Unit 4: Common Medications Flashcards
Sedative-hypnotic and anti-anxiety agents
- Used to relax the patient, reduce anxiety, and promote sleep.
- Sedative drugs promote a calming effect but do have a risk for drowsiness at a higher dose.
- Fall into two categories: barbiturates and benzodiazepines.
- Benzodiazepines are currently the drug of choice.
- On a physiological level, they reduce general excitation levels of the reticular activating system and enhance relaxation and sleep.
- Prolonged use of these drugs may cause dependency or tolerance.
- Additionally, there may be complaints of residual fatigue and drowsiness the next day.
- Administration of these drugs prior to therapy may result in drowsiness or increase risk of falls in certain populations.
Drugs used to treat affective disorders (depression & manic depression)
There are many factors that contribute to the cause of depression. On a neurochemical level, research shows depression can be the result of the interaction between several chemicals including norepinephrine, serotonin, and dopamine.
- Current drug therapy focuses on modifying the receptors for these common neurotransmitters.
- Common antidepressant drugs include tricyclics, second-generation drugs, and MOA inhibitors.
- In the past, tricyclics such as amoxapine and doxepin were the most commonly used antidepressants.
- However, these drugs are often associated with complex side effects such as sedation and lethargy.
- Currently, second-generation drugs are now more commonly being prescribed.
- Includes: common drugs such as Celexa, Prozak, and Zoloft.
- Certain second-generation antidepressants are referred to as selective serotonin reuptake inhibitors (SSRIs).
- These drugs are unique because they selectively block the reuptake of serotonin, leaving more in the synaptic cleft.
- They are also often tolerated relatively well by patients with less intense side effects.
- MAO inhibitors are not typically the drug of choice for depression but can be a good choice when tricyclics and second-generation antidepressants fail to work.
- It is important to remember that some clients may not feel the effects of antidepressants for about a month.
- It is also important to be aware of signs and symptoms that the patient may be becoming more depressed or suicidal during this time.
Drugs used to treat bipolar disorder
-Associated with mood swings from one extreme to another, including episodes of mania and depression.
One theory about the etiology of bipolar disorder is that genetic and environmental factors influence the level of norepinephrine and serotonin in the brain.
-An increase in neurotransmitter activity is thought to be responsible for euphoric or manic behavior. Then, as the pendulum swings the other way, a period of depression follows.
-Treatment focuses on preventing manic episodes using “antimanic drugs.”
-Lithium is most commonly used to stabilize neuronal excitability, decrease sensitivity of postsynaptic receptors, and stabilize mood.
-Unfortunately, side effects are common with the use of lithium because the drug is not metabolized and can accumulate in the body.
-Side effects can include nausea, diarrhea, tremors, dysarthria, hallucinations, and increased muscle tone.
Antipsychotic drugs
- Trear different types of psychosis involving thought disturbance and impaired perception of reality.
- Psychosis is common in conditions such as schizophrenia.
- Most current research indicates that schizophrenia may be caused by overactive dopaminergic pathways.
- Antipsychotic drugs typically work by blocking central dopamine receptors.
- Some adverse effects associated with the use of these drugs include abnormal movement patterns including acute dystonic reactions, akathisia, and tardive dyskinesia.
- The benefits of these drugs must be weighed against the risks and side effects.
- Therapists who work with individuals taking antipsychotic drugs should be on the lookout for early symptoms of motor disturbances.
General Anesthetics
General and local anesthetic drugs have been used over the past century to allow for safe and more effective surgical procedures. General anesthesia results in the patient being unconscious and is typically used for more extensive surgical procedures. In addition to loss of consciousness, general anesthesia has rapid onset and results in amnesia (i.e. no recollection of what occurred during surgery), skeletal muscle relaxation, and inhibition of reflexes. Local anesthetics are typically needed for a smaller, more defined area and are given to a patient when they are to remain conscious during surgery. As therapists, it is important to understand what anesthetics were used with a patient and recognize residual effects that may occur such as drowsiness or physiological changes. Anesthesia can be administered via inhalation or intravenously. As rehabilitation professionals, it is important to recognize the effects of general anesthesia that still may be present the day after surgery or while working with someone in the critical care unit. These effects include potential muscle weakness, confusion, or delirium.
Skeletal Muscle Relaxants
- Used to treat conditions associated with spasticity and muscle spasms, which result from hyperexcitable skeletal muscle.
- Spasticity is characterized by an exaggerated muscle stretch and abnormal reflex, which is typically velocity dependent (a rapid lengthening of the muscle results in a strong contraction)
- Muscle spasms are increased tension typically after injury or inflammation.
- This is involuntary, and the patient is unable to relax the muscle.
- Common drugs: baclofen and gabapentin.
- Botox can be used for both spasticity and muscle spasms.
- Diazepam is also used for muscle spasms.
- These drugs can aid with the therapy process nicely by allowing for muscle relaxation prior to therapy.
- Negative side effects may include fatigue or sedation.
Opioid Analgesics & Patient
- Primarily used for pain relief of moderate to severe pain.
- Non-opioid drugs are also used for pain relief and include: over the counter acetaminophen and aspirin, among others.
- Opioids work by binding to specific neuronal receptors that are located primarily in the central nervous system.
- Controlled substance in the United States due to their high potential for physical dependency and addiction.
- Common opioids include: morphine, fentanyl, codeine, oxycodone, and hydrocodone.
- Often administered orally, however, they can also be administered via Patient-Controlled Analgesia (PCA).
- Patient-controlled analgesia allows the patient to self-administer small doses of a drug in frequent intervals in order to provide pain relief.
- Drugs are typically delivered intravenously or into the spinal canal with a pump that is controlled by the patient.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as aspirin, ibuprofen, and naproxen, have four innate properties.
These include
1) the ability to decrease inflammation
2) the ability to relieve mild to moderate pain
3) the ability to decrease elevated body temperature
4) the ability to decrease clotting.
These drugs are commonly used and often taken for pain management.
Aspirin and other NSAIDs can cause toxic side effects if used improperly, paired with other drugs metabolized in the same manner, or if taken by a client who has a contraindicated pre-existing condition
Beta-Blockers
Work directly to influence the beta-1 receptors that are located in the heart.
- When stimulated, these receptors work to increased cardiac contractility and rate of contraction (heart rate).
- Beta-Blockers work to block these receptors and therefore reduce cardiac workload.
- Typically used with individuals who have abnormal cardiac arrhythmias, hypertension, or to limit the extent of damage after heart attack.
- Additionally, some research shows that beta-blockers can be used to improve cardiac function in certain types of heart failure.
- From a rehabilitation perspective, it is important to recognize that individuals who are taking beta-blockers may not have a typically heart rate or pressure response to activity due to medication impacting cardiac response.
- Other methods of activity monitoring may be beneficial for these clients, such as identification of their perceived rate of exertion, respiratory rate, or fatigue level.
Antihypertensive Drugs
One of the most common diseases affecting adults in the United States.
- Medications can be used to manage sustained hypertension and decrease risk for stroke and heart failure.
- In general, blood pressure is the product of cardiac output and the total resistance of the peripheral vasculature.
- Therefore, antihypertensive drugs work to influence one (or both) of these factors.
Various categories of drugs exist for the treatment of essential hypertension.
- Diuretics are typically the first type of drugs used.
- Diuretics increase the production and excretion of urine and therefore reduce the volume of fluid within the vascular system, reducing the load on the heart and therefore reducing blood pressure.
- Fluid depletion, electrolyte imbalance, or orthostatic hypotension may occur with the use of this drug.
Anticoagulants
Blood coagulation is a necessary part of the healing process in order to prevent excessive hemorrhaging from damaged blood vessels.
- Normally, clotting factors in the bloodstream interact with the damaged blood vessels to create a clot that stops bleeding.
- However, excessive and abnormal clotting can occur with certain medical conditions, prolonged bed rest, or when blood flow is partially occluded (i.e. coronary atherosclerosis).
- The abnormal formation of blood clots is called thrombogenesis.
- This can be dangerous as the thrombi can occlude blood flow in a vessel or dislodge creating an embolism which is a clot that travels elsewhere in the body and occludes blood flow in another area, such as the lungs or brain.
- Anticoagulants work to normalize clotting factors in the blood and prevent the formation of thrombi or facilitate the removal of previously formed clots.
- Many patients treated in therapy have problems relating directly to clot formation.
- This includes individuals with ischemic strokes, myocardial infarction, and pulmonary embolisms. Heparin and warfarin are both commonly used anticoagulants.
- Hemorrhaging is the primary and most serious problem observed with clients taking anticoagulants.
Antibiotics
Bacteria depend on the invasion of external structures (such as amino acids and sugars in human tissue) to maintain function.
- Bacteria can multiply, competing with the host cells for essential nutrients or directly harming human cells by releasing toxins.
- There are different antibacterial agents used to fight against different types of bacteria.
- Drugs typically fall into two categories: antibiotics that kill or destroy bacteria (bactericidal) and antibiotics that do not kill bacteria but instead limit the growth of the bacteria (bacteriostatic).
- Antibiotics must be selectively toxic to the microorganism and not harm the surrounding tissue (they enter the system and seek out the bacteria specifically)
- Risk associated with antibiotics include:
1) hypersensitivity and potential for allergic reaction (specifically noted with Penicillins)
2) resistance. - The development of antibiotic resistance is a serious problem in health care today.
- Many antibiotic resistant diseases exist, including MRSA (methicillin-resistant S. aureus), which is seen commonly in the hospital setting.
- To prevent resistance antibiotic drugs should be used judiciously and taken with adherence to frequency and dose.
