Midterm Review Flashcards
PT Role in Pharmacology = ?
a) Physical Therapist can administer and store medication to facilitate outcomes.
- Physical Therapist cannot prescribe any medications, even OTC
- Know how medications can help in our treatments
b) Need to know medication interactions
- Review medications at evaluation
Pharmacokinetics
Absorption = ?
- Drugs transferred from administration to systemic circulation
- Various types of administration
- Bioavailability is dependent on how much medication is degraded before circulation
Pharmacokinetics
Distribution = ?
- Drug is distributed to target tissue
- Determines how much drug is available at the site
Pharmacokinetics
Metabolism = ?
Drug is broken down
Pharmacokinetics
Elimination / Excretion = ?
Drug is removed from body
Pharmacodynamics = ?
a) Drugs affect on the tissue
b) Mechanism of Action
- Ion channel to alter permeability
- Enzyme influence
- Regulatory proteins
Dose Response
- Toxicity = ?
- Half Life = ?
Dose Response: Dose only has a certain beneficial range
- Has to be high enough to get past threshold
- Too high and it hits the ceiling
- Toxicity
- Too high of dose leads to toxicity
- Therapeutic Index is the range between beneficial and toxic
- Higher the TI, the safer the drug
- Half Life
- Part of drug elimination
- Amount of time 50% of drug in body for elimination (i.e. half life = 2 hours for 4000mg dose)
Factors Affecting Pharmacotherapeutics
- age
- chronic disease
- exercise
Adverse Drug Reactions
- ADR: unintened effect of the medications
- ADE: events that can go wrong with a drugs administration (prescribing, dosing, etc.)
- Side effect: expected reaction to a medication
- Toxicity: high dose issues
Opioid Analgesics
- Types = ?
- Mechanism of Action = ?
- Adverse Effects = ?
Opioid Analgesics
- Types
- Strong Agonists = Severe pain
- Mild-to-Moderate Agonists = Moderate pain
- Mixed Agonist-Antagonist = Strong-moderate pain
- Antagonists = Overdose and addiction
- Mechanism of Action
- Spinal Effects = Decrease pain-mediating transmitters
- Supraspinal Effects = Disinhibition of descending pain pathways
- Peripheral Effects = Decrease excitability of sensory neurons
- Adverse Effects
- Drowsiness, Sedation, Respiratory distress
- Addiction, Withdrawal
- ADR: falls, cognitive impairments, shortness of breath
NSAIDS (Non-Opioids)
- Purpose = ?
- Mechanism of Action = ?
- Adverse Effects = ?
NSAIDS (Non-Opioids)
- Purpose
- Decrease inflammation
- Mild-to-moderate pain relief
- Decrease elevated body temperature
- Decrease blood clotting
- Mechanism of Action
- Inhibits prostaglandin and thromboxane synthesis
- Mediates painful stimuli
- Reduces release of inflammatory markers
- Adverse Effects
- GI problems - Avoid extended NSAID use
- Cardiovascular - Increase BP and risk of CV event
- Muscle - Reduces muscle regeneration
- Reye Syndrome - Don’t use aspirin for children
Anesthetic Agents
- Types = ?
- Mechanism of Action = ?
- Rehab Considerations = ?
- Types
- General - Inhaled or IV
- Local - Injection, Topical
- Regional - Spinal anesthesia
- Mechanism of Action
- Used with general anesthesia
- Avoid muscle spasms
- Rehab Considerations
- Confusion, delirium
- Persistent muscle weakness
- Bronchial secretions
- Potential use of patches for local anesthesia
Rheumatoid Arthritis
- NSAIDS
- Glucocorticoids
- DMARDs
- NSAIDS
- Decrease Joint Inflammation and added pain relief
- Concern for stomach irritation with chronic use
- Glucocorticoids
- Decrease joint inflammation and pain
- Catabolic effects can cause damage to muscles, bone, and other tissues
- DMARDs
- Delay disease progression
- Common drug of choice for RA and cancer
- Methotrexate, Chloroquine, Hyroxychloroquine
Osteoarthritis
- NSAIDS and Tylenol = ?
- DMOADs = ?
- NSAIDS and Tylenol
- Pain management
- Maintain Active Lifestyle
- DMOADs
- Restores lubricating properties of synovial fluid through injection (Hyaluronic Acid)
- Protect articular cartilage and slow degradation (Glucosamine, Chondroitin Sulfate)
Skeletal Muscle Relaxants:
- Antispasm = ?
Diazepam
- Benzodiazepine
- Increases GABA-induced inhibition
Centrally Acting Antispasm Drugs
- Decrease reflex to cause relaxation
- Cyclobenzaprine, Metaxalone, Methocarbamol
Adverse Effects
- Sedation
Skeletal Muscle Relaxants:
- Antispasticity = ?
Baclofen
- Oral, Intrathecal
- Increases GABA-induced inhibition
Dantrolene Sodium (Dantrium)
- Inhibition of calcium channel opening for severe spasticity
Gabapentin
- Inhibition of calcium into nerve terminals
- Common for neuropathic pain
Tizanidine (Zanaflex)
- Decreases release of excitatory neurotransmitters
Sedative-Hypnotics = ?
Benzodiazepines
- Increases inhibitory effects of GABA
Non-benzodiazepines
- Barbiturates
- Sedative-Hypnotics
- Melatonin
- Alcohol
Adverse Effects
- Prolonged sedative effects and drowsiness
Antipsychotics
- Mechanism of Action
- Antagonists for dopamine receptors (Traditional)
- Antagonists for specific serotonin receptors (Atypical)
- Examples
- Traditional (First-Generation) = Chlorpormazine (Thorazine), Loxapine (Loxitane), Thiothixene (Navane)
- Atypical (Second Generation) = Aripiprazole (Abilify), Queitiapine (Seroquel), Risperidone (Risperdal)
- Adverse Effects
- Movement disorders from blocking dopamine - Tardive dyskinesia, pseudo parkinsonism, akathisia, dyskinesia, and dystonia
- Other effects - Sedation, anticholinergic, orthostatic hypotension, weight gain, increased T2DM risk
Antiepileptics
- Increase Activity of CNS inhibitory neurons
- Barbiturates, benzodiazepines
- Tiagabine, Vigabatrin
- Decrease the CNS excitatory neurons
- Gabapentin, Levetiracetam, Pregabalin
- Decrease Na+ entry
- Stabilize opening and closing of sodium channels
- Hydantoins, Valproates, Rufinamide
- Decrease calcium channel entry
- Succinimides
Antianxiety
Benzodiazepines
- Increases inhibitory effects of GABA
- Diazepam is primary used
- Others: Alprazolam (Xanax), Lorazepam (Ativan)
Buspirone
- Increase serotonin in brain
- Less sedation effects, but only moderate effects compared to benzos
B-blockers
* Cardiovascular medications that would treat symptoms of anxiety
- Decrease sympathetic nervous system activity
- Atenolol, Metoprolol, Propranolol
Antidepression
Parkinson’s Disease
Alzheimer’s Disease
Multiple Sclerosis
