the post pit?
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Ant pit - releasing hormones
Post pit - AP's |
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6 hormones the ant pit releases.
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ACTH (adrenocorticotrophic hormone)
TSH (thyroid stimulating hormone) GH (growth hormone) PRL (prolactin) FSH (follicle stimulating hormone) LH (lutenizing hormone) |
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What does ACTH from the ant pit do?
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Stim's the adrenal cortex (think andrenocorticotropic hormone) to release glucocorticoids.
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What does TSH from the ant pit do?
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Stimulates the thyroid to release thyroid hormones.
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What is another name for GH from the ant pit? What does it do?
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Somatotropin. Stimulates growth & metabolism.
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What does PRL (prolactin) from the ant pit do?
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Mamm gland - stim milk production.
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What does FSH from the ant pit do?
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REGULATES egg & sperm production.
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What does LH from the ant pit do?
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STIMULATES egg & sperm production.
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With pituitary disorders do you pharmacologically intervene upstreme or downstream? Why?
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Downstream b/c the pit gland is the 'master gland'.
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What is another name for ADH & where is it from? What does it do?
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Vasopressin. From the post pit. Hypothalamus detects dec in plasma vol therefore ADH acts on kidneys to inc water reabs.
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What do you give to Tx acromegaly?
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GH antagonists
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Name 2 GH antagonists. Describe their actions.
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Octreotide - related to somatostatin; NOT working down stream to Tx acromegaly b/c directly inhibits GH release.
Pegvisomant - GH hormone RECEPTOR antagonist. Works downstream @ lvl of tissues. |
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What is the condition caused by deficiency of ADH?
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Diabetes Insipidus (DI) - you get dilute urine & constant thirst (b/c ur excreting all ur water in ur urine).
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What would you give to Tx Diabetes Insipidus?
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Desmopressin (agonist) - causes water reabs but doesn't exert the same effects on BP as vasopressin would. Vasopressin is a potent vasoconstrictor. When giving this drug you want to monitor BP, weight, fluid in/out.
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What do thyroid follicular cells make? (3 things)
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T4, T3, calcitonin
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T3 & T4 (thyroid hormones) are derived from?
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Tyrosine amino acid & iodine.
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When Tx'ing a thyroid disorder, did you want to work upstream or downstream?
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Downstream @ the lvl of the thyroid.
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Thyroid hormone has what effect on the body (3)?
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Inc metabolic rate, inc protein synth, inc fat breakdown.
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Define Primary HypOthyroidism.
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Inactive thyroid. B/c virus-intiated autoimmune disease attacks follicular cells (Hashimoto's thyroiditis)
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Define Secondary HypOthyroidism.
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Nothing wrong w/ thyroid gland itself 0 it's the low secretion of TSH by the ant pit!
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How would you Tx HypOthyroidism?
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Levothyroxine - synthetic form of T4.
-reverses effects of hypothyroidism. -has a narrow therapeutic index therefore it may easily cause Sx's of hyperthyroidism (thyrotoxicosis/'thyroid storm') |
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What is primary HypERthyroidism? Seconday?
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Primary - overactive thyroid due to autoimmune disease (Grave's disease) - Ab's that activate TSH rec
-this causes low TSH despite high TH (Ab's stim high TH therefore you get the neg fdbk to dec TSH) Secondary - thyroiditis, pit tumors & thyroid cancer - Tx = surgical removal of thyroid |
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How would you Tx hypERthyroidism?
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Propylthiouracil (PTU) - stops T4 & T3 synth and stops conversion of T4 to T3 @ tissue lvl (remitt Grave's Disease)
Sodium Iodide-131 (Radioactive Iodine) - perm destroys follicular cells |
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What hormone is the primary glucocorticoid?
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Cortisol.
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What is the primary mineralocorticoid?
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Aldosterone - regs Na & K reabs in kidney.
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What is adrenal insufficiency?
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HypOsecretion of cortisol due to inadequate secretion of ACTH.
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What is the reason for primary adrenal insufficiency?
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Addison's. Autoimmune destruction of both adrenal glands. You have high ACTH, low cortisol, low aldosterone.
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What is the reason for secondary adrenal insufficiency?
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Adrenal atrophy due to long term glucocorticoid therapy (man made).
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Sx of adrenal insufficiency?
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HypOglycemia, fatigue, hypOtension, anorexia, diarrhea, dehydration, dec plasma Na lvls
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What special consideration do you need to make about discontinuing glucocorticoid therapy so as to maintain normal adrenal function?
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Taper doses slowly or else acute adrenal insufficiency, hypOtension, lethargy, renal fail, asthenia (loss of str), nausea & vomiting.
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Define Premixed Insulin.
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Mix rapid w/ long acting insulin (more relevant in T2DM)
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Define Bolus Insulin.
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Quick acting meal time insulin.
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Define Analog Insulin.
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No longer cloudy long acting basal insulin (given Q1D)
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Define Rapid Acting Insulin.
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Given after eating - don't need to wait to eat.
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3 basic metabolic defects in T2DM?
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-insulin resistance
-insulin secretory defect not autoimmune-mediated -inc in glucose production by liver |
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What is incretin?!
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GI hormone that inc's amt of insulin released from beta cells after eating.
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What does hyperglycemia do in T2DM?
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-inc lipolysis (adipose)
-inc glucose reabs (kidneys) -dec glucose uptake (muscles) -NT dysf'n -inc secretion of glucagon -dec secretion of insulin -inc hepatic glucose production (HGP) |
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Action of Alpha Glucosidase Inhibitor (AGI)? SE's?
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Inhibits pancreatic alpha amylase (so that polysacc's can't be broken down to be abs'd). SE = diarrhea & flatulence.
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Action of Antiobesity Agents? SE's?
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Inhibits lipase. You become more sensitive to own insulin. Has NO effect on stopping hypOglycemia. SE = GI
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Action of Biguanide? SE's?
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Enhances insulin sensitivity in live & peripheral tissues by activation of AMP-activated protein kinase. Shuts off gluconeogenesis in liver. Works in bkgrd & doesn't lower BG! SE = GI, B12 def's, don't use if renal or hepatic fail
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Action of Bile Acid Sequestrants (BAS)? SE's?
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Impedes int reabs of bile acids - traditionally used to dec LDL. Doesn't stim extra insulin therefore negligible risk to low BG.
SE = constipation, dyspepsia (upset stomach/indigestion) |
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Action of DA Agonist? SE's?
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Activates hypothalamic DA rec's to reg peripheral fuel metabolism of glucose. SE = nausea, orthostatic hypOtension, nasal congestion?
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Action of DPP-4 Inhibitor? SE?
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Amp's up incretin path activation by inhibition of DPP-4 enz that breaks down GLP-1 & GIP. SE = pancreatitis?
Negligible hypOglycemia risk if monotherapy **GLP1 = helps dec BG, shut off liver gluconeogenesis, dec abs of glucose in int's - therefore good dec of A1C*** |
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What does GLP1 do (why is it a shame that DPP-4 breaks it down?)
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GLP1 helps dec BG, shut off HGP, dec glucose abs in int's -> therefore it can help dec A1C
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Action of Glucagon Like Peptide-1 (GLP-1)? SE?
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Activates incretin path by using DPP-4 resistant analogue to GLP-1.
SE = pancreatitis, parafollicular cell hyperplasia, not Rx if fam Hx of medullary thyroid cancer/multiple endo neoplasia syndrome -has weight loss effects (T2DM!) |
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Action of Insulin? SE?
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Activates insulin rec's to reg metabolism of carbs, fat, protein.
-big risk of hypOglycemia SE = weight gain |
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Action of Insulin secretagogues (sulfonylureas & meglitinides)? SE?
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Activate sulfonylurea rec on beta cell to stim endogenous insulin secretion (stim pancreas to inc insulin secretion)
-SE = weight gain, cautious use in renal/hepatic issues & elderly |
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Action of sodium glucose co-transporter-2 inhibitor (SGLT-2)? SE?
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Inhibits renal glucose reabs'n.
SE = polyuria, inc'd genital & UTI |
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Action of TZD? SE?
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**The wonder drug turned disaster drug!!!**
Enhances insulin sensitivity in peripheral tissues & liver by activation of peroxisome proliferator-activated rec-gamma rec's. Was supposed to deal w/ HGP! SE = weight gain, edema, CHF, macular edema, fractures, MI |
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What are the 3 estrogens that may be present in a female's body & the times in her life that they may be present?
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Estradiol = maj ovarian estrogen
-most potent -from action of aromatase on testosterone Estrone = predominant during menopause -esterone converted to estradiol -esterone stored in body fat & released as a supply of estradiol Estriol = primary during preg's -from the placenta |
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What does estrogen do?
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-Proliferation of uterine endometrium
-thicken vaginal mucosa -female fat deposition -inc vasc of skin (blush = fertile - psych) -inhibition of LDL formation & inc HDL -enhanced coagulation (b/c inc clotting factors) -produces thin, clear, watery, elastic cervical mucus (facilitates sperm mov'nt = good 'spinnbarkeit') |
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What does progesterone do?
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-inc mucus thickness & prevents sperm entry (mucus plug in prego)
-limits & stabilizes endometrial growth (atrophic state) -inhibits myometrial contractions -inc's body temp (running hot all preg) |
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What hormones do combo contraceptives include? When should you be worried about becoming pregnant?
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Estrogen & progestin. After 1-2 missed pills.
-it's the 21 day hormone + 7 day placebo one |
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Why should you never combo oral BC w/ antibio's?
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Antibio's alter gut flora therefore dec's PO BC abs'n & efficacy!
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Progestin only PO ('minipills') - when should you be worried about getting preg? What precautions are u taking?
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>3hrs late with pill! - use barrier method for 48hrs after missed pill
>1day late w/ pill! - use barrier method for rest of cycle! |
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How frequent is the Depo shot (progestin only)?
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Protection for 3mo
Admin 5days after onset of menstruation Need to wait 10mo to get prego after cessation |
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Post-coital contraception is?
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High-dose Estrogen therapy! OR High Estrogen & Progestin Combo Therapy
-nausea for both so admin w/ antiemetic! |
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What's the 'morning-after pill'?
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Antiprogestins!!
-1 dose will cause endometrial shedding -take w/in 3days of intercourse |
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Define emergency contraception. Define chem abortion.
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Emergency Contraception - inhibits preg & implantation
Chem Abortion - already implanted & getting rid of the zygote! |
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What are the Sx's of menopause?
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-insomnia
-hot flashes -vaginal atrophy -mood disturbances -irritability -osteoporosis |
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Associated risks w/ HRT?
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-CAD
-stroke -breast cancer -DVT **don't use on women >59yo!*** |
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What hormones is HRT replacing?
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Estrogen & Progestin.
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