Lecture Pharmacology Flashcards
define: pharmacoprophylaxis
use of drugs to prevent disease, or slow the course of a disease
define Pharmacodiagnostics
pre-treatment testing to determine patient response to a drug therapy
define pharmacokinetics
how the body deals with a drug in terms of the way it is administered, absorbed, distributed, and eliminated
define pharmacodynamics
what a drug does to the body, including the mechanism by which it exerts its effect
define toxicology
the study of the harmful effects of drugs (incl. medication, toxins & poisons)
what are 3 classifications of drug naming?
chemical, brand/trade, generic
describe the dose response curve
Threshold dose - dose at which the response begins to occur
Potency - dose required to produce a given response
Maximal efficacy or Peak response – maximum amplitude of response (coincides with ceiling effect)
Ceiling effect – plateau effect in the curve, indicating that no further response occurs beyond the given dose
describe administration types (pharmacokinetics) - advantages and disadvantages
Enteral administration means that drug enters the body via the alimentary canal.
Parenteral administration means that the drug enters the body through non-alimentary routes.
First-pass inactivation means that the drug entering the enteral route will be metabolized by the liver before reaching its target site. Thus dosage must be adjusted to ensure adequate amount of drug reach the tissue after being partially metabolized by the liver.
describe bioavailability
The bioavailability of a drug is the extent to which the drug reaches the systemic circulation, and is expressed as a percentage of the drug administered that reaches the bloodstream. For example, for a 100mg dose, if 50mg eventually reaches the bloodstream, that drug is said to be 50% bioavailable.
what does bioavailability depend on and what are the 4 ways it can occur?
explain drug distribution
explain drug storage
describe pharmacokinetic elimitation
describe pharmacokinetic elimination rate
describe individual drug responses
describe drug receptors
NSAIDs - what it does, properties, and adverse effects
- inhibits COX (1 and 2) enxymes, except for COX-2 selective NSAIDs which inhibits only COX2
four general properties:
Anti-inflammatory - reduce inflammation
Analgesic - reduce mild to moderate pain
Antipyretic - reduce elevated body °T (fever)
Anticoagulant - reduce blood clotting (platelet aggregation) **COX-2 selective NSAID doesn’t do this
primary adverse effects of this family of NSAIDs are:
Gastrointestinal damage
High dose: liver damage
Renal problems in patients with impaired renal function
Reye syndrome in children
NSAIDs guidelines for musculoskeletal injuries
- interferes with normal inflammatory response and therefore should avoid use within first 48 hours post-injury (avoid use over 5 days)
- not more effective than simple analgesic (tylenol)
- NOT recomended for DOMS (use simple analgesic instead)
NSAIDs implication for rehab
- therapy sessions can be conducted but use caution
- ask when drug last taken when doing therapy with client
- don’t push too much
acetaminophen implications for rehab
- therapy sessions can be conducted but use caution
- ask when drug last taken when doing therapy with client
- don’t push too much
acetamenophen - properties and adverse effects
properties:
Analgesic - reduce mild to moderate pain
Antipyretic - reduce elevated body °T (fever)
The main risk of Acetaminophen is liver toxicity, but this is only a concern if taken at excessively high dosage, or for prolonged period of time (see bottle for directions). This does, however, mean that Acetaminophen is NOT indicated for patients with pre-existing liver problems.
glucocorticosteroids - implications for MSK rehab
- helps with symptoms but does not releive cause (cortisone shot)
- often told to do physio 3-7 days after injection (not right away!)
- avoid direct weight on joint right after injection
*note there is an injection for frozen shoulder which is a different form of injection and should be moved right away
glucocorticosteroid properties and adverse effects
- powerful anti-imflammatory properties
- immunosuppresive effect (used therapeutically in rheumatologic conditions)
side effects: - note never the first line of treatment
Post-injection “flare” (injection); a short-term worsening of signs and symptoms
Inhibition of collagen synthesis (impaired healing)
Infection (injection)
Avascular necrosis of femoral head (oral)
opiod analgesics - properties and side effects
properties: Treatment of moderate to severe pain, Anesthesia, Cough suppression, treatment for overdose/addiction
side effects:
Respiratory depression
Sedation/ confusion/ dizziness
Nausea & vomiting
Constipation
Hypotension
*risk of developing drug tolerance, dependence or addiction
describe the opiod analgesic administration process
- orally is more varied than with PCA
- initial does is large (loading dose) with subsequenct smaller doses (demand dose), lockout interval to prevent OD, monitor successful vs total demand (how many times button pushed vs how many times delivered), could also have a background (constant) infusion rate
opiood analgesics - implications for rehab
treatment possible but note these meds may cause:
–Sedation
–Hypotension
–GI discomfort and constipation
–Blunted respiratory response to exercise
–Withdrawal Sx may mimic MSK problem
skeletal muscle relaxants - use and side effects
use: to treat muscle spasm, purpose to decrease muscle tone
side effect: drowsiness and dizziness (from cns sedation)
skeletal muscle relaxants - implications for rehab
- schecule therapy for when sedative effects are at their lowest
- during treatment work on improving posture, mody mechanics, ms strength, and flexbility
general anesthetics - properties and adverse effects
use: for sedation for extensive surgical procedures, produce a progressive, reversible CNS depression (loss of consciousness and sensation, amnesia, skeletal muscle relaxation, and inhibition of sensory and autonomic reflexes)
adverse effects: sedation, confusion, muscle weakness (ataxia), respiratory compromise, hypotension
general anesthetics - implications for rehab
- monitor side effects (esp muscle weakness)
- effects should lessen with time, call physician if effects prolonged
local anesthetics - purpose and side effects
produce localize anesthesia (loss of sensation) and block afferent nerve transmission for surgical procedures
side effects: CNS (confusion, agitation, restlessness), CV (hypotension, bradycardia, reduced cardiac output)
local anesthetics - implications for rehab
–Loss of sensory feedback (tactile, proprioceptive)
–Possible motor impairment
–Be aware of impairment due to systemic distribution (refer to side effects)
–Non-life-threatening effects will ↓ with time
what is Hyaluronic acid therapy?
- 1-5 injections, adverse affects mostly just due to injection site, can last up to 6 months
- can be used as conservative measure before hip or knee replacement surgery
antihyprtensive drugs - implications for rehab
–Be alert during positional changes or env °T changes
–Provide a cool-down period following exercises
–Monitor BP & HR before exercise
–Monitor HR during aerobic activity, use RPE if pt is on Beta-blockers
–Allow ↑ time to complete aerobic activity to prevent dyspnea & account for depressed cardiac activity
–Have pt check glucose level prior to exercise if taking hypoglycemic drugs
antihypertensive drugs - side effects
–Orthostatic hypotension
–Bronchoconstriction, blunting early manifestations of hypoglycemia with Beta-blockers
–Diuretics can cause hypokalemia (low blood K+)
–Depression of HR and contractility
what are other drugs with similar side effects / consideration as antihypertensive drugs
Antithrombotic drugs - what they do, SE, and implications for rehab
Effect: inhibit clotting mechanism in blood
side effects: myalgia (muscle pain), arthralgia (joint pain), bleeding
Implications:
–Myalgia and arthralgia may ↓ function of pt during rehab
–Keep an eye on new bruises
–↑ bleeding may alter some wound care activities
Antihyperlipidemic drugs - what they do, SE, and implications for rehab
- lower lipid levels
SE: myalgia, arthralgia and ms weakness
implications:
–Function may be ↓ because of pain
–Needs to differentiate between pain from meds and pain associated with ex’s
Sedative-Hypnotic drugs - what they do, SE and implications
Anti-anxiety agents, Sleep disturbances
SE: Sedation, ↓ arousal or alertness, Motor control dysfunction
implications:
–Plan therapy session depending if drug is beneficial or non-beneficial for therapy
–Education about risks of fall especially in older adults
Antipsychotic drugs & lithium - what they do, SE, implications
Used to treat Schizophrenia, other psychoses or agitated states & bipolar disorders
SE: Sedation, Orthostatic hypotension, Bradykinesia, tremor, rigidity, Balance and posture problems
Implications for rehab:
–Be careful with positional changes
–Be aware of any changes in posture, balance or involuntary mvts
–Monitor psychosocial factors
Antidepressants - used for, SE, implications
- mood improvement and to treat chronic pain
SE: Sedation, hypotension, Hypertensive crisis
Implications for rehab:
–Be careful with positional changes
–Monitor BP during exercise
–Monitor psychosocial factors
Drugs for thyroid dysfunction - use, SE, implications
Hypo or hyperthyroidism
SE: Exercise intolerance, Intolerance to temperature changes
Implications for rehab
–May have ↓ capacity for aerobic activities
Diabetic patients- medication, implications for rehab
use Insulin injections or Oral hypoglycemics
SE: Hypoglycemia (mainly from insulin), Nausea and vomiting, Weight gain, MI and heart failure
Implications for rehab:
–Watch for signs of hypoglycemia during therapy: Confusion, visual disturbances, seizures (uncommon), loss of consciousness (uncommon), heart palpitations, shakiness, anxiety, sweating, hunger, tingling sensation around the mouth
–Monitor blood glucose, blood pressure and HR prior to exercise
Antibacterial agents - side effects and implications for rehab
SE:
–Most common: hypersensitivity or allergic reactions and GI problems
–Many have drug interactions
–IV infusion of certain drugs may cause phlebitis
–Fluoroquinololes may cause tendonitis
–Inhibition of red blood cells, white blood cells, platelets
–Dizziness & vertigo
Implications:
–Do some research on drugs that pt is taking
–Be aware of signs of phlebitis (imflammed walls of veins)
–Avoid high intensity RT ex’s in pt taking fluoroquinololes (risk of tendon rupture)
Drugs for upper airway problems - SE and implications
rpe = rating of perceived exertion
