TB Treatment and Contraception Complications

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Questions and Answers

What is the likely reason for the 27-year-old female's pregnancy despite being on contraceptive pills?

INH. causes hormonal imbalance

RIF. interferes with the metabolism of the contraceptive pill (correct)

PYRAZ. has a teratogenic effect

The contraceptive pill is ineffective against TB

What is the cause of the yellowish discoloration of the skin and sclera in the 39-year-old male?

PYRAZ. interacts with skin pigments

RIF. causes liver damage (correct)

INH. affects bilirubin metabolism

ETH. deficiency leads to vitamin D deficiency

What is the primary function of the endocrine system?

To regulate body temperature

To maintain blood pressure

To transmit nerve impulses

To release hormones into the bloodstream (correct)

What is the characteristic of hormones in terms of response time?

Have a broader range of response time than nerve impulses Signup and view all the answers

What type of molecules are the hormones secreted by the hypothalamus and pituitary?

Peptides and low molecular weight proteins Signup and view all the answers

How do the hormones of the anterior pituitary act on their target tissues?

By binding to specific receptor sites Signup and view all the answers

What is the term for the substances that stimulate or inhibit the release of hormones from the anterior pituitary?

Releasing or inhibiting factors or hormones Signup and view all the answers

What is the primary function of the hypothalamus in relation to the pituitary gland?

To secrete hormones that stimulate the release of pituitary hormones Signup and view all the answers

What is the primary function of prolactin?

Stimulating and maintaining lactation Signup and view all the answers

What is the effect of dopamine on prolactin secretion?

Inhibition Signup and view all the answers

What is the role of oxytocin in humans?

Stimulating uterine contraction and inducing labor Signup and view all the answers

What is the effect of hCG injection after hMG or FSH treatment?

Induction of ovulation Signup and view all the answers

What is a possible adverse effect of using hMG or FSH products?

Ovarian hyperstimulation syndrome Signup and view all the answers

What is the use of Bromocriptine and Cabergoline?

Treatment of pituitary microadenomas Signup and view all the answers

What is vasopressin's primary role?

Regulating body's osmotic balance and blood pressure Signup and view all the answers

What is a possible toxicity of oxytocin when used improperly?

Uterine rupture Signup and view all the answers

What is the half-life of GH?

25 minutes Signup and view all the answers

What is the primary mechanism of GH-like action in the body?

Induction of IGF-1 release from the liver Signup and view all the answers

Which of the following is a contraindication for the use of somatropin in pediatric patients?

Closed epiphyses Signup and view all the answers

What is the effect of somatropin administration on lean body mass in adults?

Increased lean body mass Signup and view all the answers

What is the primary site of action of somatostatin in the pituitary?

Growth hormone-secreting cells Signup and view all the answers

Which of the following is a synthetic analog of somatostatin?

Octreotide Signup and view all the answers

What is a common adverse effect of octreotide administration?

All of the above Signup and view all the answers

What is the frequency of administration of depot formulations of octreotide and lanreotide?

Once every 4 weeks Signup and view all the answers

What is the main effect of vasopressin in the kidney?

To increase water permeability in the collecting tubules Signup and view all the answers

What is a major toxicity of vasopressin?

Hyponatremia Signup and view all the answers

What is the advantage of desmopressin over vasopressin in the treatment of diabetes insipidus?

It has minimal pressor effects Signup and view all the answers

What is the receptor responsible for the vasopressor effects of vasopressin?

V1 receptor Signup and view all the answers

What is a unique characteristic of desmopressin compared to vasopressin?

It is longer acting Signup and view all the answers

What is a possible side effect of the nasal spray formulation of desmopressin?

Local irritation Signup and view all the answers

What is the effect of continuous administration of GnRH on gonadotropin release?

It inhibits gonadotropin release through down-regulation of GnRH receptors Signup and view all the answers

What is the effect of synthetic GnRH analogs on gonadal steroid hormones?

They reduce the production of gonadal steroid hormones Signup and view all the answers

What is the purpose of administering GnRH analogs in the treatment of prostate cancer?

To reduce the production of testosterone Signup and view all the answers

What is the source of menotropins (hMG)?

Urine of postmenopausal women Signup and view all the answers

What is the difference between urofollitropin and menotropins (hMG)?

Urofollitropin contains only FSH, while menotropins contain both FSH and LH Signup and view all the answers

What is the effect of human chorionic gonadotropin (hCG) on the body?

It has the same effects as LH Signup and view all the answers

What is the route of administration for gonadotropins?

IM or subcutaneous Signup and view all the answers

What is a common side effect of GnRH analogs in women?

Hot flushes and sweating Signup and view all the answers

Study Notes

TB Infection and Contraception

A 27-year-old female on a contraceptive pill gets TB infection and takes 1st line anti-TB drugs (RIF, INH, ETH, PYRAZ); however, she becomes pregnant after two months, indicating a failure of the contraceptive pill.

TB Infection and Skin Discoloration

A 39-year-old male with TB infection takes 1st line anti-TB drugs and develops yellowish skin and sclera discoloration after one month, which is likely caused by RIF.
Treatment involves stopping the drug and introducing alternative medications.

2nd Line Anti-TB Drugs

For a 45-year-old male patient with TB infection, 2nd line anti-TB drugs can be used if the 1st line treatment is ineffective.
Four examples of 2nd line anti-TB drugs are:

Anti-HIV Drugs

There are several groups of anti-HIV drugs, including:
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- Protease Inhibitors (PIs)
- Fusion Inhibitors
- Integrase Inhibitors
- CCR5 Antagonists
Two examples of drugs for each group are:
- NRTIs: Zidovudine, Lamivudine
- NNRTIs: Nevirapine, Efavirenz
- PIs: Atazanavir, Ritonavir
- Fusion Inhibitors: Enfuvirtide, Maraviroc
- Integrase Inhibitors: Raltegravir, Elvitegravir
- CCR5 Antagonists: Maraviroc, Vicriviroc

Acyclovir Administration and Side Effects

Acyclovir can be administered orally, topically, or intravenously.
Two adverse effects of Acyclovir administration are:
- Oral: Nausea, Vomiting
- Topical: Skin irritation, Rash
- Intravenous: Phlebitis, Nephrotoxicity

Neuroendocrine System

The neuroendocrine system is controlled by the pituitary and hypothalamus.
It coordinates body functions by transmitting messages between individual cells and tissues.
The endocrine system releases hormones into the bloodstream, which carries chemical messengers to target cells throughout the body.

Hormones

Hormones have a broader range of response times than nerve impulses, requiring from seconds to days or longer to cause a response that may last for weeks or months.
The two regulatory systems (neuroendocrine and endocrine) are closely interrelated.
Hormones secreted by the hypothalamus and pituitary are peptides or low molecular weight proteins that act by binding to specific receptor sites on their target tissues.

Hypothalamic and Anterior Pituitary Hormones

The hormones of the anterior pituitary are regulated by neuropeptides that are called "releasing" or "inhibiting" factors or hormones.
Therapeutic uses of hypothalamic and anterior pituitary hormones include:
- Treatment of GH deficiency
- Growth failure in children
- Growth failure due to Prader-Willi syndrome
- Management of AIDS wasting syndrome
- GH replacement in adults with confirmed GH deficiency

Somatropin (Growth Hormone)

Somatropin is administered by subcutaneous or IM injection.
Adverse effects of Somatropin include:
- Pain at the injection site
- Edema
- Arthralgias
- Myalgias
- Flu-like symptoms
- Increased risk of diabetes

Somatostatin (Growth Hormone-Inhibiting Hormone)

Somatostatin is a small polypeptide that inhibits GH and thyroid-stimulating hormone release.
Synthetic analogs of somatostatin, such as octreotide and lanreotide, are used to treat acromegaly and diarrhea/flushing associated with carcinoid tumors.
Adverse effects of octreotide include:
- Diarrhea
- Abdominal pain
- Flatulence
- Nausea
- Steatorrhea

Gonadotropin-Releasing Hormone (GnRH)

GnRH is essential for the release of the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary.
Synthetic GnRH analogs, such as leuprolide, goserelin, nafarelin, and histrelin, are used to treat prostate cancer, endometriosis, and precocious puberty.
Adverse effects of GnRH analogs include:
- Hot flushes
- Sweating
- Diminished libido
- Depression
- Ovarian cysts (in women)

Gonadotropins

Gonadotropins are hormonally active medications used to treat fertility disturbances.
Examples of gonadotropins include:
- Menotropins (human menopausal gonadotropins or hMG)
- Urofollitropin (FSH obtained from postmenopausal women)
- Follitropin alfa and beta (human FSH products manufactured using recombinant DNA technology)
- Human chorionic gonadotropin (hCG) and choriogonadotropin alfa (made using recombinant DNA technology)

Prolactin

Prolactin is a peptide hormone that stimulates and maintains lactation.
It decreases sexual drive and reproductive function.
Dopamine agonists, such as bromocriptine and cabergoline, are used to treat hyperprolactinemia and pituitary microadenomas.
Adverse effects of dopamine agonists include:
- Nausea and vomiting
- Headache
- Psychiatric problems

Hormones of the Posterior Pituitary

Oxytocin is a neuropeptide that plays roles in social bonding, reproduction, childbirth, and the period after childbirth.
It is used in obstetrics to stimulate uterine contraction and induce labor, and to cause milk ejection.
Adverse effects of oxytocin include:
- Hypertension
- Uterine rupture
- Water retention
- Fetal death

Vasopressin (ADH)

Vasopressin is a nonapeptide that plays essential roles in the control of the body's osmotic balance, blood pressure regulation, sodium homeostasis, and kidney function.
It has antidiuretic and vasopressor effects.
The major use of vasopressin is to treat:
- Diabetes insipidus
- Management of cardiac arrest
- Controlling bleeding due to esophageal varices
Adverse effects of vasopressin include:
- Water intoxication
- Hyponatremia
- Abdominal pain
- Tremor
- Vertigo

Desmopressin

Desmopressin is an analog of vasopressin with minimal activity at the V1 receptor, making it largely free of pressor effects.
It is used to treat diabetes insipidus and nocturnal enuresis.
Adverse effects of desmopressin include:
- Local irritation
- Seizures (in children using the nasal spray formulation)

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These quiz questions test your knowledge of tuberculosis treatment and its interactions with contraception. Two scenarios are presented, each with a patient experiencing unexpected consequences.