Unit 2 Pharmacology in orthopedics Flashcards
how can PT effect pharmacokinetics?
exercise depending on the intensity, mode, and duration can affect bioavailability, absorption, and elimination
how does physical agents and manual therapy affect pharmacokinetics?
can affect drug dispersion through blood flow changes
what are opioid analgesics used for? and how do they work?
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)
what effects do opioid analgesics have that we should take caution of?
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
what are some side effects of opioid analgesics?
nausea, constipation, itching, sphincter spasm, urinary retention, loss of libido, and withdrawal aches and pains
what are the four categories of opioid analgesics?
strong agonists, mild-mod agonists, mixed agonist-antagonist, and antagonists
what is the most powerful and most addictive type of opioids?
strong agonists
which type of opioids have less severe side effects and less risk of addiction but may not be as effective?
mixed agonist-antagonists
which type of opioids are used to block opioid receptors and reverse the effects of opioid use?
antagonists
what are some signs of opioid dependence?
mood/psychological, behavioral, and physical symptoms
what are NSAIDs? and what are they used for?
nonsteroidal anti-inflammatory drugs
acute and chronic MSK disorders; to relieve mild-moderate pain
how do NSAIDs work?
they block prostaglandins to decrease inflammation by inhibiting cyclo-oxygenase (COX) and PG synthase enzymes
what are the differences between COX-1 and COX-2 effects?
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
what are the 2 types of NSAIDs? and what is the difference?
non-selective: COX-1 and COX-2 inhibitors
selective: only COX-2 inhibitors
what is acetylsalicylic acid? and how does it work?
(aspirin) the prototypical NSAID
widely used analgesic, anti-inflammatory, antipyretic
inhibits platelet aggregation, prolonging clot time (8 days)
what are some adverse effects of NSAIDs?
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)
what are the risk factors for adverse effects of NSAIDs?
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
what is acetaminophen?
(tylenol)
analgesic, anti-pyretic but not an anti-inflammatory
what can over-ingestion of acetaminophen lead to?
liver damage
what is efficacy?
the ability to achieve desired response
what is potency? high vs. low?
the relationship of dose to response
high: low dose required for desired response
low: high dose required for desired response
for an OTC NSAID to have full anti-inflammatory effects they have to be in:
steady state (amount taken = amount eliminated
what is the half life of a drug?
how much time it takes to get rid of half the medication within the blood stream
what are corticosteroids? what do they do? what are they used for?
natural hormones produced by adrenal glands under control of hypothalamus
they maintain fluid and electrolyte balance
treat immunological and inflammatory MSK conditions
what is one complication of excess use of corticosteroids? what are some signs and symptoms of this?
Cushing’s syndrome
delayed healing, K+ deficiency, myopathy and osteoporosis, hyperglycemia, ophthalmic, growth suppression
what is the efficacy of corticosteroid injections?
low to medium
modest benefit
16-point reduction in pain on 100-point scale for one month
low price compared to surgery
what are DMARDs? what are they used for? what do they do?
disease specific modifying drugs
rheumatic diseases (auto-immune)
inhibit the immune system
DMARDs are relatively ___ and relatively ___.
selective; toxic
what are local anesthetics used for? how do they work?
block peripheral nerve transporting the pain signal
cause local loss of sensation by blocking NA+ channels causing no action potential propagation
local anesthetics have greater effect on ___ and lesser effect on ___.
small nerves (sensation/pain); larger nerves (motor)
what should we look out for in pts using local anesthetics?
pts will lose protective sensory function and possibly motor impairments
what are the side effects of neuropathic pain agents?
dizziness, ataxia, imbalance
what is a muscle relaxer/antispasmodic agent used for?
reducing muscle guarding and spasm due to MSK injury
acute injuries (MVA, slip and fall)
what are the side effects of muscle relaxers?
they produce sedation, drowsiness, weakness, and lethargy (make people non-functional)
what should you be cautious of when a pt is on anticoagulants and thrombolytics?
increased risk of bleeding/bruising
caution with manual therapy
what are the affects of hyperlipidemia meds?
myalgias, myositis, weakness, paresthesia
mimics MSK conditions
how can cardiac medications affect PT care?
cause suppression of normal HR and BP response to exercise
what type of diabetes are anti-diabetic medications used for? how do they work?
type 2
they lower blood glucose levels by facilitating insulin secretion, improving tissue insulin sensitivity, alter glucose uptake in digestion, and increase glucose excretion
what type of diabetes is synthetic insulin used for?
type 1
what are some signs of hypoglycemia? what should you do if someone presents with these?
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
what effects may antidepressants have on PT care?
time lag to effects
increase depression during the start of initial medication
mood changes
what effects may antianxiety medications have on PT care?
may cause sedation
