441 pituitary.txt

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karennnb
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123531
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441 pituitary.txt
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2011-12-13 21:31:34
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441 pituitary
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441 pituitary
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  1. menotropins
    FSH and LH from urine of postmenopausal women
  2. urofollitropin metrodin, fertinex, bracelle
    FSH-enriched ; from urine of postmenopausal women
  3. follitropin (rFSH)
    timulate spermatogenesis in men; SE- ovaraian hyperstimulation (reversible)
  4. chorionic gonadotropin (hCG)
    mimics LH but has longer half life; stimulates testosterone prod and masculinization (made in placenta)
  5. ovidrel
    recombinant hCG
  6. lutropin rLH
    recomb LH
  7. controlled ovarian stimulation protocol: GnRH super agonist
    Lupron + FSH + hcg
  8. controlled ovarian stimulation protocol: GnRH super agonist: LUPRON?
    day 1, blocks FSH and LH release
  9. controlled ovarian stimulation protocol: GnRH super agonist: FSH?
    day 9/1st day of bleeding; stimulates follicular development
  10. controlled ovarian stimulation protocol: GnRH super agonist: hcg?
    day 17; stimulates ovulation
  11. clomiphene citrate (clomid)
    non peptide, antiestrogen that inhibits INHIBITION BY ESTROGEN (ie LH and FSH ARE released)
  12. clomiphene citrate adverse effects
    hot flashes; multiple births, ovarian enlargement
  13. gnrh role
    stimulates release of FSH, LH, and GH
  14. FSH in males
    spermatogenesis
  15. fsh in females
    maturation of ovarian follicles
  16. lh in males
    testosterone production
  17. lh in females
    ovulation
  18. gnrh decapeptide (gonadorelin)
    VERY SHORT half life
  19. gonadorelin acetate (lutrepulse); indication
    INDUCE OVULATION (or treat male infertility) for hypothalamic deficiency
  20. gonadorelin acetate (lutrepulse); characteristics and use
    decapeptide identical to gnrh; acts on pituitary; PULSE DOSES
  21. leuprolide (lupron)
    gnrh super agonist with MUCH LONGER HALF LIFE--desensitizes gnrh receptors
  22. nafarelin
    gnrh super agonist analog nasal spray
  23. goserelin
    gnrh super agonist analog implant
  24. lupron, histrelin, triptorelin
    gnrh super agonist analog injections
  25. suppress endogenous gonadotropins (gnrh super agonist) indications
    central precocious puberty; controlled overaian stim; pharm castration
  26. suppress LH induced testosterone release (gnrh super agonist) indication
    prostate cancer tx
  27. supress estradiol syn and release (gnrh super agonist) indications
    endometriosis, advanced breast cancer
  28. ganirelex (antagon)
    gnrh antagonist
  29. cetrorelix (cetroltide)
    gnrh antagonist
  30. gnrh antagonists
    IMMEDIATE suppression of gonad. release; used to inhibit LH and FSH release during CONTROLLED OVARIAN STIM PROTOCOLS
  31. controlled ovarian stimulation protocol: GNRH ANTAGONIST
    FSH + antagon + hcg
  32. controlled ovarian stimulation protocol: GNRH ANTAGONIST: FSH
    day 1 to stimulate follicle develop
  33. controlled ovarian stimulation protocol: GNRH ANTAGONIST: antagon
    day 6 to block FSH and LH release
  34. controlled ovarian stimulation protocol: GNRH ANTAGONIST: HCG
    day 9 ovulation
  35. controlled ovarian stimulation protocol: GNRH ANTAGONIST advatange over LUPRON??
    SHORTENS PROTOCOL
  36. somatotropin
    growth hormone used therapeutically
  37. somatrem
    GH used therapeutically with an extra N-terminal methionine
  38. therapeutic GH MAIN USE
    stimulate skeletal growth in pediatric pts with growth deficiency
  39. other therapeutic GH indications
    hormone replacements in adults with PITUITARY DEFICIENCY; WASTING/CACHEXIA in hiv aids pts; DEC PARENTERALS in pts with short bowel syndrome
  40. gh direct effects in liver
    inc protein syn, gluconeogensis, IGF1, RNA syn, and glucose utilization
  41. gh direct effect on muscle
    inc amino acid uptake, protein syn and lean body mass, DEC glucose uptake
  42. gh direct effect on adipose
    (DEC FAT) inc lipolysis and FFA
  43. GH indirect effect on liver
    IGF prod
  44. IGF effect
    inc bone growth and growth of other organs
  45. what does GH activate upon binding to receptor
    JAK2, MAP kinase, STAT, PI3K
  46. mecasermin
    recomb IGF for pts who dont produce IGF in response to GH
  47. octreotide acetate
    somatostatin analog
  48. ocreotide pharm. effects and indications
    GPCR; opens K channel, inhib Ca channels, NO GH (small effect on dec insulin secretion). MUCH LONGER HALF LIFE THAN SOMATOSTATIN
  49. clinical uses of ocreotide
    acromegaly, carcinoid tumors, WDHA syndrome
  50. pegvisomant
    GH receptor antagonist for acromegaly (pegylated so it can bind but not activate)
  51. ghrh
    growth hormone releasing hormone (secreted from hypothalamus TO the pituitary)
  52. geref-sermorelin acetate
    ghrh; used for dx of GH deficiency or to stimulate growth
  53. adrenocorticotropin (ACTH)
    stimulants glucocorticoid production in adrenal cortex
  54. corticotropin, cosyntropin
    acth used for dx: testing adrenal fct
  55. tsh
    thyroid stimulation hormone; stimulates i131 uptake (lethal to thyroid cells)
  56. crh
    corticotropin releasing hormone to test ACTH release
  57. vasopression
    ADH: AD activity + vasoconstriction activity
  58. oxytocin
    1. uterine sm musc contraction/ 2. milk ejection in lactating females
  59. what stimulates vasopressin release?
    1. inc blood osmotic pressure/ 2. dec fluid (blood) vol
  60. what stmiulates release of oxytocin
    stretch receptors in cervix/ tactile receptors in nipples
  61. AVP at V1 receptors
    inc ca - vascular smooth musc contraction
  62. other tissues where there are v1 receptors?
    myometrium, bladder, intestinal sm muscle, platelets
  63. is AVP more potent at v1 or v2
    v2
  64. AVP at V2 receptors
    inc renal collecting duct water permeability, more reabsorpl; lower urin vol, inc urine conc
  65. v2 receptor mech
    inc camp, inc pka, aquaporin translocation
  66. v2 receptors also inc levels of...
    von willebrands, factor VIII
  67. vasopressin
    AVP with 8-arg substitution
  68. lypressin
    AVP with 8-lys sub
  69. desmopressin, DDAVP
    synthetic vasopressin with LOTS LOTS more selectivity for AD activity over pressor activity
  70. biggest therapeutic use of vasopressin (desmopressin)
    central diabetes insipidus
  71. other therapeutic uses of vasopression (but desmo better)
    hemophilia a, von willebrands disease, nocturnal enuresis, control esophageal varices bleeding (unlabeled)
  72. vasopressin AEs
    water intox, cramping, use with extreme caution in pts with CV disease
  73. vasopressin interactions
    NSAIDs, CBZ ad clorpropamide INC ADH effects, etoh DEC ADH release
  74. vaprisol (conivaptan)
    nonpeptide v1a and v2 antagonist for hyponatremia
  75. vaprisol SE
    phlebitis (IV), hypotension
  76. oxytocin MOAs
    1. inc myometrium contractions during late preg/ 2. contraction of sm musc cells in breast alveoli
  77. how does oxytocin cause myometrium contraction?
    1. inc Ca, 2. inc PG syn
  78. syntocinon
    oxytocin parenteral or nasal spray
  79. pitocin
    oxytocin parenteral
  80. therapeutic uses of oxytocin
    1. induce/stimulate labor (IV) 2. enhance milk ejection (nasal)
  81. oxytocin SE
    fetal distress, uterine rupture, water intox, inc bleeding
  82. monitor these during oxytocin tx
    contractions, fetal HR, fluids

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