Question

Assignment chapter 35,Hypothalamic and pituitary Agents

Learning Objective(s) Group Assignments 1. Divide the class into three groups. Assign each group an age group: children, adults, or older adults. Each group is to discuss the use of hypothalamic and pituitary agents in the assigned age group. What are the most likely reasons that each age group is receiving one of these drugs? Prepare a presentation describing special considerations for using these agents in the assigned age group. 2. Divide the class into groups. Assign each group a hypothalamic or pituitary agent. Each group is to list the therapeutic actions, indications, pharmacokinetics, contraindications, the most common adverse reactions, and the important drug-drug interactions for the drug assigned.

Answer 1

1. Children - Hypothalamic agents are used for growth failure

Adults or older adults - Hypothalamic agents are used for various reasons like :-

Gonadorelin - A synthetic GnRH used to test the function of gonadotropes and the pituitary.

Nafarelin - A gonadotropin releasing hormone agonist used to treat central precocious puberty.

Somatostatin- A naturally-occurring peptide hormone used for the symptomatic treatment of acute bleeding from esophageal varices.

Cetrorelix- A synthetic peptide antagonist of gonadotropin releasing hormone used to prevent luteinizing hormone surges in women undergoing assisted reproduction therapy.

Vapreotide- For the treatment of esophageal variceal bleeding in patients with cirrhotic liver disease and has also shown efficacy in the treatment of patients with AIDS-related diarrhea.

Pasireotide - A somatostatin analog used in the treatment of Cushing’s disease, specifically for those patients whom pituitary surgery is not appropriate.

Ganirelix- A GnRH antagonist used in assisted reproduction in women undergoing controlled ovarian hyperstimulation to control ovulation by inhibiting the premature LH surges.

Lanreotide- A somatostatin analog used for the treatment of unresectable, well- or moderately-differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors and acromegaly.

Leuprolide- A protein-based luteinizing hormone antagonist used to treat prostate cancer, endometriosis, and precocious puberty.

Sermorelin- For the treatment of dwarfism, prevention of HIV-induced weight loss.

2. #. Hypothalamic Releasing Hormone Agents Agonists

Goserlin (synthetic GnRH)- antineoplastic

Histrelin (GnRH)- antineoplastic

Leuprolide (potent GnRH)- precocious puberty, prostate cancer; block gonadotropin secretion with continuous use

Tesamorelin (GnRH analogue)- stimulate release of GH from pituitary

#. Hypothalamic Releasing Hormone Blockers (Antagonist)

Degarelix- blocks GnRH; antineoplastic for advanced prostate cancer

Ganirelix acetate- block GnRH; inhibition of premature LH surge for women as part of fertility program

#. Hypothalamus Agonist Actions

Inhibit pituitary gonadotropin secretion

Drop in sex hormones

Tesamorelin stimulates release of GH to decrease abdominal fat in HIV with lipodystrophy

#. Hypothalamus Antagonist Actions

Used for prostate cancer

Inhibits premature luteinizing hormone surge as part of a fertility program

#. Drugs Affecting Hypothalamic Hormones Contraindications

P/L

Peripheral vascular disease- because they are injectable (drug will not be absorbed well

#. Hypothalamic Agonists Adverse Effects

Increased release of sex hormones- ovarian stimulation, flushing, increased body temperature, increased appetite, fluid retention

#. Hypothalamic Antagonist Men Side Effects

Decreased testosterone levels, loss of energy, decreased sperm count, potential alterations in secondary sex characteristics (facial hair, deeper voice, Adam's apple)

#. Hypothalamic Antagonist Women Side Effects

Decreased female hormone levels- lack of menstruation, fluid and electrolyte changes, insomnia, irritability

#. Drugs Affecting Anterior Pituitary Hormones

Growth hormone agonists

Used to mimic or antagonize effects of specific pituitary hormones- replacement, block effects of anterior pituitary hormones

Growth hormone- responsible for linear skeletal growth, growth of internal organs, protein synthesis