Unit 4: Intro to Pharmacology

Question 1

Why do occupational therapists need to understand basic pharmacology?

Answer 1

Understanding pharmacology and pharmacokinetics of chemicals (e.g. medications) offered to a patient is important in the management of eventual return to functional independence.

Ask yourself….

• What setting do you plan on working in? How do you think you will need to use pharmacology in those settings?
• Have you had any clinical experience where a therapist you were working with helped a patient with a pharmacological issue?
• Have you or a family member experienced any side effects or adverse reactions to a medication?
• How do you see medication reactions impacting your role as a therapist or your ability to engage a client in a desired therapeutic activity or intervention?

Question 2

Chemical Name (Drug Nomenclature)

Answer 2

Based on structure of the compound

-Ex: N-(4-hydroxyphenyl) acetamide

Question 3

Generic Name (Drug Nomenclature)

Answer 3

Official or nonproprietary name
-Use in scientific journals and on prescriptions
-Ex. Acetaminophen
-Trade (brand) name- Name given when the patent expires, same generic drug may have several trade names
Tylenol

Question 4

Trade (brand) Name (Drug Nomenclature)

Answer 4

Name given when the patent expires, same generic drug may have several trade names
-Ex. Tylenol

Question 5

Drug Development

Answer 5

-Preclinical Studies (Animal)
-The FDA approves the investigational new drug & human clinical studies begin
-Clinical Studies
Phase 1: Safety Assessment
Phase 2: Drug Effectiveness Study
Phase 3: Large trials, often RCT
Phase 4: Drug is approved for public use

Question 6

Pharmacodynamics:

Answer 6

How does the drug affect the body?

Question 7

Dose-Response Relationship (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 7

• The relationship between the drug concentration and the effect
• Are there any unwanted side effects or indication of improper dosage?

Question 8

7 Main Drug Actions (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 8

• Stimulating action
• Depressing action
• Blocking/Antagonizing
• Stabilizing Action
• Exchanging/replacing substances or accumulating them to form reserve
• Direct beneficial chemical reaction: Free radical scavenging
• Direct harmful chemical reaction: Induced toxic or lethal damage

Question 9

Melinda is a home health occupational therapist. Her client is a 70 year old male, Sean, who was discharged home from the hospital after an acute exacerbation of his congestive heart failure. While in the hospital, Sean’s cardiologist prescribes Metoprolol, a beta-blocker often used to reduce blood pressure. Melinda noticed that since getting home, Sean’s blood pressure has been dropping very low, and he occasionally gets dizzy during activity. She calls the doctor to inform him that Sean is having unpleasant and potentially dangerous side effects of his new medication.
(Pharmacodynamics: A Case Example)

Answer 9

Pharmacodynamic implication: Beta blockers work by blocking the effects of epinephrine. They cause the heart to beat more slowly and with less force, thereby reducing blood pressure. Sean may have too high of a dosage resulting in low heart rate and hypotension.

Question 10

The role of OT in medication management

Answer 10

1. Be an active part of the interdisciplinary care team
2. Include medication management as part of the evaluation and plan of care.
3. Education & Advocacy

Question 11

Pharmacokinetics:

Answer 11

How does the body effect the drug? The movement of a drug throughout the body.

Question 12

Administration Mode (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 12

How does the body break the drug up?

Question 13

Distribution (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 13

How is the drug distributed throughout the body?

Question 14

Metabolism & Absorption (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 14

Where is the drug metabolized in the body?

Question 15

Excretion (The Basics: Pharmacodynamics and Pharmacokinetics)

Answer 15

Where is the excess processed out of the body?

Question 16

Melinda has another client, Margaret, who was diagnosed with Diabetes type 2 a few years ago. She normally manages her diabetes well; however, her blood sugar levels have not been well controlled over the past week. Margaret takes extended-release metformin for her diabetes. Melinda recently found out that Margaret has started opening her extended-release capsules and pouring the content into her morning juice because she doesn’t like taking pills.
(Pharmacokinetics: A Case Example)

Answer 16

Pharmacodynamic implication: By opening the extended-release capsule and consuming the contents directly, Margaret is changing the mode of administration. Her body is breaking up the drug differently than if it were introduced in a capsule.

Question 17

What happens when the drug is not taken properly or the client factors change?

Answer 17

Adverse Drug Reaction

Question 18

Adverse Drug Reaction

Answer 18

Unexpected or dangerous reaction to a drug or an unwanted effect caused by the administration of drug.

This can occur due to
medication non-adherence.
a change in patient status or client factors that impact the effect of the drug on the body.
physiologic changes due to disease, aging, the introduction of other drugs, or weight gain or loss.

Clinical examples:
The combination of Xarelto & NSAIDs can increase the risk of internal bleeding.
An article from Pai & Bearden (2007) found that some antibiotics did not work as well on obese clients.

Question 19

Medication adherence is important for many reasons:

Answer 19

1. Adhering to proper medication avoids adverse drug reactions.
2. Proper adherence insures the drug is working effectively.
3. Medication adherence reduced risk of medical relapse or readmission to the hospital.
4. It establishes a healthier baseline and allows the client to return to his/her normal daily routines.

Question 20

Client factors (Common reasons for non-adherence & increased risk of adverse drug reactions)

Answer 20

Cognitive or physical status of the patient.

Comorbidities that are unknown or may not have been communicated to the MD.

Question 21

Financial Limitations (Common reasons for non-adherence & increased risk of adverse drug reactions)

Answer 21

Clients are not able to afford medication.

Question 22

Medication Packaging (Common reasons for non-adherence & increased risk of adverse drug reactions)

Answer 22

Not being able to read labels or open containers.

Question 23

Health literacy & the healthcare system (Common reasons for non-adherence & increased risk of adverse drug reactions)

Answer 23

Poor communication between physician and patient or the patient does not understand the instructions.

Question 24

Polypharmacy (Common reasons for non-adherence & increased risk of adverse drug reactions)

Answer 24

Error in medication adherence occurs when clients have to manage multiple medications.

Question 25

Polypharmacy and Adverse Drug Reactions

Answer 25

-72% of people 55 yrs or older take at least one drug
In this age group, 20% take more than 4 drugs (Ziere et al, 2006)
-2/3 of all adverse drug related hospitalizations occur in the 60 and over population.
-Why is this happening? How can OTs help?

Question 26

1. Be an active part of the interdisciplinary care team (The role of OT in medication management)

Answer 26

• Monitor the client response to medication including biometric monitoring.
• Educate the team on the functional impact of polypharmacy.
• Evaluate fall risk & communicate with the team.
• Assist with medication reconciliation, which should occur at least every 6 months.

Question 27

2. Include medication management as part of the evaluation and plan of care.
   (The role of OT in medication management)

Answer 27

• Evaluate and treat client factors that may impact medication adherence: Cognition, fine motor coordination, etc.
• Provide recommendations for adaptive equipment as needed: Easy open bottles/assistive devices to open bottles, Medication sorters/pill boxes
• Assist the client in developing a medication schedule or routine.

Question 28

3. Education & Advocacy (The role of OT in medication management)

Answer 28

• Educate the patient about the national poison control hotline which can be used in case they take the wrong medication: Making this phone number and their primary care physician’s number easily accessible
• Educate the patient on modes of administration, when to take medications, what the medication does, and the potential side effects.
• Advocate for the patient: Unwanted side effects may be avoided with change of medication or conversation with the MD.