B6 Pharm Exam 1 (Lectures 1-7) with Correct Answers

B6 Pharm Exam 1 (Lectures 1-7) Adenohypophyseal Physio - - 3 func anat components = hypoth, adenohypophysis (ant pit), periph endoc gl/tiss - hypoth secr 2 horm types to hypoth-hypoph port sys in med emin = rel horms (RH, liberins) & rel-inhib horms (IH, statins) w/ hypoth-hypoph port sys carrying horms to ant pit Synthesis & Regulation of Growth Hormone (GH, somatotropin) - - synth by ant pit somatotropes (30-40% ant pit c) - +by hypoth GHRH & Dopa - -by GH, IGF-1, hypoth GHIH/somatostatin Receptor, Target Organs, Peripheral Hormone Released by GH - -GH-r = tyr kin-assoc R, memb JAK/STAT superfam - Targets = liv, bone, musc, adip, kidney - Periph horm = IGF-1 Physiologic & Pharmacologic Stimulation of GH - - Physio = GHRH, ghrelin, ADH, GABA, NE, Dopa, serot, estrog, sleep, stress, exerc - Pharm = alpha-ag, BB, Dopa ags (ie. Bromocriptine), GABA ag Physiologic & Pharmacologic Inhibition of GH - - Physio = somatostatin, elev IGF-1, GH, progest, GCs, postprand hypergly, elev FFAs - Pharm = Dopa antag, alpha antag, beta ag, serot antag General Effects of GH - (+) visc+sk growth, lipolysis, prot synth, IGF-1 prod --> suppr liv gluc prod, incr periph gluc util, inhib insul secr (-) insul sensit --> hypergly Features of GH Deficiency (hypopituitarism) in Children & Adults - - Children & adols = congen/acq def --> growth stunt, dwarf, +fat-musc mass ratio, hypogly by unopp insul - Adult = -lean bod mass, +body fat to obes, -musc mass, asthenia (phys weak), -BMD, dyslip, -CO Examples, MOA, Administration, PK of Recombinant human GH (rhGH) - incl Somatrem (protropin) & Somatropin (10 diff brand names) - MOA = mimic GH physio actions - Admin = 6-7x/wk - PK = peak pl levs 2-4hrs w/ 36hr persis - Route = IM & SQ, must be injec b/c is prot & not abs orally Indications for rhGH - - Children & Adols = idiop short stat (ISS); **many growth fail indics NOT assoc w/ GH def** - Adults = AIDS-assoc wasting synd (cachex); UNSUBST for "anti-aging" or athletic perf enh B6 Pharm Exam 1 (Lectures 1-7) AEs & CIs for rhGH - - AEs = rare pseudotum cerebri (idiop intracran HTN), slipped cap fem epiph, hypergly, DM, **asphyx in sev obese/resp impaired Prader-Willi synd** in children+adols; more comm periph ed, myalg, arthralg, CTS in adults - CIs = Prader-Willi w/ airw obstr/sleep ap/sev obes; active malig/neop, ac crit illness, ac resp fail --> incr mort; active/sev diab retinop, closed epiph in peds Clinical Notes for rhGH - - GCs may inhib growth-prom effs - concom androg, estrog, thyr horm, anab sters may accel epiph clos comprom final height - GH treat crit ill pts incr mort Examples, MOA, Indications of Recombinant human IGF-1 (rhIGF-1) - incl Mecasermin (increlex, plain IGF1) & Mecasermin rinfabate (Iplex, rhIGF1+rhIGFBP-3) - MOA = mimic IGF1 physio actions - Indics = SQ 2x/d for IGF1 def, pts nonresp to GH (ie. GHR muts, GH ABs)