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Pharmacology Midterm- Musculoskeletal and 5 others
Terms in this set (101)
Skeletal muscle relaxants
used to treat conditions associated with hyper-excitable skeletal muscle- specifically, muscle spasms with the ultimate goal a decrease in muscle hyper-excitability without a profound decrease in muscle function. Patients with various pathologies may present with muscle spasms including whiplash, sciatica, HNP, as well as other conditions presenting with muscle spasms.
Non-steroidal anti-inflammatory drugs
-relieve mild-moderate pain (analgesia)
-decrease the elevated body temperature associated with fever (antipyresis)
- decrease blood clotting by inhibiting platelet aggregation (anticoagulation)
Steroidal anti-inflammatories (corticosteroids)
extremely effective anti-inflammatory agents, but are associated with a number of serious side effects. Systemic administration may be indicated for management of rheumatoid arthritis and osteoarthritis. Corticosteroids are often utilized to manage chronic inflammation within joints through a steroid injection in conditions such as trochanteric bursitis, bicipital tendonitis.
medications target the inflammation and pain to attempt to manage the condition allowing the patient continued mobility of the joint. NSAID's are often utilized in addition to pain medications.
Note: Tylenol/Acetaminophen is NOT a NSAID. Though it does provide pain relief, it does not manage inflammation. For this reason it is the drug of choice for the pain associated with OA as it has fewer side effects.
not an inflammatory condition but rather results in a weakening of the bone secondary to demineralization. Though typical management involves calcium supplements and exercise to stimulate bone growth, medications are often utilized to facilitate this process.
are used to decrease muscle excitability and contraction through an effect at the spinal cord level (centrally/CNS acting relaxants) or on the muscle cell itself (direct-acting relaxants). Produce muscle relaxation by inducing a sense of calm or tranquilizing effect on the patient. Examples: Diazepam (Valium) or Flexeril.
Considered to be prostaglandin (found in inflammatory exudates) inhibitors. Prevent synthesis of prostaglandins at the site of inflammation. Common examples: aspirin, naproxen, Aleve, ibuprogen, Motrin, Advil and Celebrex.
Steroidal anti-inflammatories (corticosteroids))
can be administered systemically (orally), epidurally or injected directly into the facets/discs/joints (intraarticular injection) as well as soft tissues such as bursae and tendons. Local injections minimize adverse effects. Examples: Prednisone, Dexamethasone and Hydrocortisone
inhibit bone resorption to retain the integrity of the bone. Vitamin D and Calcium may also be utilized. Example: Fosamax
The most common side effect seen with NSAIDs is gastrointestinal irritation i.e., heartburn, indigestion, nausea, vomiting, diarrhea and constipation.
Long term use of corticosteroids have a general catabolic (breakdown) effect on muscle, tendon and bone resulting in side effects of osteoporosis, muscle wasting/weakness, aggravation of diabetes mellitus. Additionally, the immune system may become depressed. These side effects emphasize the need to limit coricosteroid therapy as much as possible.
Elevation in blood pressure may indicate fluid retention which is often a side effect of prostaglandin inhibitors (NSAIDs)
Aspirin and other prostaglandin agents (NSAIDS) have as their main side effect, gastric irritation. Never take aspirin on an empty stomach. Enteric coated aspirin have less gastric irritation associated with them.
Routine use of aspirin prior to surgery is discontinued as excessive bleeding may occur.
Certain antacids (TUMS) alter the pH of the stomach limiting the absorption of Calcium. This is a particular concern for patients taking Calcium for osteoporosis.
Tylenol/Acetaminophen is often preferred for children (under age of 18) over aspirin due to the connection of aspirin and the development of Reyes Syndrome.
Considerations for the PT Assistant
Muscle Relaxants often enhance the results that can be obtained by the use of therapeutic modalities and other interventions.
Since sedation/drowsiness is often a side effect of agents used to treat muscle spasms, pain and inflammation, it may be necessary to consider scheduling patients at times when the agent is less active. Additionally, patients with already compromised balance/mobility due to their pathology may be at an increased risk of falls if this drowsiness is experiences.
Be aware that a reduction in spasm, pain, and/or inflammation will often result in an increase in movement as motion will no longer produce discomfort which would typically be protective inhibiting movement. If movement should be discouraged, due to a medical condition or surgical procedure, it is important to discuss this with the patient.
Because of the inhibition of platelet activity by the NSAID user, people taking these drugs on a chronic basis have the potential for easy bruisability. Avoid soft tissue trauma.
Patient's with osteoporosis are at an increased risk for fractures. Fall Precautions as well as Fall Education should be incorporated into Physical Therapy.
hormone secreted by the beta cells of the islets of Langerhans in the pancreas. Its action is to increase cellular uptake of glucose and amino acids, which are then utilized for cellular synthesis of glycogen, fatty acids and proteins. Its secretion is stimulated by increased concentrations of glucose in the blood. As exerts its action to increase uptake and incorporation of glucose and amino acids within the cell, the blood levels of these substrates decrease. This decrease in blood glucose then inhibits secretion. Allows for storage of nutrients than can be released and utilized by the body in times of fasting.
Diabetes Mellitus type 1
disease in which insulin is either not present or is not appropriately secreted or acting. requires replacement of insulin injection coordinated with meals
Diabetes Mellitus Type II
since insulin may not be lacking, may be accomplished with diet and/or an oral hypoglycemic. Insulin may also be used
Some medications stimulate the pancreas to release insulin while others may increase the sensitivity of the various cells in the body (including muscle) to insulin. In both cases, insulin can more effectively move glucose into the cells for energy to lower blood glucose levels. Still other medications, slow the body's digestion of carbohydrates allowing for a slower rise in blood sugar throughout the day which can be more easily managed with diet.
plays a critical role in controlling the metabolic rate of cells particularly the heart and respiratory rate as well as metabolism of fats, proteins and carbohydrates. Patients with Hypothyroidism, will present with intolerance to cold, bradycardia, lethargy as well as other symptoms related to this slowing of the body's metabolism.
to elevate the level of thyroid hormone to restore the metabolism to an appropriate level allowing proper functioning of the body's systems.
As their estrogen levels have decreased, they experience not only hot flashes and fatigue but are at an increased risk for osteoporosis as one of the roles of estrogen is related to maintaining calcium levels. Management is controversial: although HRT Estrogen Hormone Replacement Therapy is effective in managing osteoporosis, at the same time it may increase the risk of certain cancers, thrombophlebitis and cardiovascular disease. Many patients opt to take other medications to manage just the osteoporosis which is covered in the musculoskeletal unit.
utilized to manage Type 1 and possibly Type 2 Diabetes. Typically 1-4 injections are utilized daily into the arms, legs or abdomen and are coordinated with meals. There are many types of insulin available with varying rates timeframes of how quickly they act on the body to lower blood glucose levels as well as how long lasting their effects are on the tissues.
Type 2 Diabetes
oral medications combined with proper diet and exercise may be sufficient to control blood glucose level. Medications to manage blood sugar levels are often taken from 1-3 times a day coordinated with meals. An example of an oral medication is Glucophage.
hormone therapy through daily ingestion of a tablet with a hormone (Levothyroxine) that exactly replicates the hormone normally secreted by thyroid gland. The proprietary name for these medications often includes -thyroid such as Synthroid
Causes of hypoglycemia include: insufficient food consumption, too much insulin has been injected or increased physical activity. Causes of hyperglycemia include: to much food consumption, too little insulin has been injected, stress, surgery or acute illness.
To manage an acute hypoglycemic event, glucose should be administered in the form of a glucose supplement, honey, fruit juice, or injection. Hard candy should be used with caution as there may be a risk of choking. Potential allergies should always be considered prior to providing any food to a patient.
Certain medications when administered with insulin may affect the ability of insulin to manage glucose levels. Examples include, alcohol, calcium, corticosterioids, diuretics.
HRT is associated with increased risk of stroke, DVT and breast cancer.
Considerations for the PT Assistant
Diabetic patients frequently monitor their glucose level throughout the day. The PTA should be in the routine of asking the patient or checking with nursing to determine if the patients glucose is at an appropriate level and whether or not their insulin has been administered prior to performing mobility activities and exercises with the patient.
Secondary to the multiple system involvement in diabetes mellitus, these patients can present to the physical therapist assistant with a multitude of problems. Because of poor circulation to the lower extremities, open wounds are slow in healing. Sores may develop more frequently in diabetics because of peripheral neuropathy, with decreased sensation. Thus, the sores may be quite large before the person notices them. Meticulous foot care is essential. Correct fitting shoes can prevent pressure sores from developing. Going barefooted is contraindicated because of the likelihood of foot injury. Prevention is overall much easier than treatment.
Peripheral neuropathy also may lead to a loss of proprioception. Precise movement and placement of feet during ambulation may be lacking. This can lead to apparent gait deviations.
Autonomic neuropathy can cause postural hypotension. Avoidance of rapid changes in posture are necessary to prevent serious injury occurring from falls and fractures.
Exercise is very important to the total treatment of diabetes mellitus. Exercise causes a non-insulin-dependent glucose uptake. The patient should either reduce the dose of insulin if he knows that exercise will occur or else consume a glucose-containing food in order to prevent hypoglycemia from developing.
Another aspect of exercise is important to those taking insulin. Exercise increases blood flow to the exercising muscles. If insulin had been administered by injection to that area, the increased blood flow will remove insulin faster from its site of injection. This means that the insulin many not be present later on when the patient needs it to move the glucose into their cells. Insulin administered before exercise should be injected into a non-exercising extremity or into the abdomen.
Patients should exercise during the peak phase of their glucose cycle, which is approximately 2 - 3 hours after eating. They will need to adjust their insulin requirements as they will not need as much insulin to control the serum glucose concentration. Exercise tends to produce an insulin-like effect. Overall, exercise improves circulation and improves glucose tolerance.
Infection, surgery and physical/emotional stress will alter a patient's requirement for insulin.
Do not exercise a patient just before a meal as their serum glucose will be low and the exercise may cause a hypoglycemic reaction. Patients should prepare for possible hypoglycemia by eating a light snack prior to exercising.
Too much thyroid hormone may increase calcium reabsorption and risk of osteoporosis as well as causing symptoms of palpitations, insomnia, nervousness. The PTA should monitor the patient for these side effects. Conversely, continued low levels of thyroid hormone will result in fatigue, weakness, muscle cramps, memory loss.
the absence of feeling, sensation or pain) either through the skin as topical drugs, through injection, through nerve blocks or through inhalation as used in the operating room. Central nervous system depressants may be general in that that depress the entire CNS or they can be more specific; affecting one or more centers of the brain.
To relieve certain painful conditions such as RSD with medication administered directly to the sympathetic ganglia.
For analgesia during surgery through application to a specific region such as the brachial plexus for UE arthroscopy or biopsy.
Sympathetic Ganglion Block
Epidural Steroid Block
Brachial Plexus Block
General Anesthetic Drugs
produce a loss of sensation throughout the body which leads to unconsciousness most utilized for surgery. The drugs of this category are most often administered by inhalation. Anesthetic drugs used today have a shorter duration of effect than in previous years, allowing prompt recovery and a low incidence of nausea or vomiting.
indicated to manage the pain that often accompanies the various orthopedic conditions (OA, HNP, Tendonitis, rib fractures, post surgical conditions, etc.) afflicting patients receiving physical therapy.
as Lidocaine are typically administered via subcutaneous injection or topically to block pain.
typically managed with OTC medications. Often pain is associated with inflammatory conditions of NSAIDs covered in the Musculoskeletal System are often utilized. Pain medications such as acetaminophen work peripherally to limit pain without any anti-inflammatory effects and are considered non-narcotic analgesics.
(producing stupor/sleep with CNS depression) are controlled substances often utilized derived from opium and used today to effectively treat moderate to severe pain. While effective, these medications carry the risk of addiction with prolonged use. Medications in this category can be delivered orally, intravenously or via a transdermal patch.
PCA pump (patient-controlled analgesia)
allows the patient to administer his/her own medication. The patient receives an IV in the arm which is attached to a small pump that provides continuous infusion of the medication or delivery of a dose of the medication each time that the patient presses a button on the pump. The unit is preset to a specific dose and time frame between dosages to avoid overdose
often requires medication which will at on the central nervous system to affect the patient's perception of pain while promoting a sense of well-being. Often, this type of medication will be used in combination with aspirin, acetaminophen or other analgesic drugs. Codeine and Percocet are examples of this type of medication.
Severe and unrelenting pain
often warrants medications that will act to suppress the central nervous system by blocking the pain pathways thereby dulling all sensation of pain as well as the perception of pain. Additionally, anxiety and apprehension regarding the pain will disappear as the patient will experience euphoria. The patient often will appear markedly drowsy. This type of medication is most effective if it is administered prior to the onset of the pain. Medications such as Morphine, Demerol, Vicodin and Oxycodone are examples of the medications used in this type of clinical situation.
Lidocaine can be delivered in physical therapy through the skin via Phonophoresis (US) or Iontophoresis (Estim) for deeper local effects. More often anti-inflammatory medications such as Hydrocortisone are utilized to manage the pain via controlling the inflammatory process.
Drugs that can effectively control pain are also the most addicting. While short-term use does not necessarily lead to addiction if the doses are monitored closely. Severe withdrawal symptoms are experienced with cessation of its use.
After repeated doses tolerance may develop with continual increase of the dose occurring to obtain the same level of pain relief.
Many narcotic medications act as CNS depressants with depression of the respiratory system a common side effect which patients should be monitored for as it can be potentially fatal.
Acetaminophen utilized over prolonged periods of time may contribute to liver and kidney damage as the medication is metabolized by those organs. This risk is increased when combined with alcohol consumption.
Considerations for the PT Assistant
When performing data collection relative to pain, the PTA should ask when the last dose of pain medication was administered.
Patient education should occur related to appropriate activity level as medications may mask pain.
When post operative patients are recovering from anesthesia, they will present with lethargy and often nausea as the sedative effects are diminishing. Care should be taken when performing mobility activities with these patients as participation may be limited.
General anesthesia limit ciliary clearance of mucus in the airways. Following surgery, patients should be encourage to perform deep breathing exercises, incentive spirometry and coughing splinted if necessary to assist in clearing sections which may have settled in the airways.
Many pain medications can cause a patient to be markedly drowsy which may be combined with decreased cognitive function (problem solving, ability to follow commands, etc.) decreasing participation in therapy. The PTA should attempt to schedule therapy at a time when pain relief is at its peak but this lethargy side effect is minimal should be attempted.
Anti-anxiety medications and sedative which promote relaxation are often utilized in combination with analgesics to manage pain. Patients should additionally be monitored for the considerations covered in the Psychiatric Unit.
For patients with PCA pumps, the PTA should be cautious of the IV line as well as being aware of whether the unit is set to continuous infusion of the medication of delivery is dependent upon the patient pressing the handheld button. If the latter is the case, determination of the most appropriate time during the session to initiate the dosage will be related to the level of pain relief required based on activities performed.
Patients who are taking morphine may experience decreased motor coordination. Misjudging distances and staggering may occur during gait.
Patient's taking narcotics should be monitored for orthostatic hypotension and dizziness with mobility.
reduce the viscosity of mucus allowing it to more effectively be cleared by coughing or chest physical therapy.
are utilized to relieve coughing by effecting the cough center in the brain or diminishing the sensitivity of the cough receptors in the lungs. This does not include coughing induced by asthma but arising from other conditions. Examples: opiods such as Codeine and menthol lozenges.
are agents that liquefy the mucus in the bronchi and facilitate the expulsion of sputum
assist with breathing and oxygenation by relaxing the smooth muscles in the bronchi allowing for increased airflow. This is critical for patients with COPD, emphysema and asthma. These medications may be delivered orally as well as via inhaler or nebulizer. Examples :The suffix -terol/-terenol , -phylline Albuterol and Salmeterol.
to reduce inflammatory response but do not alter diameter of bronchiole) may be delivered via inhaler or nebulizer
liquid medication with oxygen and delivered fine mist local with face mask or mouthpiece
measured dose thorugh aerosol delivery
Long term use of systemic corticosteroids have a general catabolic (breakdown) effect on muscle, tendon and bone resulting in side effects of osteoporosis, muscle wasting/weakness, aggravation of diabetes mellitus. Additionally, the immune system may become depressed. These side effects emphasize the need to limit coricosteroid therapy as much as possible. When administered locally via inhaler or nebulizer, the risk of these adverse reactions is limited.
Dry mouth is a side effect of some respiratory medications which is exacerbated by pursed lip breathing often performed in therapy.
Considerations for PTA
Adequate fluid intake is necessary during treatment of respiratory infections so that mucus will be liquefied and expectorated easier.
Coughing may be beneficial to clear secretions and may need to be taught to the patient so that it will be effective.
Cough preparations, especially those that contain codeine or similar agents, will cause drowsiness.Use caution.
Arterial blood gases are often drawn on patients who have had an acute respiratory condition so that oxygen and drug dosages can be adjusted.
Patients with respiratory ailments tend to be anxious and should be approached in an understanding manner.Cyanosis, particulary involving the lips and nail beds, is a signof decreased blood oxygen levels.
Although exercise is a part of the overall treatment, some asthma's are triggered by exercise. Cold air seems to be the culprit, rather than any specific airborne entity. Administration of an oral inhalant, before exercise, can reduce this problem.
ac: before meals pc: after meals meds.: medications
qd: one time a day qid: four times a day bid: two times a day
prn: whenever necessary tid: three times a day q2h: every 2 hours
stat: immediately n.s.: at bedtime qod: every other day
I & O: intake and output D/C: discontinue use IV: intravenous
TPN: total parenteral nutrition Ca: calcium K: potassium
PO: by mouth NPO: nothing by mouth OTC: over the counter
qh: every hour
(may have # of hours indicated between q and h. i.e. q4h: every 4 hours)
PRBC: packed red blood cells (blood transfusion)
an uncoordinated contraction of the atria, which is usually asymptomatic but may lead to cardiac failure or embolism. Normal cardiac functioning depends on the heart contracting at a consistent rate and rhythm allowing sufficient cardiac output for the delivery of oxygen and nutrient-rich blood to the cells of the body. Medical management is directed toward maintaining this rhythm.
lifestyle modification including sodium restriction, weight reduction, smoking cessation, exercise, and modification of diet. utilize several different mechanisms to lower and control blood pressure including acting on the peripheral blood vessels (vasodilation) and decreasing heart contraction.
Atherosclerosis (Coronary Artery Disease CAD, Peripheral Arterial Disease PAD, Angina)
involves the formation of plaque on the intima of the blood vessel, which narrows the lumen. Blood vessel walls damaged from wear and tear, as a result of high blood pressure, create a site for lipid molecules to attach to the wall. The lumen is narrowed which results in ischemia of the tissues the vessel serves. While dietary management and lifestyle changes of cholesterol levels is the first choice, medications may also be utilized which directed toward controlling cholesterol (hypercholesterolemia) which fosters the development of plaques.
Congestive Heart Failure (CHF) or Left Sided Heart Failure
results in decreased cardiac output with congestion of fluid in the lungs or peripheral circulation. Management involves decreasing this fluid volume to lessen the workload on the heart as well as strengthening the heart's contraction to allow improved cardiac output.
decrease peripheral resistance by promoting salt and water excretion in the urine. This results in decreased plasma volume which diminished the workload on the heart in addition to 'thinning' or decreasing the viscosity of the blood. Used in the management of HTN, CHF. ex :Lasix.
Calcium channel blockers
limit the movement of calcium into cardiac muscles and smooth muscle cells of blood vessels resulting in decreased heart rate and blood pressure to manage HTN, Atrial Fibrillation and CHF. Examples: suffix -ipine and Cardizem.
are vasodilators acting on smooth muscle in the blood vessels resulting in vasodilation to decrease the peripheral resistance and blood pressure to manage HTN. They are often used in conjunction with diuretics to manage CHF. Examples: suffix -pril and Vasotex.
inhibit the sympathetic nervous system to slow heart rate and reduce the force of contraction of the heart. In doing so they reduce the work demand on the heart and its need for oxygen. They are utilized to manage angina, MI, HTN and arrhythmia. Examples: suffix -olol, Lopressor and Inderal.
Digitalis type medications
increase strength of contraction and decrease AV node conduction and heart rate. This combination of effects allows for additional filling of the ventricles with resultant improvement of cardiac output. This medication is used to manage Atrial Fibrillation and CHF. An example: Digoxin.
Management of CAD to dilate the coronary arteries increasing oxygenation to the heart during episodes of angina.
is utilized prophylactically to decrease the risk of clot formation and subsequent myocardial infarction.
increase the blood coagulation time. They are used to prevent coagulation of blood that will be used in transfusions, preserve blood and to prevent post-operative formation of thrombi (DVT) and emboli or in patients at risk for the development of thrombus secondary to cardiovascular disease. These medications may be delivered orally or intravenously. Examples: Heparin, Coumadin, and Plavix.
Cholesterol management medications
utilizes several different mechanisms which act to inhibit cholesterol production in addition to raising the HDL levels or via lowering the LDL levels. High HDL levels are desirable as they facilitate the movement of cholesterol to the liver for excretion in the bile. This category of medications is referred to a statins with the generic medications often ending in the suffix -statin. An example: lipitor.
Digitalis toxicity may result from prolonged use of cardiovascular medications. Symptoms include bradycardia, confusion, nausea/vomiting, and/or hallucinations.The patient's blood is frequently monitored to determine the exact level of medication in their system.
Statins are metabolized by the liver. Patients on this category of medication must have their liver function closely monitored via blood tests to ensure the organ is not compromised.
Statin medications when utilized in combination with the antibiotic erythromycin may lead to the development of rhabdomylosis. The PTA should interview the patient regarding the intensity of their muscle soreness to see if it is appropriate for the patient's level of exercise.
Considerations for the PT Assistant
-cardiac patient must be monitored closely for changes in vital signs
-decrease in visible edema from fluid retention is generally noted as a sign of improvement in patients with congestive heart failure. Caution should be observed with patients who are taking anticoagulants as there may be bleeding with apparently insignificant trauma. The PTA should pay particular attention to the force of their manual contacts on the patient as well as educate the patient in fall precautions.
Post surgical patients as well as patients with impaired/limited mobility should be monitored for the development of a DVT. When treating a patient who has developed a DVT and is receiving anticoagulant medications, the PTA should check the physician protocol to see if any type of in bed exercises may still be performed. During early treatment to stabilize the thrombus, gait and transfers (OOB out of bed) activities are often contraindicated as mobility can dislodge the clot leading to a pulmonary embolism (PE).
In individuals with CAD, angina is typically experienced as retrosternal pain which radiates into the left upper extremity. However, this may not be the only distribution of the pain. The clinician should be aware that this pain could radiate into the neck, jaw, upper trapezius, upper back, shoulder, and both arms. This is important when distinguishing particular pain from pain originating due to other pathologies such as nerve root impingement, muscle spasm, etc. to determine if the patient should administer their nitroglycerine. Review of medications utilized in the management of the individual's disease is critical. For example, certain medications are utilized to lower blood pressure by inhibiting an increase in heart rate in an individual diagnosed with HTN. When exercising this individual, the PTA should be aware that the typical response to activity (increased heart rate) will be altered. Sudden changes in position with patients on cardiac medications should be limited to avoid episodes of orthostatic hypotension.
When performing interventions with a patient who utilizes sublingual nitroglycerine, the PTA should ensure the medication is readily accessible. Should therapy cause an episode of angina, analysis of the session and consultation with the PT to determine future intensity of activities and possible need for referral to the physician is indicated
Patients taking diuretics should be closely monitored for signs of dehydration and electrolyte imbalance including weakness, dizziness, low urine output, and thirst
Patients taking any antihypertensive medication are at risk for postural (with sudden position changes from lying/sitting) and orthostatic (with standing) hypotension
Some key points regarding nitroglycerine the PTA should be aware of include: Do not handle the medication tablets as sublingual tablets are designed to dissolve, the tablet should be placed under the tongue or between the gums and cheek to dissolve, it is normal for the patient to report slight burning or tingling as the tablet dissolves.
As nitroglycerine tablets may not be frequently utilized by the patient if angina is managed, expiration dates should be checked frequently. As Beta blockers reduce HR, decreased exercise tolerance may be occur. Additionally, vital signs may not be sufficient indicators of stress on the CV system during therapy. Use of the Borg scale may be beneficial.
Food and Drug Administration (FDA)
segment of the US government that oversees not only drug development but also provides approval prior to the marketing of any new drug as well as regulating the approval of a new use for an older drug
health volunteers are used to see the drug effects
a small number of patients with specific medical conditions for which the drug is indicated is used.
a larger number of patients is used and additional information is obtained regarding the drug's safety and effectiveness in a larger patient population
Result of the studies are reviewed by a panel of experts who submit their recommendation to the FDA. If found favorable post-marketing surveillance is then conducted. The drug company continues to collect data on the safety and effectiveness of the drug with an emphasis on monitoring any adverse reactions.
To restrict the dispensing of drugs that are potentially addictive, the "Controlled Substance Act" was written. It provides a listing of drugs that are considered illegal for uses other than therapeutic. Controls were devised to establish five (5) schedules or categories of controlled substances based on their potential for physical dependence (compulsion to use substance repeatedly to avoid withdrawal) or psychological dependence (compulsion to use substance to derive pleasure). The lower the schedule number the higher the potential for abuse.
heroin, marijuana - not approved for medical use in the US without special approval
oxycodone, morphine - high abuse potential and dependence but approved medial applications do exist.
codeine in cold/cough medicines - limited potential for abuse.
Specific structure of the compound (the long name)
Name derived from the chemical name and typically represents the official name of the compound.
Name the company gives the product so the consumer can easily recognize the product.
N-Acetyl-p-aminophenol Acetaminophen Tylenol
Para-isobutyl phenyl-proprionic acid Ibuprofen Motrin, Advil
3,4-Dihydroxyphenyl-l-alanine Levadopa L-dopa
5,5-Phenylethylbarbituric acid Phenobarbital Barbital, Luminal
7-Chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one Diazepa Valium
Just a reminder of what to know from medications list
The names of these medications, their classification, conditions they manage and basic effects should be committed to memory.
This is intended for an effect limited to the site of application. limits undesired absorption by other areas of the body. application to the skin, application to the mucous membrane, suppositories, enemas (rectal), otic (ear) preparation
Intended for a general effect in which the drug is absorbed into the blood and carried to one or more tissues within the body : orally, sublingually or parenterally, Subcutaneous, Intramuscular, Intravenous
-interventions we perform in physical therapy may impact the absorption of the medication and ultimately its effectiveness in managing the patient's condition.
- various routes of administration of medications are directly linked to the mediations absorption and therefore the time for the medication to achieve its desired effect to manage the patient's condition.
refers to the extent to which a certain drug reaches systemic circulation (how completely it is absorbed once it is administered)
Drug metabolism. refers to chemical changes that take place in the drug following administration. Metabolism refers to the process of transforming the drug into a more water soluble compound so that it can be eliminated. This prevents the body from becoming a "junk yard" full of drugs. Enzymes located within specific tissues change the drug's structure, altering its pharmacological properties
liver but may also occur in the lungs, kidneys, gastrointestinal tract and skin
primary location for drug metabolism
drug has been introduced to the system are the result of an interaction between the "chemical" and some part of the body. The interaction may be specific (selects one tissue or cell type) or non specific.Most pharmaceutical agents (drugs) are specific in that they have target sites. The target cell has a specific receptor (lock) that the drug binds to (key). When the cell with the receptor binds with the drug, a change in the function of the cell occurs (in the presence of an enzyme to activate the process) yielding the desired/primary effect, as well as any secondary effects. The binding of the cell with the drug is called the "Lock and Key Mechanism" of "Drug-Receptor Interaction".
Non-receptor Mechanisms of Drug Action
Certain drugs do not appear to exert their effects by binding to a specific cellular component. They cause chemical/physical reactions that yield the desired effects
Drugs acting on enzymes
Certain medications target enzymes responsible for the symptoms of a condition or by stimulating enzymes to breakdown certain substances present in abundance. By inhibiting these enzymes the condition can be managed. For example, jaundice in the newborn may be treated by stimulating enzymes responsible for the breakdown of the biliruben present in excessive amounts which is causing the jaundice.
ancer chemotherapeutic agents become incorporated into the manufacture of specific cellular components, acting as an improper ingredient in the biosynthesis of the cancer, so that the cancer cell dies.
Chelating (combining with metals) agents
bind to harmful compounds such as the heavy metals, and prevent them from exerting toxic effects.
Drugs acting on cell membranes
general anesthetics may directly affect the cell membrane, possibly by becoming directly imbedded in the lipid portion of the membrane
Drugs acting non specifically
do not fall into any of the other categories discussed.
very low dose which does not produce any observable effect.
lowest dose capable of producing a barely perceivable response
maximal effect/efficacy of the drug
the plateau in the response (when there will be no further increase in the response to the drug, even if the dosage continues to be increased).
refers to the absolute amount/dose of a drug required to produce a specified pharmacological effect.
Clearance of a drug
via organs such as the liver, kidney, etc.) can be described in terms of the ability of all organs and tissues to eliminate the drug (systemic) or the ability of a single organ or tissue to eliminate the drug.
the amount eliminated equals the amount administered
refers to the elimination of the drug through the kidney (urine) as well as the gastrointestinal tract (feces)
Side effects of medications
minor effects that result on tissues/systems other than the target from taking a particular medication. Side effects are those effects which occur in a larger population and are considered to be minor in their impact on the body system.
term utilized to refer to serious side effects or undesirable effects from a medication. They are not as commonly encountered and tend to be more severe in nature.
negative effect of a medication that occurs with a high dose of a medication or when the level of medication in the individual's system rises above the therapeutic level. Patients on medications which are at a high risk for toxic effects are frequently monitored via blood test to avoid this condition. Additionally, the PTA can monitor the patient for known signs of toxicity of particular medications
medications are combined resulting in either decreased response to the medication wherein one medication interferes with the action of the other or combined effects which can be beneficial or harmful. One drug may interfere with the absorption of another, the distribution of another, decrease or increase the other drug's metabolism, or prohibit elimination of the other drug.
implications for PTA
-reviewing all of the medications that a patient is on and are documented by the PT in the evaluation.
-you may note changes that can be correlated to medication interactions
-you might bring to the attention of the PT and Physician potential interactions that might adversely be effecting the patient.
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