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3004 - Coggle Diagram

- - - - Somatropin (increases IGF-1 production, acting through GH receptors) / replacement in GH deficiency , used in patients with short bowel syndrome / causes pseudotumor cerebri in children (looks like pressure is increased on MRI but not when measured)
      - Mecasermin (IGF-1 agonist) --> recombinant IGF-1 / replacement in IGF-1 deficiency that is not responsive to exogenous GH
      - Octreotide (somatostatin analog) --> acromegaly patients / may cause GI disturbances **somatostatin is a natural inhibitor of GH
    - - Pegvisomant (GH receptor antagonist) --> patients with acromegaly
      - Bromocriptine (dopamine D2 receptor agonist) --> used in pts with hyperprolactinemia, Parkinson's disease
        
        high doses of D2 receptor agonists have some efficacy in the treatment of smal GH-secreting tumors
        
        PROLACTIN ANTAGONIST
    - - Pituitary dwarfism, anti-aging supplements, Prader Willi Syndrome
      - Turner Syndrome (Single X chromosome)
  - - - Indications
        
        Female infertility (hypopituitarism) + induction of ovulation (IVF)
        
        Male infertility (oligospermia + to induce spermatogenesis)
      - Menotropins (mixture of FSH and LH purified from the urine of postmenopausal women)
        
        Urofollitropin (obtained from the urine of postmenopausal women, like menotropins, but with the LH content removed)
      - Follitropin alpha &
        follitropin beta (recombinant forms of human FSH)
      - LH and its analogs
        
        Human chorionic gonadotropin (hCG) - purified from human urine or recombinant / placental protein with identical structure to LH
        
        Lutropin (recombinant form of human LH)
  - - - Ganirelix (receptor antagonist) --> prevention of premature LH surges during controlled ovarian stimulation
      - Cetrorelix
        degarelix, abarelix (approved for advanced prostate cancer)
    - - Leuprolide (receptor agonist) --> used in ovarian suppression, controlled ovarian stimulation
      - Gonadorelin (synthetic human GnRH)
  - - - Oxytocin (receptor agonist) --> induction and augmentation of labor, control of uterine hemorrhage after delivery
      - Atosiban (receptor antagonist) --> tocolysis of preterm labor
    - - Desmopressin (V2 receptor agonist) --> pituitary diabetes insipidus
      - Conivaptan (V1a and V2 receptor antagonist) --> hyponatremia in hospitalised patients
- - - - long half life (~7 days)
    - - short half life (1 day)
  - - - inhibit hormone release
      - propythiouracil
        
        relatively safe and preferred in pregnancy
      - treatment of mild thyrotoxicosis
      - inhibit thyroid peroxidase (to block iodine organification and coupling reactions)
      - methimazole (more potent and long-acting)
      - side effects
        
        serious side effect: adranulocytosis
        
        common: maculopapular rash, arthralgia, vasculitis
    - - block hormone release
      - decrease size and vascularity of the hyperplastic gland
      - effect is reversible and transient, used in preparation for surgical thyroidectomy
      - contraindicated in pregnancy: fetal goiter
    - - emission of beta particles - destructs thyroid tissue
      - patients can become hypothyroid - managed with thyroxine (T4)
      - contraindications: pregnancy & lactation, age<25yrs
    - - ipodate and lopanoic acid
      - adjunctive therapy in the treatment of thyroid storm
      - they inhibit peripheral conversion of T4 to T3 in the liver, kidneys and brain
    - - perchlorate (CIO4-) , pertechnetate (TcO4-) , thiocyanate (SCN-)
      - competitively block the uptake of iodide
      - adverse effect: aplastic anemia
- - - - Prolactin (PRL)
      - Growth hormone (GH)
      - Thyroid stimulating hormone (TSH)
      - Adrenocorticotropic hormone (ACTH)
      - Follicle-stimulating hormone (FSH)
      - Luteinizing hormone (LH)
    - - Oxytocin
      - ADH (vasopressin)
  - - - produced from cholesterol
      - cortisol and other glucocorticoids, aldosterone, testosterone, adrenal androgens, estrogens, progesterone
- - - - Glucocorticoids
        
        Synthetic glucocorticoids
        
        prednisone-prednisolone, dexamethasone, triamcinolone
        
        longer half life and duration of action than cortisol
        
        Beclomethasone (& budesonide)
        
        Treatment of airway diseases (asthma)
        
        readily penetrate the airway mucosa but have very short half lives after they enter the blood
        
        Clinical uses: chronic adrenal cortical insufficiency (Addison's disease) , acute adrenal insufficiency (shock, trauma), congenital adrenal hyperplasia
        CHEMOTHERAPY INDUCED VOMITING
        
        Bethamethasone (glucocorticoid with a low degree of protein binding)
        
        given to pregnant women in premature labor to hasten maturation of fetal lungs
      - Mineralocorticoids
        
        Fludrocortisone (favored replacement therapy after adrenalectomy because of its long duration of action (Addison's disease)
    - - Receptor antagonists
        
        Glucocorticoid antagonist
        
        Mifepristone (competitive inhibitor of glucocorticoid receptors and progesterone receptors) --> treatment of Cushing's syndrome
        
        Mineralocorticoid antagonist (spironolactone - aldosterone receptor antagonist)
      - Synthesis inhibitors
        
        Ketoconazole (antifungal drug) --> inhibits cytochrome P450 enzymes necessary for synthesis of all steroids