Pharmacology PDF Notes

Pharmacology Question of the day A patient with a known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self administers a nitroglycerine tablet to control the angina. Nitroglycerine helps to control this symptom by: a. Decreasing heart rate b. Inhibiti...

Pharmacology Question of the day A patient with a known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self administers a nitroglycerine tablet to control the angina. Nitroglycerine helps to control this symptom by: a. Decreasing heart rate b. Inhibiting vasospasm c. Dilating peripheral arteries and veins d. Decreasing platelet aggregation  The Basics Remember your PHYSIOLOGY when studying pharmacology (this will also help with understanding the side effects) Drugs are categorized medically by “classes” For study purposes, focus on the common suffixes Medication may be categorized as an agonist or antagonist Agonist: Alters the physiology of a cell by binding to plasma membrane or intracellular receptors. Typically increases a response secretion or a response by an organ Antagonist: inhibit or block responses caused by agonists  Routes of Drug Administration Oral (PO): by mouth, self-administered, absorption is affected by gastric motility Sublingual: Under the tongue, self- administered, not concerned about GI motility Rectal (PR): beneficial for unconcious or vomitting patients, small children Inhalation: rapid absorption, self- administration Topical: through the skin. For dermatologic, opthalmologic, nasal, vaginal and otic prescriptions Transdermal: delivered via “patch” applied to the skin. Buccal: Placing drugs between gum and cheek, dissolves and is absorbed into the blood Parenteral: around the GI tract: intravenous (IV), intramuscular (IM), subcutaneous (SubQ, SC) Bariatric Intervention Multi-system involvement Medical management is focused on CO-MORBIDITIES Goal: help assist patient throughout the weight loss process Function of the Sympathetic Nervous System  Function of the Parasympathetic Nervous System Sluggish heart beat Digestive tract hogs “Parasympathetic energy Pig” Increased secretions (drooling) Heavy breathing (bronchioles are constricted) Increased defecation and urination Pupils constricted Alpha Receptors: Review Alpha 1 Receptors: constriction of arterioles and veins, decreased secretion of glands, decreases GI motility, constricts radial muscle of eye Alpha 2 receptors: Decrease sympathetic outflow from brain, decrease norepinephrine release at CNS pre-synaptic terminals, decrease islets cells of pancreas Alpha receptors (unknown): contraction of urinary bladder sphincter, contraction of pregnant uterus, ejaculation of penis Beta Receptors: Review Beta 1: Increases heart rate (SA node), increases contractility, increases conduction velocity, increases automaticity, increases renin secretion at the kidney Beta 2: Relaxation of trachea and bronchioles, relaxation of uterine contractions in pregnancy, dilation of arterioles and veins (except in skin or brain) Beta receptors (unknown): relaxation of ciliary eye muscles (minimal effect), relaxation of detrusor muscle, internal effect Cardiac Medications Alpha Adrenergic Antagonistic Agents Diuretic Agents Angiotensin-Converting Enzyme (ACE) inhibitor Agents Nitrate Agents Anticoagulant Agents Positive Ionotropic Anti-hyperlipidemia Agents Agents Anti-thrombolytic Agents Beta Blocker Agents Thrombolytic Ca 2+ Channel Blocker Agents Agents  Alpha Adrenergic Antagonistic Agents (-azosin) Action: Reduce peripheral vascular tone by blocking alpha-1 adrenergic receptors. Allows for dilation of arterioles and veins, DECREASES BLOOD PRESSURE Indications: HTN, benign protostatic hyperplasia, CHF Side effects: dizziness, palpitations, orthostatic hypotension, drowsiness, edema, Implications for PT: Use caution when transitioning between positions (i.e. sit-->stand), closely monitor patients during exercise Examples: Prazosin (minipress), terazosin (hytrin), doxazosin (cardura)  Angiotensin-Converting Enzyme (ACE) inhibitor Agents (-oprils) Action: DECREASES BLOOD PRESSURE (and afterload) by blocking conversion of angiotensin 1-->angiotensin 2 (vasoconstrictor) in the lung Indications: HTN, CHF Side effects: dizziness, hypotension, dry cough, hyperkalemia, hyponatremia Implications for PT: use caution with sudden changes in position due to dizziness or fainting. Always monitor pts with CHF for rapid increases in physical activity. Examples: catopril (capoten), lisinopril (prinivil), enalapril (vasotec), ramipril (altase)  Anticoagulant Agents Action: inhibit blood coagulation, platelet aggregation and thrombus formation Indications: prevention of DVT and PE postoperative (post percutaneous transluminal coronary angioplasty and CABG procedures), maintaining circulation during open heart surgery and renal hemodialysis, ischemic heart dz., rheumatic heart dz. Side effects: hemorrhage, increased risk of bleeding, gastrointestinal distress with oral medication, hematoma or necrosis at injection site (Heparin only) Implications for PT: avoid injury to patient as they are at risk excessive bleeding or bruising, pt. Education of side effects Examples: Heparin (PO, SubQ, IV), Coumadin (warfarin) (PO) *Limit LEAFY GREENS*  Anti-hyperlipidemia Agents (-statins) Action: 5 categories of lipid modifying agents. The most common group are the “-statins”. Inhibit enzyme action in cholesterol synthesis, break down LDL, decrease triglyceride levels and increase HDL levels Indications: hyperlipidemia, atherosclerosis, prevent coronary artery events in patients with existing coronary disease, diabetes or peripheral vascular disease Side effects: headache, GI distress, myalgia, rash Implications for PT: aerobic exercise may increase HDL and maximize the effects of drug therapy Examples: Lipitor (atorvastatin), Zocor (simvastatin), Pravachol (pravastatin), Mevacor (lovastatin) **NO GRAPEFRUIT JUICE** Anti-thrombotic (antiplatelet) agents Action: inhibit platelet aggregation and clot formation Indications: post myocardial infarction, atrial fibrillation, prevent arterial thrombus formation Side effects: hemorrhage, thrombocytopenia, potential liver toxicity, with the use of aspirin, GI distress Implications for PT: avoid injury as they are at increased risk for excessive bleeding or bruising, pt. Education about side effects Examples: Aspirin, plavix (clopidogrel), cilostazol (pletatl), Bayer  Beta-blocker agents (-olols) Action: decrease the myocardial oxygen demand by decreasing HR and contractility by blocking B1-adrenergic receptors Indications: HTN, angina, arrythmias, heart failure, migraines, essential tremor Side effects: bradycardia, cardiac arrythmias, fatigue, depression, dizziness, weakness, blurred vision Implications for PT: Diminished HR and BP response to increase intensity of exercise, **May see sinus bradycardia on EKG**, RPE is advised method to monitor exercise integrity, closely monitor for signs of orthostatic hypotension Examples: atenolol (tenormin), penbutolol (levatol), metaprolol (lopressor), propanalol (inderol) Calcium Channel Blocker Agents Action: decrease entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decrease O2 demand on the heart Indications: HTN, angina pectoris, congestive heart failure, arrythmias Side effects: dizziness, headache, hypotension, peripheral edema, constipation, bradycardia Implications for PT: Diminished HR and BP response to increase intensity of exercise, RPE is advised method to monitor exercise integrity, closely monitor for signs of orthostatic hypotension, Monitor for signs of CHF (i.e. worsening peripheral edema, dyspnea or weight gain). Examples: Nifedipine (Procardia), Diltiazem (Cardizem) Nimodipine (nimotop)  Diuretic Agents Action: Increase the excretion of sodium and urine, which results in a reduction in plasma volume which decreases blood pressure. All enhance water and sodium production, effect depends on mechanism of action Categories: thiazide, loop, potassium sparing and osmotic diuretics Indications: HTN, edema associated with heart failure, pulmonary edema, glaucoma, Side effects: dehydration, hypotension, electrolyte imbalance, polyuria, increased LDL, arrythmias Implications for PT: position changes secondary to decreased BP, monitor for signs of electrolyte imbalance and muscle weakness or cramping Examples: Chlorothiazide (diuril), furosemide (lasix), amilioride (midamor), mannitol (resectisol) Nitrate Agents Action: Decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels Indications: angina pectoris. May be used before before exercise or stress to prevent ischemic exercise. Side effects: headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting, aggravation of peripheral edema Implications for PT: Pts should come up to standing SLOWLY to decrease risk of orthostatic hypotension. Examples: Nitrostat, Nitrogylcerine ***SUBLINGUAL NITROGLYCERINE CAN BE A LIFESAVER FOR AN ACUTE HEART ATTACK***  Positive Ionotropic Agents Action: increase the FORCE and VELOCITY of myocardial contraction, SLOW HR, decrease conduction velocity through the AV node, and decrease the degree of activation of the sympathetic nervous system Indications: heart failure, A-fib, hypoventilation, cardiogenic shock Side effects: cardiac arrythmias, gastrointestinal distress, dizziness, blurred vision Implications for PT: monitor HR during activity, education family and pt. About taking pulse, IF HR 100 bpm GET HELP!! Examples: Digoxin (lanoxin)  Thrombolytic Agents Action: degrade clots that have already formed Indications: acute myocardial infarction, pulmonary embolism, ischemic stroke, arterial or venous thrombosis Side effects: hemorrhage (intracranial in certain populations), allergic reactions, cardiac arrythmia Implications for PT: PTs must be mindful to avoid injury due to altered clotting activity Examples: Kinlytic (Urokinase), Alteplase (Activase), streptokinase Treatment of Arrythmias Class 1: Na+ channel blockers Action: Slow conduction velocity and prolong refractory period Indications: Atrial tachycardia, premature atrial depolarization, premature vantricular depolarization, atrial flutter, ventricular tachycardia Side effects: arrythmia, nausea, vomitting, hypersensiivity, Examples: quinidine, procainamide (pronestyl), disopyramide, lidocaine, mexiltene Class 2: Antagonistic Adrenergic Receptors Action: decreases heart rate, contractility and automaticity, prolongs A-V conduction time and refractories Indications: sinus tachycardia, atrial flutter, atrial fibrillation, A-V re-entry Side effects: heart failure, depressed A-V conductor, bronchospasm, hypotension Examples: propalnalol (inderal), esmolol (kerlone) Class 3: Prolong repolarization Action: Reduces potassium efflux, reduces automaticity of SA node, reduces conduction velocity and increases refractoriness. Indications: Ventricular fibrillation, atrial fibrillation or flutter, ventricular tachycardia Side effects: hypo/hyperthyroidism, photosensitivity, pulmonary fibrosis, arrythmias Examples: amiodarone, ibutilide (corvert), dofetillide (tikosyn), sotalol (betaspace) Class 4: Block slow inward (Ca2+ driven) Action: reduces calcium entry into myocardial cells, sa node and ectopic foci automaticity, increase refractory period of AV node. Indications: multifocal atrial tachycardia, atrial flutter Side effects: GI upset, sinus bradycardia, constipation, Examples: verapamil Unclassified Cardiac Medications Dobutamine: Beta-receptor adrenergic agonist. Increases cardiac output in heart failure. Side effects: tachycardia, hypotension, nausea, headache, palpitations, arrythmias. Digitalis: Used to treat CHF and a-fib. Inihibits sodium/potassium ATP-ase. Increases concentration of sodium ions and calcium in the cell. Side effects: nausea, vomitting, diarrhea, xanthopsia (yellow tinted vision), irregular heartbeat Categories of Cardiac Drugs HTN: dilate the blood vessels, block adrenergic receptors Diuretics: decrease blood volume by increasing the water that is excreted in the urine Clonidine: alpha (2) receptor agonist, inhibits the release of norepinephrine and inhibits our sympathetic outflow from the brain. Antenolol: beta blocker-RPE to measure! Prazosin (alpha 1) adrenergic receptor, cause vasodilation Nifedipine: block Ca entry, relax arterial Catopril: reduce production of angiontensin 2 and cause vasodilation  Angina: Stable: ○ NITROGLYCERINE: emergency action plan as needed. ○ Antenolol ○ Diltiazem: decrease BP through vasodilation Unstable: ○ Beta blockers ○ Aspirin ○ Heparin (anticoagulants) The Endocrine System: Goal: to help maintain balance within the endocrine system Drugs will either act to provide the system with a hormone that is deficient OR Inhibit oversecretion of target hormones Hormone Replacement Agents Action: Restore normal endocrine function when endogenous production of a particular hormone is deficient or absent Indications: decrease in endogenous hormone secretion Side effects: depends on hormone that is being replaced Implications for PT: be mindful or signs/symptoms or hormone therapy  Hyperfunction Agents Action: Manage hyperactive endocrine function to allow for inhibition of hormone function. This is accomplished through a negative feedback loops or through hormone antagonists. Indications: hyperactive or excessive endocrine function, excessive hormone levels Side effects: Depends on hormone being affected Implications for PT: mindful of the effects of excessive release of a particular hormone  Hyperthyroidism Medication Action: Thionamides are used to treat an overactive thyroid. Prevent the thyroid from producing excess hormones. Indications: hyperactive or excessive endocrine function, excessive hormone levels Side effects: ill feeling, high temp, headaches, aching joints, altered taste, upset stomach, itchy rash, *rare side effect: drop in white blood cell count (pt. Is MORE vulnerable to infection) Implications for PT: Muscle weakness, muscle cramps and pain Examples: Carbimazole, propylthiouracil  Hypothyroidism Medication Action: Daily hormone replacement tablets because thyroid is not making enough of thyroxine hormone Indications: hypoactive endocrine function, insufficient hormone levels Side effects: only if you are taking excessive amounts: sweating, chest pain, headaches, diarrhea Implications for PT: Monitor and report signs of excessive or inadequate dosing; monitor for arrhythmias, chest discomfort, SOB, fainting, fatigue and weakness, CNS toxicity: irritability and sleep loss Examples: Levothyroxine  Bone Mineral Regulating Agents Action: Enhance and maximize bone mass along with preventing bone loss or rate of bone reabsorption. Typical agents can include estrogens, calcium, vitamin D, bisphosphonates, calcitonin, and anabolic agents Indications: Paget’s dz., osteoporosis, hyperparathyroidism, rickets, hypoparathyroidism, osteomalacia Side effects: (agent dependent) gastrointestinal distress, dypepsia, dysphagia, anorexia, bone pain, cardiac arrythmias Implications for PT: Pts with bone mineralization deficit are at risk for fracture and side effects from drug therapy. Facilitate bone formation through ambulation and other WBng activities Examples: Premarin, Tums, Fosamax, Calcitonin Genitourinary Management Treatment is focused on symptoms relating to urgency, frequency, infection and pain Overactive Bladder Agents Action: relieve the symptoms of an overactive bladder. This condition is noted by involuntary contractions of the bladder (detrusor muscle) Indications: urinary urgency, urinary frequency, urge incontinence, nocturia Side effects: vary depending on drug classification: GI distress, nausea, photosensitivity, headache, constipation, pulmonary reactions Implications for PT: these medications do not typically interfere with rehab. Any signs of pulmonary distress or impairment should be reported to the physician Examples: Ditropan (oxybuinin chloride), detrol (tolterodine titrate)  Urinary Anti-Infective Agents Action: treat urinary tract infections but are not typical antibiotics or sulfonamide agents. These agents can be used independently or in combination to treat urinary tract infections Indications: cystitis, urinary urgency, bruning with urination, urinary tract infection, nocturia Side effects: widely based on drug classification, gastrointestinal distress, nausea, dizziness, photosensitivity, headache, constipation, rash Implications for PT: Be mindful of potential side effects of specific medications however do not typically interfere with PT Examples: Cinobac (conxacin), Furadantin (nitrofurantoin) Musculoskeletal System Nonopiod Agents NSAIDs Opioid Agents (Narcotics) Glucocorticoid Agents (Corticosteroid) Disease Modifying Anti-rheumatic agents Nonopioid Agents Action: Provide analgesia and pain relief, produce anti-inflammatory effects, and initiate anti-pyretic properties (reduce fever). Decrease production of prostaglandin formation that decreases the inflammatory process, decreases uterine contractions, lowers fever and minimizes impulse formation of pain fibers. Indications: mild to moderate pain, fever, headache, muscle ache, inflammation (except acetaminophen), primary dysmenorrhea, reduction of risk of myocardial infarction (aspirin only) Side effects: nausea, vomitting, vertigo, abdominal pain, GI distress or bleeding ulcer formation, Implications for PT: pts. Are at increased risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility. ℅ stomach pain should be referred to a physician ASAP Examples: Tylenol  Non-steroidal anti-inflammatory agents (NSAIDs) Action: Inhibit thromboxanes (assist with platelet adhesion) and prostaglandin (cause vasodilation) synthesis. Also, act to increase temperature in the hypothalamus. Indications: mild to moderate pain, fever, headache, muscle ache, inflammation, primary dysmenorrhea, flu, colds, sprains/strains, anti-thrombotic Side effects: indigestion, diarrhea, stomach ulcers, headaches, drowsiness, allergic reactions, problems with the liver, heart or kidneys, Implications for PT: pts. Are at increased risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility. Delay in soft tissue and bone healing, renal and liver toxicity, hemorrhagic events, gastric irritation and ulceration, and central nervous system effects. Examples: Ibuprofen (Motrin or Advil), naproxen sodium (Aleve), dicofenac, celecoxib, mefenamic acid, etoricoxib, indomethacin, high dose aspirin* Opioid Agents (Narcotics) Action: provide analgesia for acute severe pain management. Medication stimulates opioid receptors within the CNS to prevent pain impulses from reaching their destination. Certain drugs may also be used to assist with dependency and withdrawal symptoms. Indications: moderate to severe pain, induction of concious sedation prior to a diagnostic procedure, management of opioid dependence, relief of severe and persistant cough (codeine) Side effects: mood swings, sedation, confusion, vertigo, dulled cognitive function, orthostatic hypotension, constipation, incoordination, physical dependence, tolerance Implications for PT: monitor for signs of respiratory depression, treatment that is painful should be scheduled 2 hours after administration for analgesic benefit. A pt may not accurately describe pain while on this medication. Examples: Morphine, Oxycodone, Codeine, Meperidine (Demerol)*Used for patient controlled analgesia*  Glucocorticoid Agents (Corticosteroids) Action: Provide hormonal, anti-inflammatory and metabolic effects including suppression of articular and metabolic diseases. Reduce inflammation in chronic conditions which may also damage healthy tissue as well. May result in vasoconstriction. Indications: replacement therapy for endocrine dysfunction, anti-inflammatory and immunosuppressive effects, treatment of rheumatic, respiratory and other disorders Side effects: muscle atrophy, GI distress, glaucoma, adrenocortical suppression, drug-induced Cushing’s syndrome, weakening with breakdown of supporting tissues (bone, ligament, tendon, skin), mood changes, HTN Implications for PT: Mask required due to immunosuppression while on glucocorticoid therapy! Signs of toxicity: moon face, buffalo hump and personality changes. Pts. are at risk for osteoporosis and muscle wasting. Treatment of injected joint will require special care due to ligament and tendon laxity or weakening. Examples: Hydrocortisone, Prednisone, Dexamethasone Glucorticoid Toxicity Moon Face Buffalo Hump  Disease Modifying Anti-rheumatic Agents (DMARD) Action: slow or halt the progression of rheumatic disease. Used early during the dz. Process in order to slow progression prior to widespread damage of affected joints. Induce remission by modifying pathology and inhibiting the immune response responsible for rheumatic dz. Indications: rheumatic dz. Side effects: nausea, headache, joint pain and swelling, toxicity, GI distress, sore throat, fever, liver dysfunction, hair loss, potential for sepsis, retinal damage Implications for PT: Monitor for signs of toxicity (nausea, vomitting, diarrhea, myeolosuppresion, pancytopenia, liver dysfunction, acute renal failure, pulmonary symptoms, mucositis, somatitis, ulceration/erosion of the GI system and cutaneous ulcerations Examples: Methotrexate, Ridaura, Humira, Exbrel Methotrexate Toxicity: Skin lesions Neuromuscular Management Antiepileptic Agents Antispasticity Agents Dopamine Replacement Agents Muscle Relaxant Agents Antiepileptic Agents Action: Reduce or eliminate seizure activity within the brain Indications: seizure activity (partial, generalized or unclassified seizures) Side effects: ataxia, skin issues, behavioral changes, GI distress, headache, blurred vision, weight gain Implications for PT: KNOW SEIZURE PROTOCOL FOR Pt! May be more sensitive to certain lights or noises. Examples: Dilantin, Tegretol Antispasticity Agents Action: Promote relaxation in spastic muscles. Spasticity is not a primary condition but a secondary effect from CNS damage. Indications: increased tone, spasticity, SCI, CVA, MS Side effects: drowsiness, confusion, headache, dizziness, muscle weakness, tolerance, dependence Implications for PT: balance the need to decrease spastic muscles with the loss of function that a patient may experience with the reduction of hypotonicity. Examples: Baclofen, Valium, Dantrium  Dopamine Replacement Agents Action: help relieve symptoms of Parkinson’s dz. Due to decrease of endogenous dopamine. Used to improve planning, initiation and execution of movement Indications: Parkinson’s dz., Parkinsonism Side effects: arrythmias (levodopa), GI distress, orthostatic hypotension, dyskinesia, mood, behavioral changes, tolerance Choreoathetosis: Type of dyskinesia characterized by uncontrolled, involuntary movements. May occur 3 months after receiving first receiving levodopa therapy. Implications for PT: therapy to be scheduled 1 hour after administration of levodopa, monitor BP for possible orthostatic hypotension, Muscle relaxant agents Action: promote relaxation in muscles that typically present with spasm that is continuous, tonic contraction. Secondary to musculoskeletal or peripheral nerve injury rather than a CNS injury Indications: muscle spasm Side effects: sedation, drowsiness, dizziness, nausea, vomitting, headache, tolerance, dependence Implications for PT: use of PT to increase active muscle relaxation Examples: Valium, Flexeril Airway and Lung Disease Management Antihistamine Agents Anti-inflammatory Agents Bronchodilator Agents Expectorant Agents Mucolytic Agents Antihistamine Agents Action: Block the effects of histamine resulting in a decrease in nasal congestion, mucosal irritation, and symptoms of the common cold, sinusitis, conjunctivitis and allergies Indications: respiratory seasonal allergies, rhinitis, sneezing from the common cold, allergic conjunctivitis, motion sickness, Parkinson’s disease Side effects: arrythmia’s, postural hypotension, gastrointestinal distress, dizziness, drowsiness, headache, blurred vision, fatigue, nausea, thickening of bronchial secretions Implications for PT: increased guarding when moving into sitting or lying position due to orthostatic hypotension. Monitor vitals during ther-ex Examples: Benadryl, Allegra, Claritin  Anti-inflammatory Agents Action: inhaled corticosteroids, leukotriene modifiers, and mast-cell stabilizers, help prevent inflammatory-mediated bronchoconstriction by inhibiting production of inflammatory cells, suppressing release of inflammatory mediators and reversing capillary permeability. Indications: bronchospasm, asthma Side effects: risk is slightly lower due to delivery method of medication, damage of supporting tissues, skin breakdown, osteoporosis, decreased bone density, glaucoma and delayed growth. Local effects include nasal irritation and dryness, sneezing and bloody mucous Implications for PT: educate patient about rinsing mouth after using inhaler to avoid irritation of local mucosa. Refer to MD if there are signs of liver dysfunction (i.e. fatigue, flu-like symptoms, jaundice and lethargy) Examples: Pulmicort, Aerobid, Cromolyn Sodium  Bronchodilator Agents Action: Relieve bronchospasm by stimulating the receptors that cause bronchial smooth muscle relaxation or by blocking the receptors that trigger bronchoconstriction (Beta-2 agonists). Indications: bronchospasm, wheezing, SOB in asthma and COPD Side effects: bronchospasm, dry mouth, GI distress, chest pain, palpitations, tremor, nervousness, Implications for PT: Advise patients to take bronchodilator as prescribed before therapy and have on hand during session in case they are necessary, Cardiac or vision abnormalities may indicate toxicity and should be referred to MD Examples: Atrovent, Albuterol, Serevent  Expectorant Agents Action: increase respiratory secretions to help loosen mucous. Reducing viscosity of secretions and increasing sputum production improves efficiency of cough reflex and ciliary action in removing accumulated secretions. Indications: cough associated with respiratory tract infections: sinusitis, pharyngitis, bronchitis, asthma when complicated by tenacious mucous, mucous plugs or congestion Side effects: GI distress, drowsiness Implications for PT: PT may assist by using airway clearance intervention one hour after administration of drug. Encourage patients to drink water with medication Examples: Mucinex, Guaifenesin, Terpin Hydrate  Mucolytic Agents Action: decrease the viscosity of mucous secretions by altering their composition and consistency making them easier to expectorate. Delivered via nebulizer Indications: viscous mucous secretions due to PNA, emphysema, chronic bronchitis, and cystic fibrosis Side effects: pharyngitis, oral mucosa inflammation, rhinitis and chest pain Implications for PT: PT may assist by using airway clearance intervention one hour after administration of drug. Examples: Pulmozyme, Mucomyst Psychiatric Management Anti anxiety medications Anti-depressant agents Antipsychotic agents Bipolar disorder agents Sedative-hypnotic agents  Anti anxiety Medication Action: Antianxiety target the CNS through targeting dopamine and serotonin within the brain Indications: general anxiety disorder, social anxiety, obsessive compulsive disorder, post-traumatic stress syndrome Side effects: drowsiness, sedation, withdrawal symptoms including rebound anxiety, dysarthria, ataxia, dematitis Implications for PT: integration of alternative methods to decrease stress: exercise, massage, relaxation techniques and stress management education Examples: Xanax, Valium, Effexor, Paxil  Antidepressant Agents Action: classified as tricyclic monoamine oxidase inhibitors (MAOI) and selective serotonin reuptake inhibitors (SSRI) and other misc. Agents to normalize neurotransmission activity Indications: depression, possible anxiety disorders Side effects: depends on class of drugs. Sedation, blurred vision, tachycardia, dry mouth, insomnia, weight gain, sexual dysfunction Implications for PT: Monitor for improvement in pt. Affect with medical intervention, be mindful of side effects: sedation, fatigue, hypertension, orthostatic hypotension, further signs of depression or suicidal tendencies Examples: Elavil, Nardil, Prozac, Wellbutrin  Antipsychotic Agents (Neuroleptic Agents) Action: Reduce the overactivity of dopamine transmitted in the limbic system Indications: schizophrenia, psychotic disorders, Alzheimer’s (certain cases) Side effects: traditional agents produce increased extrapyramidal (motor) effects: tardive dyskinesia, pseudoparkinsonism, akathisia, sedation, constipation, dry mouth, atypical agents can produce weight gain, diabetes or hyperlipidemia Implications for PT: agents allow for increased participation in PT sessions by improving sense of self, attention span and improving affect. Early detection of extrapyramidal effects is beneficial and may assist medical and pharmacological intervention. Examples: Haldol, Thorazine, Abilify Side effects  Bipolar disorder agents Action: Focus on prevention of manic episodes in order to avoid extreme mood swings that follow. Primary agent is lithium. Certain anti-seizure and antipsychotic medication may assist as mood stabilizers with bipolar disorder. Indications: bipolar or manic-depressive disorders Side effects: GI distress, tardive dyskinesia, fatigue, confusion, nystagmus, lethargy, tremor, Parkinsonism, seizures, diabetes, toxicity, coma, risk of death Implications for PT: familiarize with side effects of particular medication, especially symptoms of toxicitiy as they relate to lithium. Long term use of lithium may result in osteoporosis, impacts plan of care Examples: lithobid (lithium), tegretol, neurontin Sedative-hypnotic Agents Action: Sedative agents produce a calming and relaxation. Hypnotic agents induce sleep Indications: anxiety, postoperative sedation, insomnia Side effects: drowsiness, decreased motor performance, anterograde amnesia, tolerance dependency, rebound insomnia with withdrawal; barbituates are highly addictive and can be fatal Implications for PT: may be beneficial to treat when peak blood levels of agent exist so pt. Is calm, relaxed and can focus on the treatment regimen, however, may be problematic if patient is experiencing side effects of drowsiness and impairments of motor control. Increased risk of falling. Examples: Halcion, Sonata, Ambien Question of the Day A patient with a known cardiac disease experiences angina while exercising on a recumbent bicycle. The patient self administers a nitroglycerine tablet to control the angina. Nitroglycerine helps to control this symptom by: a. Decreasing heart rate b. Inhibiting vasospasm c. Dilating peripheral arteries and veins d. Decreasing platelet aggregation