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Pharmacology

ENDOCRINE SYSTEM
By- Dr Ankit Kumar
MD, DM – Pharmacology
DR ANKIT KUMAR Pharmacology 1
1 Diabetes mellitus, Thyroid

Osteoporosis, Gonadal hormones

2

3 Corticosteroids and HPA axis hormones

DR ANKIT KUMAR Pharmacology 2

DR ANKIT KUMAR Pharmacology 3
 Diabetes Mellitus
DRUGS FOR TYPE -1 DM DOC INSULIN
(Beta cell destruction: No insulin) 3
only
Add: PRAMLINTIDE

ACARBOSE

DRUGS FOR TYPE - 2 DM DOC METFORMIN

(peripheral resistance to Insulin) All DRUGS.
Add other OHA

INSULIN

GESTATIONAL DM (pregnancy) DOC INSULIN

only ③
o MET FORMIN

• GLYBURIDE

DR ANKIT KUMAR Pharmacology 4

 DURATION
INJECTABLE INSULIN → not Absorption ORAL

ULTRASHORT •L LI SPRO (3 HOURS)

13 HRS Monomeric insulin?
①
(Rapid) •A AS - PART
•G GLULIS - INE
SHORT • REGULAR (6 6HRS Hexameric 2n
HOURS) Zn

Amorphous ② 301.

INTERMIDIAT • LENTE INSULIN mixture of 2

E Crystalline ② 701.

12-15 HRS

INTERMIDIAT • NPH (15 HOURS) Hs PROTAMINE Insulin

E / I Longest ?
(NEUTRAL PROTAMINE
HAGEDORN)
18hr DEGLUDEC
LONG • DETEMIR (18
HOURS)
• GALRGINE (24 24 HRS
HOURS)
DR ANKIT KUMAR Pharmacology
42 HRS. 5
ULTRALONG • DEGLUDEC (42
 BOLUS INSULIN:

All Insulin

+
→ K BOLUS insulin *
Neutral pH (7. 2)
Before meals to control PPH
BASAL INSULINS:
r
MIXED in same
BASAL Insulin exception syringe
3nA
6 "PS ⊖ CATABOLISM

Glargine, Degludec:
1¥
PEAKLESS Insulin

Glargine: Acidic
ACIDICinsulin
Insulin

Never mix with

Never mixed other
with insulin
other in same
insules

Given injection
separate injection.
DR ANKIT KUMAR Pharmacology 6
 QQ

NASAL INSULIN : AFREZZA

DRY POWDER Short acting Bolus
SHORTEST Acting Given along
insulin 1 with long C/I: smokers, COPD, Asthma
CI Asthma
INHALATION insulin acting injectable insulin smokees
RISK OF LUNG CANCERS
Bolus insulin
CONTROL Along ∈ Long Acting

POSTPRANDIAL ↑ Risk lung cancer.

Before meals injection of BASAL insulin
HYPERGLYCEMIA

Hyperosmolar Hyperglygenic State

DR ANKIT KUMAR Pharmacology 7
 Insulin uses sking.
1. Type
Type 11 DM and Type
Type 2 2 DM: all S.C. insulins

DKA HHS 
2. DKA, i.v.
i Regular insulin
insulin QQ s cing.
Hyperkalemia 
3. Hyperkalemia i.v.
in Regular insulin +50%
Regular insulin + 50% dextrose
dextrose 0

Adverse effect
ADVERSE of Insulin
EFFECTS:
intranasal
1.①HYPOGLYCEMIA (T/T: oral/IV glucose, i.M. Glucagon),
HYPOGLYCEMIA (Toxicity): T/+ ORAL, I/v glucose,
ilm
2.②Weight
WEIGHTgain,
GAIN
Glucagon.
3. Lipodystrophy  repetitive s.c. injection at same site
3 LIPODYSTROPHY → Ab" fat growth
Prevent
4. Hypokalemia

change site
skin;

FREQUENTLY
repetite

Never: 22cm
cm around umblicus
around umblicus.
DR ANKIT KUMAR Pharmacology 8
 OHA: ORAL HYPOGLYCEMIC AGENTS

ACTING AT PANCREAS
ACT AT Pancreas
ACTING
ACT on AT PERIPHERAL
other organs

ORGANS
leur
•S SULFONYLUREAS • B IGUANIDES
d)
•M MEGLITINIDES ✓ • A LPHA GLUCOSIDASE
{3
•A A MYLIN ANALOGUE INHIBTORS GIT

• INCRETINS (GLP-1 • THIAZOLIDINEDIONES ☁☁

analogue) • SGLT-2 INHIBITORS
•D DPP-4 INHIBITOTS
9

Sundar -MAID BATS

DR ANKIT KUMAR Pharmacology 9

 ACTING AT PANCREAS
CLASS DRUGS MOA ROUTE WEIGHT HYPOG ADVERSE EFFECTS
LYCEM
IA
ORAL GAIN SULFA Allergy
- AMIDE
SULFONYLUREA FIRST GEN: • CLOSE
Act on ORAL GAIN YES
YES SULFA ALLERGY
CHLORPROPAMIDE β Cell on Pancreas
ACETOHEXAMIDE ATP SENSITIVE
TOLBUTAMIDE Q K+ CHANNEL CHLORPROPAMID
TOLZOLAMIDE E CHLORPROPAMIDE
ON BETA CELL • CHOLESTASTIC
Close ATP sensitive K+ channel
JAUNDICE
SECOND GEN: Hence insulin • Aplastic anemia
Depolarize sech of ADH DISULFIRAM
(more potent and secretion
kt
• DISULFIRAM
GL:- Like Rx
shorter) β Cells ①
REACTION
GLIMEPIRIDE • SIADH
① # DIABETES Avoid
GLIPIZIDE
insipidus Alcoholics
GLICLAZIDE
GLYBURIDE (GLIBENCLAMID E) Insulin Secretion ↑

DR ANKIT KUMAR Pharmacology 10

CLASS DRUGS MOA ROUTE WEIGHT HYPO ADVERSE
GLYCEMI EFFECTS
same A

MEGLTINID REPAGLINID E CLOSE ORAL GAIN YES FLU LIKE

ES E CLOSE ATP sensitive ORAL GAIR YES Flu like
SYMPTOMS
NATEGLINIDE ATP
K+ SENSITIVE
channel symptoms
K+ CHANNEL
- GLINIDE

ON BETA
Insuller CELL
seen

Hence insulin secretion

- T/D=
AMYLIN PRAML INTID E SUPRRESS
supress Glucagon ↓↓
GLUCAGON S/C INJ LOSS
LOSS NO
NO ALLERGY
GASTRO PARESIS
ANALOGUE E
• + +
Sking
SUPRRESS
Hormone from ☁} supres Apetite
APETITE
β Cells

DR ANKIT KUMAR Pharmacology 11

CLASS DRUGS MOA ROUTE WEIGHT HYPOGL ADVERSE EFFECTS
YCEMIA
we peptide - NATIDE
Glucagon TIDE
- GLUTIDE QQ
GLP-1 Exenatide Stimulate Insulin S/C INJ LOSS NO PANCREATITIS
ANALOGU Liraglutide +
E Lixesenatide Suppress Glucagon PANCREAS AND THYROID
(INCRETINS + CANCERS
Albiglutide
S) Suppress Appetite
Dulaglutide SEMAGLUTIDE ⇒ ORAL
Semaglutide
(longest)
DPP-4 Sitagliptin GIPTINStimulate Insulin ORAL NEUTRAL NO INFLAMMATION
INHIBITOR Vildagliptin + • JOINT PAIN
S Alogliptin Suppress Glucagon • NASOPHARYNGITIS
DPP-4 Linagliptin +
Incretions
Suppress Appetite Rarely: Pancreatitis
Saxagliptin
④ endogenous GLP-1)
XXX

Semaglunde
Semaglutide → OnlyORAL
ORAL GLP-1
GLP-1 Teduglutide  GLP-2
Oanalogue
TWO
analogue
Tirzepatide (inj.)  Dual GLP-1
- & GIP
DR ANKITanalogue
GIP
KUMAR Pharmacology
Use: Short Bowel syndrome
12
CLASS DRUGS MOA ROUTE WEIGHT HYPO ADVERSE EFFECTS
GLYC
EMIA

BIGUANIDE S METFORMIN ⊛ AMPK

LIVER: ORAL LOSS NO Diarrhea, Dyspepsia (mc)
ORAL LOSS NO ♀ Megaloblastic Anemia
S
•
AMPK enzyme (+) (Reduce Vit B12 Abs
MEGALOBLASTIC
inhibit
stimulate Hepatic ANEMIA
from GIT)
Gluconeogenesis (reduce Vit B-12
PHENFORMIN INHIBIT HEPATIC absorption from GIT)
Liver
GLUCONEOGENESIS ① Lactic acidosis
Deaths Banned
are
LACTIC ACIDOSIS
Lacttaudosh
(PHENFORMIN BANNED)

• Metformin
METFORMIN is DOC
→ DOCfor METFORMIN C I Renal failure C/I GFR < 30mi/min].

1.
TypeType
2PM2 DM, Metformin Is C/I in Renal failure (GFR < 30ml/min)
SAFE: Linaguptin, Teneligliptin. QQ
2. Impaired
• PRE DIABETESglucose
(IGT) tolerance,
3. PCOD with hyperglycemia,
- PCOD
4. Clozapine induced hyperglycemia
DR ANKIT KUMAR Pharmacology 13
CLASS DRUGS MOA ROUT WEIGH HYPOGLY ADVERSE EFFECTS
E T CEMIA

ALPHA ACARBOS E INTESTINE:

Inhibit Breakdown ORAL NEUTRAL NO GIT UPSET
GLUCOSIDASE of Complex carbohydrate
INHIBITORS
E (starch,
REDUCE sucrose,
breakdown ORAL neutral No MALABSORPTION
Malabsorption
VOGLIBOS E OF complex
E Carbohydrates to
Intestine monosaccharides
MIGLITOL monosacceride I/t

into Glucose/Fructose
Before meals to
(monosaccari
Control PPH

SUCROSE (table sugar) CANNOT CORRECT HYPOGLYCEMIA if the patient is on Acarbose

DR ANKIT KUMAR Pharmacology 14

CLASS DRUGS MOA ROUT WEIGH HYPO ADVERSE EFFECTS
E T GLYC
EMIA
do Warning
THIAZOLIDINEDIONE PIOGLITAZON E ADIPOSE TISSUE: ORAL
ORAL
GAIN
GAIN
NO
NO
• OSTEOPOROSIS/FRACTURES
Pio G : urinary bladder
•
E + PPAR-8
Agonist Risk ↑
• MI/CHF
GLITAZONE
TROGLITAZO NEPPAR-GAMMA (ROSIGLITA: BANNED)
•
NE Agonist
HEPATOTOXIC
•TRO ⑨ : Hepatotoxic
ROSIGLITAZO NE
(in presence of insulin) (TROGLITA: BANNED)
Adipose tissue
NE
• Banned
ROS 1910: MI/CHF
• PIOGLITAZONE 
URINARY BLADDER
CANCER

PPAR-Alpha Agonist  Fibrates (use: Dyslipidemia) Q

Dual PPAR-Gamma + Alpha Agonist  Saroglitazar (use: Diabetic Dyslipidemia)

DR ANKIT KUMAR Pharmacology 15
SGLT-2 Canagliflozin
CANAGLIFLOZIN KIDNEY: ORAL
ORAL LOSS
wt loss NO
NO • 3UTI/CYSTITIS
∈ QQ
UTI
INHIBITOR Dapagliflozin Bact.
DAPA G INHIBIT Hypog
Empagliflozin • Urogenital-
UROGENITAL
S EMPA G
Remogliflozin SODIUM/glucose
/✗ inhibit INFECTION → fungal
1.amp
ABSORPTION
REMO G PCT of nephron
QQ
- GLIFLOZIN IN PCT • Diabetic Keto
Sodium Glucose ↑ DKA
Acidosis
NEPHRON
Transporter 2 QQ
SOTAGLIFLOZI
SOTA G
→ Nat/glucose • FOURNIERS
N
↑ OSTEOPOROSIS
(dual SGLT 1 + 2 GANGRENE
INHIBITOR)
⊖ SALT 1 + 2 urine ↑↑ → Cast excretion.
• Osteoporosis

PIOGLITAZONE/ROSIGLITAZONE: PPAR-8 DAPAGLIFLOZIN, EMPAGLIFLOZIN:

“Anti-Diuretic effect” “Diuretic effect”
↳ ^ Blood volume (Load on Heart)
→ Reduce Blood volume (→ Load) QQ

C/I IN CHRONIC HEART FAILURE APPROVED FOR CHRONIC HEART FAILURE

DR ANKIT KUMAR Pharmacology 16
PIOGLITAZONE/ROSIGLITAZONE: DAPAGLIFLOZIN, EMPAGLIFLOZIN:
“Anti-Diuretic effect” “Diuretic effect”

C/I IN CHRONIC HEART FAILURE APPROVED FOR CHRONIC HEART FAILURE

Given

¥ HF

DR ANKIT KUMAR Pharmacology 17

 ONE LINER MCQ’s
Diabetic Gastroparesis •IERYHTROMYCIN:
Erythromycin
+ Motilin
⊕ MotileReceptors In Stomach
receptor → ↑ Stomach motility

Diabetic Diarrhea • CLONIDINE: Alpha 2a +  Reabsorb Ions In Intestine

Diabetic Retinopathy • ANTI-VEGF

Anti-VEGF : →
Bevacizumab,
inhibit BEVACIZUMAB
Ranibizumab, Alfibercept, Pegaptanib
Neovascularization
Diabetic Neuropathy • Pregabalin
DOC
(DOC), Gabapentin
PREGABALIN EPALRESTAT
• EPALRESTAT (Aldose Reductase Inhibitors)
Aldose Reductase inhibitor

No Dose Modification In • Linagliptin

Renal Failure →
• Dulaglutide (All GLP-1)
Linag leptin & Tenelylphn
• Pioglitazone/Rosiglitazone
(Renal Safe) • Pramlintide

• Metformin
IF Is C/I in Renal failure (GFR < 30ml/min)
Metformin

Anti-obesity Drug • LIRAGLOTIDE

Liraglutide (Inj), Semaglutide
& (Oral)
SEMAGLUTIDE [GLP-1].
DR ANKIT KUMAR Pharmacology 18
 Anti-thyroid drug
Thyroid

Nat I
symport
I I- Oxidation
organificehan
① Thyroid Peroxidase
enzyme
coupling

73/Ty

Release

RATE UMM
14 more
③

Conversion 4
5'
☐EOID""A"
Ts active
DR ANKIT KUMAR Pharmacology 19
cell
1. Na+ I– symporter inhibitor: ⊖ entry of iodine

• Thiocyanate,
• Perchlorate, ✓
not used

• Nitrates ✓

• Pertechnate,
• Floroborates

DR ANKIT KUMAR Pharmacology 20

 2. Thyroid peroxidase inhibitors: Thionamides Ethionamide
E

Inhibit synthesis of T3/T4  Oxidation,

MC used Anti thyroid
Organification,
GROUP
Coupling of Iodine
⊖ synth 73/Ty Anti-TB
ATT (TB drug
DRUG) r
DRUG bn
SI: HYPOTHYROIDISM
s/e: Hypothyroidism

1 Propylthiouracil ② Carbimazole (prodrug) 7

PTU
3 Methimazole (active form)
DOC 2nd/3rd Trimester ✓
DOC HYPER thyroidism → 1ˢᵗ Trimester ✓
pregnancy
C/I 1ˢᵗ trimester: Teratogenic
# 2nd/3rd: MOST Hepatotoxic

APLASIA
DOC THYROID STORM : Also inhibit CUTIS

Peripheral Ty 73 DOC GRAVE's DISEASE

MC RASHES
T 10 : SULFA Allergy
S/E
BM suppression
DR -
ANKITSH
KUMAR Pharmacology 21
(Agranulocytosis)
• Hyperthyroidism in pregnancy

Ans:

Answer
yourself

• Thyroid storm
Ans APLASIA CUTIS
C/I 1st trimester:
AplasiaCarbimazole
cutis congenita

• Chronic hyperthyroidism
Ans DR ANKIT KUMAR Pharmacology 22
• 3. ORAL IODIDES: inhibit Release 73/Ty (RATE Limiting)

• Na-Iodide,
FASTEST Antithyroid
• Saturated solution of KI (SSKI), Q
S/E
• Lugols iodine (5% Iodine + 10% KI)
use: Thyroid storm

 Reduce Thyroid blood supply

 Inhibit release of T3/T4
 INHIBIT PERIPHERAL T4 T3 CONVERSION SIALLORHEAL
mimics
SIALADENITY
mumps, mus

• FASTEST ANTITHYROID DRUGS

DR ANKIT KUMAR Pharmacology 23
• BEFORE SURGERY to reduce size
④
DRUGS INHIBITING T4--->T3 Conversion → inhibit
o P 1ˢᵗ DRUG 5' DEOIODINASE
• PROPRANOLOL
p
• PTU o
o T/+ Thyroid storm
I
• IODIDES
l LAST
• DEXAMETHASONE

• AMIODARONE ☐ Ty → ⅓

↳ iodine S/E: HYPOTHYROIDISM

- isotope

Radioactive iodine: IODINE-131 ✓ OLD

DESTROY THYROID : BY BETA RAYS ✓ Heart Dis

HALF LIFE: 8 DAYS

unfit of St Inoperable cases
DOC
C/I: Pregnancy, Age<35 years
Hyperthyroidism

S/e: Permanent Hypothyroidi Sm

(lifelong: T4 “levothyroxine”)
DR ANKIT KUMAR Pharmacology 24
 Drugs for osteoporosis reduce Bone mineral
Density

Along With
✓ Vitamin D and Pathological
calcium
fracture
BMD

↑↑
Inhibit OSTEOCLAST Stimulate OSTEOBLAST
DESTRUCTION ANABOLIC Both
(INHIBIT RESORPTION) PROMOTE FORMATION

Resistant

Bisphosphonates DOC
B TERIPARATIDE name
C Calcitonin ◦ Strontium Ranelate
Rec. (PARATHYROID
HORMONE)
G Gallium Nitrate .

do o
Denosumab Oost Romosozumab
• = 05#
every Estrogen/Raloxifene
child Cinacalcet
DR ANKIT KUMAR Pharmacology 25
 DOC FOR OSTEOPOROSIS:g PAGET'S DIS Reflux Esophagitis
Osteonecrosis of mandible
“BISPHOSPHONATE”  inhibit FPPS enzyme Slt
- DRONATE
• ALENDRONATE i once a week
Teriparatide → Rec. PARA thyroid Hormone
• IBANDRONATE : once a month
• ZOLENDRONATE (longest/MOST POTENT) ⊕ OSTEOBLAST
Renal stones
once/year
sking. ˢ# OSTEOSARCOMA

Distal Radial fracture.

DENOS
DEN UMARblock RANK RECEPTORS
OSUMAB: OC
ROMOS UzumpyBlock RANK receptor
ROMOSUZUMAB: block SCLEROSTIN
→ Block Sclerostin ⊕ 013.

Loop Diuretic (c/I thlaudi

DOC
Bisphosphonate  Maximum 10
5 years (femur fracture)
↑ Risk. ✓ BS @
✓ Calcitonin
Teriparatide  Maximum 2
2 years (Osteosarcoma) ✓ DEnosumaS*
Granuloma: CORTICOSIN'Ids

Calcitonin –> fastest

Fastest Calcium lowering
Case dowery → #agent for Hypercalcemia
HYPERCALCEMIA.

DR ANKIT KUMAR Pharmacology 26

 Tamoxifen :
selective Estrogen Receptor modulator Tamoxifen
• Increase Endometrial cancer
SERM FEN/-PHEN.
•↑ Risk endometrial
Cataract
← Not ERaloxifen:
• Hepatotoxic
cancer No RALOXIFEN.
risk of endometrial cancer
TAMOXIFEN: T/T & Prevention of Breast Cancer Q
Good for osteoporosis S/E
¥ HOT flash
Q Hot Flushes
Thromboembolism
RALOXIFEN: T/T of post-menopausal osteoporosis Thromboembolism
Prevention of Breast Cancer

☐ ◦ angular

→ SERD use: Resistant Breast cancer.

FULVESTRANT
Every Estrogen Receptor Antagonist

DR ANKIT KUMAR Pharmacology 27

 Other SERM

#Post
1. Bazedoxifen → treatment of Hot Flushes
menopausal HOT Flushes

TH PLOD
2. Clomiphene 
→ Ovulation
DOC inducer
Induce ovulation
in vitro fertilization

3. Ormeloxifen (Centchroman)
→Contraceptive (made
Made in India → in india)
SAHELI use: Contraceptive
&
(DRI-Lucknow)
CHAYA Adv: ↓ Risk Breast
cancer.
4. Ospemifen  Senile
: I/t Senilevaginitis
vaginitis.

DR ANKIT KUMAR Pharmacology 28

 Aromatase inhibitors
Testosterone Estrogen-H

Q
① FORMESTANE ② -TROZOLE

Postmenopausal
EXEMESTANE Breast cancer
VOROZOLE
ANASTRAZOLE

Post Menopausal Breast cancer.

1. Formestane,
DOC Exemestane

2. Letrozole, vorozole, anastrazole

Letrozole Ovulation inducer

in PCO D)

Clomiphene
DR ANKIT KUMAR Pharmacology 29
 Glucocorticoids ⑨

CORTICOSTEROIDS MC
Mineralocorticoid

1. MOST POTENT/LONGEST GLUCOCORTICOIDS: BETAMETHASONE OR

DEXAMETHASONE
BECLAMethas.me
2. MOST POTENT TOPICAL GC: BETAMETHASONE OR CLOBETASOL (0.05%)

3. PURE GC WITH NO MC ACTIVITY: BETAMETHASONE OR DEXAMETHASONE

Q
4. PURE MC WITH NO GC ACTIVITY: DOCA (DEOXY-CORTICOSTERONE ACETATE)

5. MC replacement: FLUDROCORTISONE 1- HYPOTENSION

DR ANKIT KUMAR Pharmacology 30

 DOC HYDROCORTISONE
ADRENAL INSUFFICIENCY:

Dexamethasone
i)m
↑ surfactant prod"
FETAL LUNG MATURATION: Betamethasone

l Block GC → Ht Cushing syndrome

Mifepristone
Q
(RU-486) 2 Block Progesterone → induce ABORTION

ULIPRISTAL l Block Progesterone → Emergency Contraceptive pill

# SPRM
30mg one task with 5 days of unprotected
intercourse.

DR ANKIT KUMAR Pharmacology 31

MEDICAL ADRENELECTOMY DRUGS
Adrenal
o
tumor
Q
M
• Mitotane
• Osilodrostat Corticosteroid
Q M
• Metyrapone excess

11inhibit
beta Hydroxylase inhibitor
11 β Hydroxylase 0 synthesis of ⑤

DR ANKIT KUMAR Pharmacology 32

 Anti-Androgens Adverse effect: Gynecomastia, Q
Tests
SYNTHESIS Impotence
 Ketoconazole ALL ARE USED :
INHIBITOR  Abiraterone
Testosterone
Testosterone Antifungal
QQ
5-ALPHA  Finasteride
1. Prostrate cancer Q m

5 'α Reductas
5-ALPHA e REDUCTASE
REDUCTASE  Dutasteride 2. Hirsutism F
INHIBITORS
"If
DiDIHYDRO TESTOSTERONE
Hydro Testosterone A" BPH
BPH
ANDROGEN  Flutamide  Finasteride
RECEPTOR  Bicalutamide  Dutasteride
ANTAGONIST  Enzalutamide • a
TAMIDE
Androgen receptor  Nilutamide
(cytoplasmic) ✓ l ALOPECIA
 Spironolactone
ONE  Cyproterone
• MINOXIDIL (2-5% CREAM)
 Drosperinone
DR ANKIT KUMAR Pharmacology 33
Growth Hormone and related hormones

Hypothalamus

GHIH

GNRH
+ 0
Pituitary

GH IGF-1

Somatomeder C.

DR ANKIT KUMAR Pharmacology 34

Tesamorelin GHRH

Sermorelin

DOC DWARFISM SI HYPERGLYCEMIA

Somatropin GH

Resistant Sf HYPOGLYCEMIA
DOC
Mecasermin Rec. IGF-1 →
Dwarfism

DR ANKIT KUMAR Pharmacology 35

 Pituitary tumors
• GH (ACROMEGALY) exess • Prolactinomas excess

SURGERY
DOC Dopamine (D2) Agonist +

not • Overall: CABERGOLINE

Somatostatin: OCTREOTIDE • in pregnancy: Bromocophne

DOC
LANREOTIDE

not (↓ sech GH from pitulary) no

PEGUISOMANT SURGERY
Block GH receptor
• OCTREOTIDE USES : SOMATOSTATIN
SHORT BOWEL
DOC SYNDROME
• I nsulinoma, Glucaginana, Gastrinoma [PNET
• GH ↑ intestinal growth
• D I ARRHEA in Carcinoid, V1 Poma, HIV, Cancer
• E sophageal VAR deal Bleed (now: TERLIPRESSID • OCTREOTIDE

• A cromegaly
• Tedughtide (GLP-2)
• S HORT Bowel synd ( MALABSUPTON)

DR ANKIT KUMAR Pharmacology 37

 • LEUPROLIDE
NAFARELIN
run GnRH agonist •
•
Gonadorelin
Busrelin RELIN
NAFARELIN

INTERMITTENT injection CONTINUOUS injection • Histrelin

• Triptorelin if
NASALspray
Nasal spray
increase FSH/LH Decrease FSH/LH
→
1. Female
Female infertility Prostate
Infertility(Annulation) 1. DOC CancerCancer.
PROSTRATE (DOC) Receptor densitize after 7 days

infertility (Azoospermia) 2. Breast Cancer/Endometriosis,

Male Infertility
2. Male
3. Delayed Leiomyoma
Delayed Puberty
puberty (Dog S/E: Initial Flare up reaction
3. DOC
Precocious puberty
Precocious pushy.
↑ FSH/LM

↓ Fsh/U

Gn RH receptor antagonist
Cetorelix, degarelix, abarelix, ganirelix  Prostrate cancer Advantage
o
ZELI * No initial flare up
Elagolix  endometriosis
DR ANKIT KUMAR Pharmacology only ↓ FSH/H 38
 wishes
But

thankyou

Dr Ankit Kr

Thank you DR ANKIT KUMAR Pharmacology 39