Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Special Topics
Pharmacology
| Question | Answer |
|---|---|
| Medical Pharmacology | -Science of chemicals that interact with the human body |
| Basic facts: 1970 Controlled Substance Act | -Established schedules of abusable drugs -Lower the number; the more addictive -Higher numbers may be obtained OTC |
| Pharmaceutical Phase | -Disintegration/Dissolution of various drug forms(tablet, capsule, liquid, topical) -Influences pharmacokinetic and pharmacodynamic phases |
| Pharmacokinetic Phase | -Determines site concentration/general effects -Absorbed, distribution, metabolized(mostly by liver, limited by enteric coating) and excreted(mostly by kidneys and intestines) |
| Pharmacodynamic Phase | -Determines specific cellular mechanisms of the drug interactions and it's effects by 3 theories: -Specific receptor target(i.e. cancerous tissue) -Enzyme interaction- stimulant of inhibitor of chemical reactions -Non-specific-more general effects |
| Drug names | -Each drug has a generic name/chemical (i.e. Ibuprofen and a brand/trade name- Advil) -Generic versions use the chemical name -Generic versions may: -Use less expensive ingredients -Use differenti nactive ingredients -Have a different effectiveness |
| Consult Physician's Desk Reference to obtain information on... | -Manufacturer -Indications -Standard doses -Possible side effects -Drug interactions |
| Drugs: Generic/Chemical names | -Generic/chemical name will be followed by brand/trade name -Most known by trade names but some by generic/chemical names -Take special note of bolded desired and/or side effects and how they may influence PT interventions |
| Drugs by Numbers | -2009 prescriptions filled per person -19-64 yrs of age -US- 11.3 -TN #3- 16.3 -#1 and #2 were WV and KY - 65 and older: US-31.2 -TN #1 47.1 |
| Death rate for drug overdoses | -Tripled to 16 deaths per 100000 in TN since 1999 per TN Division of Health -TN ranks #8 in US per 2010 Centers for Disease Control |
| Health rankings | -TN ranks 42 out of 50 states as of 2013: -Diabetes= 12% -Obesity= 31% -High cholesterol= 39% -Hypertension= 39% -Stroke= 4% -Heart attack= 7% -Heart disease= 7% -Physically active= 71% |
| HTN | -BP= HR x SV x TPR -Lowering BP pf patients with a diastolic pressure > 90 mm HG decreases mortality rate in 25% of the population -CDC: over half of the 67 million American adults with HTN cannot get it under control even with medications |
| Pre- and Stage 1 HTN Rx | -Weight reduction -Decreased salt in diet -Smoking cessation -Reduced alcohol consumption -Exercise |
| Stage 2 HTN Rx | -Continue lifestyle modifications plus... -1 to 3 different types of drugs may be used at the same time |
| Drugs used in HTN | -Diuretics -Beta blockers -ACE inhibitors -Calcium channel blocker -Alpha blocker -Centrally acting adrenergic inhibitors -Vasodilators |
| Diuretics | -Controls fluid volume; blocks NaCl reabsorption in kidneys -3 types: Thiazide, Loop, Potassium-Sparing |
| Thiazide Diuretics | -Chlorothiazide (Diuril) -Side effects: gout, weakness, increased urination |
| Loop Diuretics | -Furosemide (Lasix) -Bumetanide (Bumex) |
| Potassium-Sparing Diuretics | -Spirionolactone (Aldactone) |
| Beta-adrenoceptor antagonists | -A.k.a Beta-blockers -Decreases BP by decreasing cardiac output by decreasing HR |
| Beta-blockers | -Propranolol (Inderal) -Atenolol (Tenormin) -Metoprolol (Lopressor) -Nadolol (Corgard) -Side effects: cold hands, fatigue, increased asthma and triglycerides, and decreased HDL and HR -Banned by Olympics |
| Angiotensin Converting Enzyme Inhibitors | -A.k.a. ACE inhibitors -Block vasoconstriction resulting in vasodilation thus less TPR |
| ACE inhibitors | -Not as many side effects: dry cough, hyperkalenemia -Benazepril (Lotensin) -Enalapril (Vasotec) -Captopril (Capoten) |
| Calcium anatgonists | -A.k.a Calcium Channel Blocker -Block calcium flow into cells resulting in arterial relaxation; again a decrease in TPR |
| Calcium antagonists: side effects | -Dizziness, hypotension, flushing, ankle edema, constipation -Nifedipine (Procardia) -Diltiazem (Cardizem, Dilacor) -Verapamil (Calan) |
| Alpha Adrenergic Blockers | -A.k.a Alpha Blockers -Decrease in TPR -Prazosin (Minipress) -Terazosin (Hytrin) |
| Centrally Acting Adrenergic Inhibitors | -Clonidine (Cataprs) -Methyldopa (Aldomet) -Guanfacine (Tenex) |
| Vasodilators | -Decrease in TPR -Minoxidil (Loiten, Rogaine) -Hydralazine (Apresoline) -Diazoxide (Hyperstat) -Nitroprusside (Hypride, Nitropress): used for HTN crisis |
| Importance of HTN medications to PT | -Beta blockers blunt HR response to activity so...even though the heart rate may not be as high as it should be doing a certain activity it is working just as hard.The medications just make it appear low. -Plenty of bathroom breaks 4 those on diurectics |
| Importance of HTN medications to PT cont.. | -Potential fall risk -Be aware of timing of meds and fatigue |
| Angina | -Usually due to increased plaque in coronary arteries: -Blocks blood flow to heart -So with increased activity of the heart, the heart muscle doesn't receive enough oxygen -Ischemic P! develops |
| Angina S&S | -Chest P! or discomfort -P! in arms, neck, jaw, shoulder or back accompanying chest pain -Nausea -Fatigue -Shortness of breath -Anxiety -Sweating -Dizziness |
| Angina: basic aims of drug treatment is to... | -Reduce demand for oxygen by decreasing HR/SV and thus CO -Increase oxygen supply by dilating coronary arteries thru decreasing TPR which decreases BP and subsequently SV |
| Angina medications | -Nitrates -Beta Blockers -Calcium Antagonists |
| Nitrates | -First line of defense -Cause arterial dilation and increase in TPR |
| Nitrates cont... | -Nitroglycerin most common: -Sublingual tablet/spray- short acting & used for acute attacks -Patches-long acting and used for prevention -Also available in oral (Cardilate) & IV form (Nitrostat) -Isosorbide dinitrate (Isordil, Sorbitrate)- less common |
| Beta Blockers act to.. | -Decrease CO by depressing myocardial contractility and reducing HR -Side effects are common: cold hands, fatigue, increased asthma and triglycerides, and decreased HDL and heart rate |
| Calcium Antagonists | -Cause arterial vasodilation to decrease TPR and some cause changes -Side effects: dizziness, hypotension, flushing, ankle edema, constipation |
| Keep ____ handy if ____ angina is present | -Nitro -Unstable |
| Unstable angina | -More easily and unpredictably brought on |
| Also remember... | -Decreased endurance associated with B-Blockers and other side effects from Calcium antagonists |
| Drugs used in blood coagulation | -Anticoagulants -Antiplatelets -Thrombolytics |
| Deep Vein Thrombosis (DVT) S&S | -Active cancer -Paralysis/immobilization -Bedridden/major sx -Tender along deep veins -Entire LE swelling -Pitting edema -Collateral superficial veins -Alternative diagnosis |
| Anticoagulants | -Prevention and treatment of DVT and embolism -Primary side effects is hemorrhaging, especially intracranial |
| Anticoagulant: Heparin | -(Hep-lock/Hepalean): -Decreases thrombin (clotting enzyme) -Injected or IV and is short-acting |
| Anticoagulant: Warfarin | -(Coumadin) -VItamin K (need for clotting) antagonist -Active orally with a 1-3 day delayed affect & w/ gradual dosing -Interactions with other drugs than heparin -Neither Heparin or Warfarin advantage to aspirin or mechanical prophylaxis 4 prevention |
| Anticoagulant: Enoxaparin sodium | -(Lovenox) -Injected subcutaneously or by IV -Max activity 3-5 hour after injection |
| Antiplatelet drugs | -Salicylate (Aspirin) is the most common -Better for arterial thromboses since they consist of mostly platelets rather than fibrin |
| Thrombolytics (Fibrinolytics) | -Used as clot busters -Used for extensively in MI pts to lyse the thrombi that block coronary arteries |
| Thrombolytics: Streptokinase (Streptase) or SK | -Made in Streptococci bacteria -Increases conversion of plasminogen to plasmin to break up clot |
| Thrombolytics: Tissue Plasminogen Activator (tPA, Alteplase) | -Naturally occurring enzyme that is more "clot specific" than SK -Only drug approved by the US Food and Drug Administration for the acute(urgent) treatment of ischemic stroke -Side effect: hemorrhagic stroke |
| Common orthopedic drugs | -Analgesics -Anti-inflammatories -Muscle relaxors |
| Analgesics | -Opioids (aka narcotics)- psycho-active drugs -Narcotic antagonists -Non-opioids -Muscle relaxants -Anti-inflammatories |
| Opioids | -From poppy plant -17 different alkaloids which are synthetically altered -Mimic endogenous opiate(endorphins, enkephalins) -Produce: analgesia, respiratory depression, euphoria, sedation -Cont. use results in tolerance and dependence/addiction |
| Opioids: 1070 Controlled Substance Act | -Established schedules of abusable drugs -Lower the number; the more addictive -Higher numbers may be obtained OTC -52 million people use prescription painkillers |
| Morphine | -Injected for severe pain -Orally for terminal P! for terminal care -Schedule II |
| Diamorphine (Heroin) | -Twice as potent as morphine but slower acting -Schedule I- no medically accepted use |
| Methadone | -Used in drug rehab to replace heroin |
| Meperidine (Demerol) | -Schedule II |
| Methylmorphine (Codeine) | -Schedule II if given alone -Schedule III in combination with others |
| Oxycodone | -With aspirin (Percodan)-schedule II -With acetaminophen (Tylox, percocet)- schedule II |
| Hydrocodone (Lortab) | -With acetaminophen (Lorcet, Vicodin)- schedule III |
| Prolonged use of Opioids side effetcs | -Musculoskeletal: muscle rigidity and osteoporosis -Other systems are slowed down and supressed -Ineffectiveness of analgesics leads to addiction and withdrawal issues |
| Narcotic Antagonists: Naloxone (Narcan) | -IV medicine -Used to treat an overdose |
| Narcotic Antagonists: Naltrexone (Texan) | -Oral medicine -Used to prevent abuse |
| Non-opioids or OTC P! medication | -Acetaminophen (Tylenol) -Found in 600 different drugs -Also a anti-pyrectic (fever reducer) -No anti-flammatory effects -Ineffective for LBP and only minimal short term benefit for people with OA |
| NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) | -Analgesic and anti-inflammatory agent -May also be an anti-pyretic |
| Anti-inflammatories | -NSAIDs -Corticosteroids -Supplements |
| NSAIDs | -Drugs that combat swelling by blocking prostaglandins -OTC or prescription -Some may also include analgesic and/or anti-pyretic agents -More effective for OA P! than Tylenol |
| Most common NSAIDs | -Salicylates= Aspirin -Ibuprofen= Motrin, Advil, Midol -Naproxen sodium= Aleve -Naproxen= Naprosyn/ prescription Aleve -Piroxicam=Feldene -Etodolac= Lodine -Nabumetome= Relafen |
| NSAIDs: COX 2 (cyclooxygenase) inhibitors | -Celebrex- COX 2 inhibitor -Limit formation of prostaglandins which promote inflammation -Same P! relieving and anti-inflammatory effects as traditional NSAIDs w/o causing the gastric irritation -More expensive |
| Other COX 2 inhibitors | -Vioxx and Bextra: withdrawn from market bc of higher risk of cardiovascular problems than Celebrex |
| NSAID side effects | -GI tract irritation due to increased sensitivity to stomach acid except with Cox 2 inhibitors -Nephrotoxicity -Skin rash -Tinnitus -Allergic reactions |
| NSAID application: Acute symptoms | -PRICED over NSAIDs most often -NSAIDs- more side effects but small benefit as Tylenol if PRICED not effective |
| NSAID application: Chronic symptoms | -Low evidence of a small benefit vs.placebo for LBP -Increased risk of GI bleeding and other side effects with long term or recurrent use -Greater support for manual therapy, MET, and cognitive behavioral therapy for LBP |
| NSAID application: Bone and Tendon healing | -Deleterious to fx healing -Varying negative effects with various NSAIDs -Tylenol good alternative for P! although it won't influence inflammation -Tendon healing: no influence unless at the insertion point |
| Glucocorticoids | -Primarily anti-inflammatory agents: fast acting, very effective -Other functions: horomonal replacement, immunosuppression, adrenal horomone suppression |
| Glucocorticoids cont... | -Facilitate conversion of protein to glycogen -Increases the ability of skeletal muscles to maintain contractions and avoid fatigue |
| Cortisone | -Injected |
| Hydrocortisone | -Oral replacement therapy -IV for shock -Topical for wound, rash, etc |
| Prednisone | -Orally for severe inflammatory or allergic conditions -Medrol Dosepak |
| Dexamethasone | -Iontophoresis |
| Glucocorticoid indications | -Acute inflammatory conditions -Asthma -Autoimmune disease (RA, lupus, MS) -Skin conditions (eczema and poison ivy) -Some cancers |
| Glucocorticoid injections | -Analgesic and/or anti-inflammatory -Procedures: intramuscular, epidural and intra-articular -Equipment: needles or catheters, fluoroscopy -Initially weakens tissue -For 2-3 days: avoid exer. and hot tubs/baths to prevent circulation of meds |
| Injection evidence | -Major limitations are the lack of replication of the findings for MND |
| Intra-muscular injection: Lidocaine evidence | -Effective for: Chronic MND & Myofasical trigger points -Moderate evidence that Botox A for chronic MND were no better than saline |
| Epidural injection evidence | -Limited effectiveness of methylprednisolone and lidocaine for chronic MND with radicular findings |
| Intravenous injection evidence | -Moderate evidence for the benefit of methylprednisolone given within eight hours of acute whiplash |
| Injection evidence: Sub-acute and chronic LBP | -Intra and periarticular, nerve blocks, trigger points -No evidence for or against these injections -Can't rule out certain unspecified groups may receive a benefit -Side effects: small to rare |
| Glucocorticoid injection side effects | -HA -Dizziness -Insomnia -Erythema -Rash/itching -Increase blood sugars(diabetic) -Mild BP changes -Increase P! -Fluid retention (cardiac pts) -Mood swings -Gastritis -Menstrual irregularities |
| Chronic Glucocorticoid Adverse Effects | -Immunosuppressant effects -Cushing's syndrome -Ecchymosis -Fluid retention -Adrenal suppression -Peptic ulcer disease -Mm weakness & atrophy -Poor healing -Osteoporosis -Increases blood sugar so avoid diabetics |
| Don't do strenuous ____ or _______ for 48 to 72 hrs after injection | -Exercise -Iontophoresis *Watch for bruising and skin tears after prolonged use |
| Do ___ activities in a pool or <____activities to combat osteoporosis | -Wt. bearing -< FWB |
| Supplements: Glucosamine and chondroiten sulfate | -NO evidence that minimum clinically important outcomes have been achieved compared to placebo in knee -P! improved in short term but functional changes and side effects were nearly absent |
| Different types of muscle relaxants | -Diazepam= Valium -Tizanadine= Zanaflex -Cyclobenzaprine= Flexeril -Orphenadrine= Norflex -Metaxalone= Skelaxin -Carsioprodol= Soma -Baclofen= Lioresal |
| Muscle relaxers general | -Brain relaxants-most don't have direct effect on muscle -Create mental and systemic sedation -Don't operate machinery, drive, perform safety sensitive jobs -Also have analgesic properties |
| Muscle relaxers general cont... | -Limited efficacy with chronic P!, best with acute P! -No studies that support their long term use -Long term use does not improve functional recovery and may hinder function |
| Oral evidence for MND | -Psychotropic agents had mixed results -NSAIDs, had contradictory or limited evidence effectiveness -Muscle relaxants, analgesics, and NSAIDs had limited evidence and unclear benefits |
| Importance to PT | -Taking orthopedic meds is not a license for the pt to over do it or for you to be overly aggressive -Few and rare situations exist where pts will not improve with proper activity modification, treatment, and the taking of meds as directed |
| Prolotherapy injections | -Sclerosing agent -Purposed to stabilize jts -Absence or inconsistency in effectiveness for chronic LBP |
| Parkinsonism drugs | -Disease of the nasal ganglia with deficient dopamine -Dopamine= neurotransmitter that enables smooth movements -Characterized by a slow movement, rigidity, impaired balance, tremor -Come out with new drugs/regimes every year |
| What do Monoamine Oxidase Inhibitors do | -Reduce oxidative stress on neurons -Prevents break down of dopamine |
| MAOI-B's | -Selegiline= Eldepryl -Rasagiline= Azilect -Decrease symptoms by only 10% |
| Dopaminergics | -Replacement drug -Passes the blood-brain barrier unlike the actual dopamine itself -Levadopa= Sinemet, is the oldest one |
| Dopaminergics-L-dopa: Honeymoon period | -Dramatic improvements that are initially seen -Therapeutic window is only 5-7 yrs -Begins to wear off quicker and have rebound effects |
| Dopaminergics S&S | -N&V -Psychiatric problems -Orthostatic (postural) hypotension -Dyskinesias |
| Dopamine Agonists | -Also activate the dopamine receptors -Used only in moderate to advance cases who aren't responding to L-dopa -Bromocriptine= Parlodel -Pergolide= Permax |
| Anti-cholinergics | -Decreases tremors, but little to no effects on rigidity -May decrease memory along with dopaminergic side effects -Trihexyphenidyl= Artane -Beztropine= Cogentin |
| Anti-viral agents | -Dopaminergic & anti-cholinergic properties -Amantadine= (Symmertral) -Few side effects -Quicker tolerance develops with only moderate symptom improvement |
| Importance to PT | -PTs are seen for regular tune-ups as disease progresses and drugs lose effect -Do treatment when drugs are in effect (2-3 hr after taking) for best effort |
| Alzheimer's Disease Medications: Mild to moderate | -Breakdown of neurotrnsmitter -1994 -Tacrine (Cognex) FDA approved - 2006: Cholinesterase inhibitors to prevent break down of acetylcholine=neurotransm. -Galantamine= Razadyne, Reminyl -Reivastigmine= Exelon -Donepezil= Articept -Tacrine= Cognex |
| AD medication: Moderate to severe | -N-methyl D-aspartate (NMDA) antagonist which regulates glutamate -Glutamate is another neurotransmitter for memory and learning -Another is Memantine= Namenda |
| AD med S&S | -All drugs only slow down the progression of the disease -N&V, diarrhea, weight loss -Muscle weakness -Dizziness, HA, confusion |
| PT implications | -Drug interactions: NSAIDs and journaling |
| Psychiatric drugs | -Sedatives for insomnia -Anxiolytics -Antipsychotics -Antidepressants -Alzheimer's |
| Insomnia medications: Prescription | -Benzodiazepines- Schedule IV -Temazepam=Restoril -Triazolam= Halcion |
| Insomnia meds: OTC | -Non-barbituates and non=benzodiazepines -Diphenhydramine -Found in Sominex, Benadryl, Tylenol PM, etc. |
| Anxiolytics | -Nerve pills; minor tranquilizers -Benzodiazepines= used forminor imaging orsurgical procedures: -Alprazolam= Xanax -Chlordiazeposide= Librium -Midazolam= Versed |
| Anxiolytic others... | -Beta blockers -Diphenhydramine= Benadryl -Phenobarbitol- Schedule IV -Buspione=BuSpar |
Created by:
alovedaytn
Popular Physical Therapy sets