BIO 290 – Module 9 Pharmacology Vocabulary

Antidiabetic Medications

• Sulfonylureas (e.g., Glyburide)

  • MOA: Stimulate pancreatic β–cells to release insulin → risk of hypoglycemia.
  • Classic hypoglycemia presentation: ↑ hunger, irritability, dizziness, sweating, tremors.
  • Clinical Pearl: If a type-2 diabetic on a new drug develops the above S/S while eating normally, suspect a sulfonylurea (MOST LIKELY answer in Q-1).

• SGLT-2 inhibitors (e.g., Canagliflozin)

  • Promote urinary glucose loss; hypoglycemia uncommon unless combined with insulin/secretagogues.
  • Additional benefits: ↓ weight, ↓ BP, cardiovascular & renal protection.

• Other agents mentioned

  • Levothyroxine: Thyroid replacement; unrelated to glycemic control.
  • Desmopressin: Synthetic ADH; treats central diabetes insipidus, not DM-2.

Endocrine Hormone Therapies

Desmopressin (DDAVP)

• Indications (Q-3):
  • Central Diabetes\ insipidus (MOST COMMON TEST ANSWER).
  • Nocturnal enuresis, mild hemophilia A & von Willebrand disease.
• Key Nursing Points: Monitor serum Na^+ (risk of water intoxication / hyponatremia), daily weight, I&O.

Somatotropin (Recombinant Growth Hormone)

• Used for pediatric growth-hormone deficiency, wasting, short bowel syndrome.
• Adverse effects (Q-5):
  • Hyperglycemia (anti-insulin effect).
  • Arthralgia, edema, slipped capital femoral epiphysis.

Fludrocortisone

• Mineralocorticoid replacement for adrenal insufficiency (Addison’s).
• Potential adverse effects (Select-all Q-2):
  • Osteoporosis (bone resorption)
  • Thinning/Friable skin
  • Insomnia / mood changes
  • Also: Hypokalemia, HTN, edema, weight gain.
• NOT typical: Hypoglycemia, Hyperkalemia.

Anticoagulants, Antiplatelets & Fibrinolytics

Mechanistic Overview

• Antiplatelet agents (e.g., aspirin, clopidogrel, abciximab) → “Prevent platelet aggregation; keep stents patent.”
• Factor Xa inhibitors (e.g., apixaban, rivaroxaban) → “Block coagulation cascade → ↓ DVT/Stroke risk.”
• Heparins (unfractionated, enoxaparin) → Potentiate antithrombin III → inactivate IIa & Xa.
• Warfarin → Inhibits vit-K–dependent factors II, VII, IX, X.
• Alteplase/Tenecteplase → Fibrinolytics (“clot busters”): Convert plasminogen → plasmin → degrade fibrin.

Alteplase Specifics (Pg-11)

• Uses: Acute MI, acute ischemic stroke, massive PE, occluded central line.
• Critical Pre-check: Rule-out hypoglycemia (finger-stick) because BG < 70\ mg/dL can mimic stroke S/S.
• Contraindications: Recent surgery, active bleed, uncontrolled HTN, history of hemorrhagic stroke.

Common Adverse Effects of ALL Blood Thinners (Pg-9)

• Bruising / Ecchymosis.
• Bleeding (GI most common; also intracranial, GU, etc.).
• Secondary anemia → hypotension, tachycardia.
• Thrombocytopenia (esp. with heparin → HIT).

Cautions & Contra-Indications (Pg-10)

• Active bleeding, PUD, recent surgery/trauma.
• Thrombocytopenia (platelets < 150\times10^3/\mu L).
• Avoid: Combination of multiple anticoagulants/antiplatelets, NSAIDs, alcohol.

Monitoring Parameters & Education

• Heparin Infusion (Q-Pg-15)
  • Therapeutic effect → monitor aPTT; desired ≈ 1.5–2.5 × control (≈ 60–80\ s).
• Warfarin Teaching (Q-Pg-16)
  • Statement requiring re-education: “I will take aspirin for headaches.” (↑ bleeding risk).
  • Safe behaviors: Observe urine/stool color, avoid alcohol, use gentle hair-removal cream vs. shaving.

Blood Products & Hematopoietic Growth Factors

Blood Components (Pg-18)

• Whole Blood → acute blood loss, dehydration, hemorrhagic shock.
• PRBCs → anemia; same reactions as whole + hyperkalemia.
• Platelet concentrate → thrombocytopenia.
• Fresh Frozen Plasma → massive transfusion, burns, shock, warfarin reversal, DIC.
• Albumin → hypoalbuminemia (cirrhosis), large-volume paracentesis, ARDS; risk of fluid overload/pulmonary edema.
• Apheresis Granulocytes → severe neutropenia, neonatal sepsis, refractory infections.

Adverse Reactions (highlighted)

• Allergic reaction, anaphylaxis.
• Acute hemolytic transfusion reaction.
• Febrile non-hemolytic reaction.
• Sepsis.
• Circulatory overload (esp. plasma/albumin).
• Hyperkalemia (massive PRBC transfusion).

Growth Factors (Pg-17)

• Erythropoietin → stimulates RED BLOOD CELLS.
• Filgrastim → stimulates NEUTROPHILS (G-CSF).
• Oprelvekin → stimulates PLATELETS (IL-11 analog).

Antihypertensive Therapy (Pgs 20-21)

• General “Start-Up” Rules:

  • Change positions slowly to ↓ orthostatic hypotension.
  • “Start low, go slow” with dosing.
  • Give FIRST DOSE AT BEDTIME (esp. \alpha-blockers) to prevent first-dose syncope.
  • Never ABRUPTLY STOP (rebound HTN/crisis).
  • Hold dose if BP < 90/60 mmHg or HR < 60 bpm.
  • Daily weight monitoring (fluid retention with some classes).

• Additional (illegible pages likely covered):

  • Diuretics, ACE-Is, ARBs, CCBs, \beta-blockers, central \alpha_2 agonists, vasodilators.
  • Emphasize fall precautions and need for life-long adherence.

Miscellaneous / Illegible Sections

• Several pages contained unreadable text blocks referencing platelet inhibition, factor Xa blockade, and antihypertensive drug tables.
• Key themes inferred (and commonly tested):
  • Antiplatelet drugs keep coronary stents open.
  • Factor Xa inhibitors lower stroke risk in atrial fibrillation.
  • Always verify platelet counts before GP IIb/IIIa inhibitors (e.g., abciximab) because of severe thrombocytopenia risk.