Unit 2 Pharmacology in orthopedics

Question 1

how can PT effect pharmacokinetics?

Answer 1

exercise depending on the intensity, mode, and duration can affect bioavailability, absorption, and elimination

Question 2

how does physical agents and manual therapy affect pharmacokinetics?

Answer 2

can affect drug dispersion through blood flow changes

Question 3

what are opioid analgesics used for? and how do they work?

Answer 3

relief of moderate to severe pain
they act on CNS receptors in the spinal cord and brain to reduce transmission of pain receptor signals (receptors: Mu, kappa, delta, sigma receptors)

Question 4

what effects do opioid analgesics have that we should take caution of?

Answer 4

they increase threshold for noxious stimuli (pain signal), cause sedation, respiratory depression, bradycardia, orthostatic hypertension, and cardiac/respiratory arrest
they have a high risk of dependency, tolerance and abuse

Question 5

what are some side effects of opioid analgesics?

Answer 5

nausea, constipation, itching, sphincter spasm, urinary retention, loss of libido, and withdrawal aches and pains

Question 6

what are the four categories of opioid analgesics?

Answer 6

strong agonists, mild-mod agonists, mixed agonist-antagonist, and antagonists

Question 7

what is the most powerful and most addictive type of opioids?

Answer 7

strong agonists

Question 8

which type of opioids have less severe side effects and less risk of addiction but may not be as effective?

Answer 8

mixed agonist-antagonists

Question 9

which type of opioids are used to block opioid receptors and reverse the effects of opioid use?

Answer 9

antagonists

Question 10

what are some signs of opioid dependence?

Answer 10

mood/psychological, behavioral, and physical symptoms

Question 11

what are NSAIDs? and what are they used for?

Answer 11

nonsteroidal anti-inflammatory drugs
acute and chronic MSK disorders; to relieve mild-moderate pain

Question 12

how do NSAIDs work?

Answer 12

they block prostaglandins to decrease inflammation by inhibiting cyclo-oxygenase (COX) and PG synthase enzymes

Question 13

what are the differences between COX-1 and COX-2 effects?

Answer 13

COX-1(+): normal constituent of cells in homeostasis, GO mucoprotection, regulate normal platelet activity, renal and vascular homeostasis, uterine function, embryo implantation, regulation of sleep-wake cycle and body temperature

COX-2(-): produced by injured cells. produces prostaglandins that mediate pain, inflammation, pyresis. vasodilation and inhibition of platelet aggregation, modulation of platelet aggregation

Question 14

what are the 2 types of NSAIDs? and what is the difference?

Answer 14

non-selective: COX-1 and COX-2 inhibitors
selective: only COX-2 inhibitors

Question 15

what is acetylsalicylic acid? and how does it work?

Answer 15

(aspirin) the prototypical NSAID
widely used analgesic, anti-inflammatory, antipyretic
inhibits platelet aggregation, prolonging clot time (8 days)

Question 16

what are some adverse effects of NSAIDs?

Answer 16

gastric irritation, renal dysfunction, skin reactions, bleeding/bruising, liver disorders and bone marrow depression especially in elderly, perinatal effects, headache, dizzy, lightheaded, tinnitus-toxicity (aspirin)

Question 17

what are the risk factors for adverse effects of NSAIDs?

Answer 17

female, >85y, smoking, EtOH abuse, history of peptic ulcer, Gi bleeding, concomitant use of multiple antithrombotic agents, concomitant use of other NSAIDs or steroid agents, hypovolemic states, renal impairment due to age, atherosclerosis, hypertensive renal disease, or other intrinsic renal disease

Question 18

what is acetaminophen?

Answer 18

(tylenol)
analgesic, anti-pyretic but not an anti-inflammatory

Question 19

what can over-ingestion of acetaminophen lead to?

Answer 19

liver damage

Question 20

what is efficacy?

Answer 20

the ability to achieve desired response

Question 21

what is potency? high vs. low?

Answer 21

the relationship of dose to response
high: low dose required for desired response
low: high dose required for desired response

Question 22

for an OTC NSAID to have full anti-inflammatory effects they have to be in:

Answer 22

steady state (amount taken = amount eliminated

Question 23

what is the half life of a drug?

Answer 23

how much time it takes to get rid of half the medication within the blood stream

Question 24

what are corticosteroids? what do they do? what are they used for?

Answer 24

natural hormones produced by adrenal glands under control of hypothalamus
they maintain fluid and electrolyte balance
treat immunological and inflammatory MSK conditions

Question 25

what is one complication of excess use of corticosteroids? what are some signs and symptoms of this?

Answer 25

Cushing’s syndrome
delayed healing, K+ deficiency, myopathy and osteoporosis, hyperglycemia, ophthalmic, growth suppression

Question 26

what is the efficacy of corticosteroid injections?

Answer 26

low to medium
modest benefit
16-point reduction in pain on 100-point scale for one month
low price compared to surgery

Question 27

what are DMARDs? what are they used for? what do they do?

Answer 27

disease specific modifying drugs
rheumatic diseases (auto-immune)
inhibit the immune system

Question 28

DMARDs are relatively ___ and relatively ___.

Answer 28

selective; toxic

Question 29

what are local anesthetics used for? how do they work?

Answer 29

block peripheral nerve transporting the pain signal
cause local loss of sensation by blocking NA+ channels causing no action potential propagation

Question 30

local anesthetics have greater effect on ___ and lesser effect on ___.

Answer 30

small nerves (sensation/pain); larger nerves (motor)

Question 31

what should we look out for in pts using local anesthetics?

Answer 31

pts will lose protective sensory function and possibly motor impairments

Question 32

what are the side effects of neuropathic pain agents?

Answer 32

dizziness, ataxia, imbalance

Question 33

what is a muscle relaxer/antispasmodic agent used for?

Answer 33

reducing muscle guarding and spasm due to MSK injury
acute injuries (MVA, slip and fall)

Question 34

what are the side effects of muscle relaxers?

Answer 34

they produce sedation, drowsiness, weakness, and lethargy (make people non-functional)

Question 35

what should you be cautious of when a pt is on anticoagulants and thrombolytics?

Answer 35

increased risk of bleeding/bruising
caution with manual therapy

Question 36

what are the affects of hyperlipidemia meds?

Answer 36

myalgias, myositis, weakness, paresthesia
mimics MSK conditions

Question 37

how can cardiac medications affect PT care?

Answer 37

cause suppression of normal HR and BP response to exercise

Question 38

what type of diabetes are anti-diabetic medications used for? how do they work?

Answer 38

type 2
they lower blood glucose levels by facilitating insulin secretion, improving tissue insulin sensitivity, alter glucose uptake in digestion, and increase glucose excretion

Question 39

what type of diabetes is synthetic insulin used for?

Answer 39

type 1

Question 40

what are some signs of hypoglycemia? what should you do if someone presents with these?

Answer 40

sweating, shakiness, irritability, confusion, tachycardia, hunger
if severe: arrythmias, ischemia, cognitive disfunction, seizure, coma and death
always give glucose (4ox of OJ or 6 jelly beans) hyperglycemia is not as bad as hypoglycemia

Question 41

what effects may antidepressants have on PT care?

Answer 41

time lag to effects
increase depression during the start of initial medication
mood changes

Question 42

what effects may antianxiety medications have on PT care?

Answer 42

may cause sedation