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Pharm- Pit. H.

Pit H.

What is growth hormone called Somatotropin
What regulates secretion of GH GHRH (positive) and Somatostatin (negative)
What is interesting about the release of GHRH Pulsile
What is activated by GH (include receptor, and one hormone, and one location) In the liver, GH binds a JAK-STAT receptor and leads to the release of IGF-1
Who has high level of GH (4 – random mix) 1.Kids, 2.Hypoglycemia, 3.Long sleep, 4.Ppl that exercise
Other than GH what leads to increase IGF-1 Eating/nutrition
How does IGF-1 feedbacks on the growth hormone pathway 1.inhibitis the release of GHRH and 2.promote the release of somatostatin
What are three causes of GH deficiency/malfunction 1.Laron’s syndrome, 2.Dwarfism, 3.Pit Adenomas
What is dwarfism due to Hypothalamic defect (can't make GHRH)
What are the tx for dwarfism (2) (which one works better) 1.recombinant GH (better), 2.synthetic GHRH
what is synthetic GHRH called sermorelin
What are the side effects of dwarfism tx (2) 1.Intracranial hypertension, 2.Scoliosis: due to too fast growth (+maybe leukemia)
What is somatrem A derivative of GH with a methionine (can be used to tx dwarfism)
What are the tx of Laron’s (drug also called) IGF-1 (mecasermin)
Why can’t one use GH or GHRH to tx Laron’s Receptors don’t work
What are the 3 Sx of GH deficiency in adults (due to pit adenoma) 1. fat distribution, 2. Decrease muscle, 3.impaired psychosocial
How is GH deficience due to pit adenoma txed (1) GH/Somatotropin
What are the AE of Somatotropin in adults (4) Edema, and carpal tunnel , arthalgia, myalgia
How is GH deficiency dxed (2) 1.Induced hypoglycemia using insulin (should raise GH), 2.Give sermorelin (should raise GH)
Why can’t GH deficiency not be dxed by looking at serum GH levels Not consistent (pulsile)
How is GH deficience tx, monitored IGF-1 serum levels
Is hGH effective at increasing muscle strength No (not proven)
What are the side effects of hGH in athletes (5) Edema, and carpal tunnel , arthalgia, myalgia + ACROMEGALY
Why aren’t athletes tested for hGH Can’t (remember the pulsile thing)
3 other medical uses of GH (all related to decrease growth or maintenance of weight) 1.AIDS wasting, 2.Short bowel syndrome, 3.Intrauterine growth retard
What are the 2 GH excess disorders (which one is after puberty
Causes of GH excess disorders (1) Pit adenoma
How are GH excess disorders dx (2) Sx and IGF-1
3 Tx for GH excess disorders 1.Pit surgery, 2.Octreotide (synthetic somatostatin), 3.Pegvisomant (GH-receptor antagonist)
What is the advantage of octreotide, what is the advantage of pegvisomant Octreotide: targets the tumor, can make it smaller, Pegvisomant: treat Sx better
What is a major problem (not AE) of octreotide Many tumors do not respond
AE of octreotide (1) Gallstones
AE of pegvisomant: (1) Abnormal liver test (reversible)
what is the function of prolactin (1~2) 1.breast development, 2.lactation
Who has low level of prolactin (1) Males
Who has high levels of prolactin (3) 1.cycling females, 2.early pregnancy, 3.lactation
what can lead to increase serum levels of prolactin (4) 1.Hypoglycemia, 2.Deep sleep, 3.excercise, 4.children
Prolacting inhibitis: _____________ (~1) Gonadotropins release
What regulates the release of prolactin (2) 1.TRH increases the release of prolactin, 2.Dopamine inhibitis the release of prolactin
What are the 4 causes of hyperprolactinemia 1.Pit adenoma, 2.Hypothalamus problems, 3.Renal failure (decrease excretion), 4.Chest trauma (autonomic response)
what are the Sx of hyperprolactinemia (males: 4, women: 3) Males: infertility, impotence, loss of libido, breasts; Females: infertility, amenorrhea, milk secretion when non-pregnant
What are the Tx of hyperprolactinemia (4) 1.Surgery, 2.Radiation, 3.Bromocriptine, 4.Pergolide
How do bromocriptine and pergolide work (what is important to note) They are dopamine agonist, thus inhibit the production of prolactin. It is important to note, that if Tx is stopped, tumor will resume.
what are 2 AE of bromocriptine and pergolide 1.rare CNS effects, 2.insomnia
what are the causes of decrease FSH or LH (2 vague) 1.hypothalamic, 2.pituitary
What are the Sx of FSH deficiency (3 women, 2 men) Women: amenorrhea, infertility, decrease breast development; Men: decreased testis size, oligospermia
What are the Sx of LH deficiency (3 women, 2 men) Women: amenorrhea, infertility, cystic ovaries; Men: infertility, no puberty
what are the tx used in hypogonodotropism (5 – which ones is not used anymore) They are all about hormone replacement: 1.Chorionic gonadotropin (CG) – mimics LH, 2. Menotropins (urinated FSH and LH from postmenopausal women), 3.Urofollitropin (FSH - menotropins with LH removed), 4.recombinant FS
What are the AE of gonadotropim tx (2) 1.Multiple births, 2.Ovarian hyperstimulation syndrome (OHSS): ovaries start secreting substances that increase permeability and you get systemic edema (including lungs)
What are the causes of hypergonadotropism (1- who gets it) Males can get LH receptor which are always active (dominant disease)
What are the Sx of hypergonadotropism (2) 1.Precocious puberty, 2.Testicular tumor
What is the Tx of hypergonadotropism (vague) Steroid synthesis inhibitors
How are gonadotropic disease dx (2~3) 1.FSH and LH levels, 2.give GnRH (if LH goes up: it is a hypothalamic problem, if it does not: it is a pit problem)
2 other uses of gonadotropins CG can be used for undescended testes, FSH and CG can be used for In Vitro Fertilization (IVF)
What is addison’s Low cortisol
How is addison’s txed Cortisol
What is cushing’s syndrome High cortisol
How is cushing’s txed ketoconazole (suppress corticosteroid synthesis)
What is the precursor of ADH Vasopressin
What are the receptors for ADH (2 – their function) V1 (sm. Muscle contraction) and V2 (conservation of water by the kidney)
How does ADH work at the cellular level (2) 1.binds receptor, thus leading to increase in cAMP, 2.aquaporins go from inside the cell to binding the plasma membrane
ADH leads to increase or decrease permeability Increase
What makes ADH Hypothalamus
From where is ADH released Post. Pit.
What controls the release of ADH (3) Osmoreceptors in the hypothalamus, heart, and aorta
Other than osmoreceptors what can lead to increase ADH (3) Pain, nausea, hypoxia
What are the 2 diseases of decrease ADH 1.Diabetes insipidus, 2.Nephrogenic diabetes insipidus
What are the 2 causes of DI  1.autosomal dominant due to misfolding of vasopressin prohormone (lead to neuronal death), 2.autosomal recessive due to misfolding of vasopressin
What are the 3 Sx of DI 1.Polyuria, 2.Polydipsia, 3. Dehydration
How are DI and NDI DDxed from polydipsia High osmolarity
How are DI and NDI DDxed DI responds positively to desmopressin
What are the 2 tx of DI Vasopressin or desmopressin (analog vasopressin)
AE of Vasopressin or Desmopressin (for each receptors) (5) V1 (most): intestinal cramping & vasoconstriction/pallor/MI – V2: water intoxication, seizures, dizziness (brain swelling)
Who cannot receive vasopressin or desmopressin (2) Heart problem patients, Renal failure
What are the 3 causes of NDI 1.X-linked NDI-V2 receptor defect, 2.autosomal recessive or dominant mutations in aquaporins 2, 3.Drug/Lithium induced inhibition of V2
What are the Sx of NDI (general) Same as DI (1.Polyuria, 2.Polydipsia, 3. Dehydration)
Tx of NDI (2, one drug, one behavioral) 1.Increase water intake, 2.Thiazide diuretics (paradoxical, MOA:
What disease is linked with increased ADH SIADH
What can cause SIADH (5) Cerebellar disease, pulmonary disease, cancer, head trauma, drugs
What are the tx of SIADH (3, only 1 drug) 1.water restriction, 2.IV saline, 3.demeclocycline
MOA of demeclocycline Inhibitis decrease cAMP in the collecting duct
What drug is known to increase ADH NSAIDs
How come many drugs seem to influence the level of ADH Might influence pain and nausea
what are the 2 functions of oxytocin 1.milk ejection, 2.uterine contraction
Where is oxytocin made Hypothalamus
What leads to oxytocin release (2) 1.suckling on breast, 2.uterine stretching
Where are receptors for oxytocin found (3) 1.epithelial of mammary glands, 2.oviducts, 3.uterus
what is oxytocin used for (2) 1.induce labor/initiate contraction/ enhance contraction, 2.inducte lactation
What form is oxytocin given in when used to induce lactation 1.nasal spray
3 AE of oxytocin 1.fatal hypoxia, 2.excessive contraction, 2.uterine rupture
What is used to tx preterm labor (to suppress it) Atosiban, an oxytocin antagonist
Created by: mcafej02