Lecture Pharmacology

Question 1

define: pharmacoprophylaxis

Answer 1

use of drugs to prevent disease, or slow the course of a disease

Question 2

define Pharmacodiagnostics

Answer 2

pre-treatment testing to determine patient response to a drug therapy

Question 3

define pharmacokinetics

Answer 3

how the body deals with a drug in terms of the way it is administered, absorbed, distributed, and eliminated

Question 4

define pharmacodynamics

Answer 4

what a drug does to the body, including the mechanism by which it exerts its effect

Question 5

define toxicology

Answer 5

the study of the harmful effects of drugs (incl. medication, toxins & poisons)

Question 6

what are 3 classifications of drug naming?

Answer 6

chemical, brand/trade, generic

Question 7

describe the dose response curve

Answer 7

Threshold dose - dose at which the response begins to occur

Potency - dose required to produce a given response

Maximal efficacy or Peak response – maximum amplitude of response (coincides with ceiling effect)

Ceiling effect – plateau effect in the curve, indicating that no further response occurs beyond the given dose

Question 8

describe administration types (pharmacokinetics) - advantages and disadvantages

Answer 8

Enteral administration means that drug enters the body via the alimentary canal.
Parenteral administration means that the drug enters the body through non-alimentary routes.

First-pass inactivation means that the drug entering the enteral route will be metabolized by the liver before reaching its target site. Thus dosage must be adjusted to ensure adequate amount of drug reach the tissue after being partially metabolized by the liver.

Question 9

describe bioavailability

Answer 9

The bioavailability of a drug is the extent to which the drug reaches the systemic circulation, and is expressed as a percentage of the drug administered that reaches the bloodstream. For example, for a 100mg dose, if 50mg eventually reaches the bloodstream, that drug is said to be 50% bioavailable.

Question 10

what does bioavailability depend on and what are the 4 ways it can occur?

Answer 10

Question 11

explain drug distribution

Answer 11

Question 12

explain drug storage

Answer 12

Question 13

describe pharmacokinetic elimitation

Answer 13

Question 14

describe pharmacokinetic elimination rate

Answer 14

Question 15

describe individual drug responses

Answer 15

Question 16

describe drug receptors

Answer 16

Question 17

NSAIDs - what it does, properties, and adverse effects

Answer 17

• inhibits COX (1 and 2) enxymes, except for COX-2 selective NSAIDs which inhibits only COX2

four general properties:

 Anti-inflammatory - reduce inflammation

 Analgesic - reduce mild to moderate pain

 Antipyretic - reduce elevated body °T (fever)

 Anticoagulant - reduce blood clotting (platelet aggregation) **COX-2 selective NSAID doesn’t do this

primary adverse effects of this family of NSAIDs are:

 Gastrointestinal damage

 High dose: liver damage

 Renal problems in patients with impaired renal function

 Reye syndrome in children

Question 18

NSAIDs guidelines for musculoskeletal injuries

Answer 18

• interferes with normal inflammatory response and therefore should avoid use within first 48 hours post-injury (avoid use over 5 days)
• not more effective than simple analgesic (tylenol)
• NOT recomended for DOMS (use simple analgesic instead)

Question 19

NSAIDs implication for rehab

Answer 19

• therapy sessions can be conducted but use caution
• ask when drug last taken when doing therapy with client
• don’t push too much

Question 20

acetaminophen implications for rehab

Answer 20

• therapy sessions can be conducted but use caution
• ask when drug last taken when doing therapy with client
• don’t push too much

Question 21

acetamenophen - properties and adverse effects

Answer 21

properties:

Analgesic - reduce mild to moderate pain

Antipyretic - reduce elevated body °T (fever)

The main risk of Acetaminophen is liver toxicity, but this is only a concern if taken at excessively high dosage, or for prolonged period of time (see bottle for directions). This does, however, mean that Acetaminophen is NOT indicated for patients with pre-existing liver problems.

Question 22

glucocorticosteroids - implications for MSK rehab

Answer 22

• helps with symptoms but does not releive cause (cortisone shot)
• often told to do physio 3-7 days after injection (not right away!)
• avoid direct weight on joint right after injection

*note there is an injection for frozen shoulder which is a different form of injection and should be moved right away

Question 23

glucocorticosteroid properties and adverse effects

Answer 23

• powerful anti-imflammatory properties
• immunosuppresive effect (used therapeutically in rheumatologic conditions)

side effects: - note never the first line of treatment

Post-injection “flare” (injection); a short-term worsening of signs and symptoms

Inhibition of collagen synthesis (impaired healing)

Infection (injection)

Avascular necrosis of femoral head (oral)

Question 24

opiod analgesics - properties and side effects

Answer 24

properties: Treatment of moderate to severe pain, Anesthesia, Cough suppression, treatment for overdose/addiction

side effects:

 Respiratory depression

 Sedation/ confusion/ dizziness

 Nausea & vomiting

 Constipation

 Hypotension

*risk of developing drug tolerance, dependence or addiction

Question 25

describe the opiod analgesic administration process

Answer 25

- orally is more varied than with PCA - initial does is large (loading dose) with subsequenct smaller doses (demand dose), lockout interval to prevent OD, monitor successful vs total demand (how many times button pushed vs how many times delivered), could also have a background (constant) infusion rate

Question 26

opiood analgesics - implications for rehab

Answer 26

treatment possible but note these meds may cause: –Sedation –Hypotension –GI discomfort and constipation –Blunted respiratory response to exercise –Withdrawal Sx may mimic MSK problem

Question 27

skeletal muscle relaxants - use and side effects

Answer 27

use: to treat muscle spasm, purpose to decrease muscle tone side effect: drowsiness and dizziness (from cns sedation)

Question 28

skeletal muscle relaxants - implications for rehab

Answer 28

- schecule therapy for when sedative effects are at their lowest - during treatment work on improving posture, mody mechanics, ms strength, and flexbility

Question 29

general anesthetics - properties and adverse effects

Answer 29

use: for sedation for extensive surgical procedures, produce a progressive, reversible CNS depression (loss of consciousness and sensation, amnesia, skeletal muscle relaxation, and inhibition of sensory and autonomic reflexes) adverse effects: sedation, confusion, muscle weakness (ataxia), respiratory compromise, hypotension

Question 30

general anesthetics - implications for rehab

Answer 30

- monitor side effects (esp muscle weakness) - effects should lessen with time, call physician if effects prolonged

Question 31

local anesthetics - purpose and side effects

Answer 31

produce localize anesthesia (loss of sensation) and block afferent nerve transmission for surgical procedures side effects: CNS (confusion, agitation, restlessness), CV (hypotension, bradycardia, reduced cardiac output)

Question 32

local anesthetics - implications for rehab

Answer 32

–Loss of sensory feedback (tactile, proprioceptive) –Possible motor impairment –Be aware of impairment due to systemic distribution (refer to side effects) –Non-life-threatening effects will ↓ with time

Question 33

what is Hyaluronic acid therapy?

Answer 33

- 1-5 injections, adverse affects mostly just due to injection site, can last up to 6 months - can be used as conservative measure before hip or knee replacement surgery

Question 34

antihyprtensive drugs - implications for rehab

Answer 34

–Be alert during positional changes or env °T changes –Provide a cool-down period following exercises –Monitor BP & HR before exercise –Monitor HR during aerobic activity, use RPE if pt is on Beta-blockers –Allow ↑ time to complete aerobic activity to prevent dyspnea & account for depressed cardiac activity –Have pt check glucose level prior to exercise if taking hypoglycemic drugs

Question 35

antihypertensive drugs - side effects

Answer 35

–Orthostatic hypotension –Bronchoconstriction, blunting early manifestations of hypoglycemia with Beta-blockers –Diuretics can cause hypokalemia (low blood K+) –Depression of HR and contractility

Question 36

what are other drugs with similar side effects / consideration as antihypertensive drugs

Answer 36

Question 37

Antithrombotic drugs - what they do, SE, and implications for rehab

Answer 37

Effect: inhibit clotting mechanism in blood side effects: myalgia (muscle pain), arthralgia (joint pain), bleeding Implications: –Myalgia and arthralgia may ↓ function of pt during rehab –Keep an eye on new bruises –↑ bleeding may alter some wound care activities

Question 38

Antihyperlipidemic drugs - what they do, SE, and implications for rehab

Answer 38

- lower lipid levels SE: myalgia, arthralgia and ms weakness implications: –Function may be ↓ because of pain –Needs to differentiate between pain from meds and pain associated with ex’s

Question 39

Sedative-Hypnotic drugs - what they do, SE and implications

Answer 39

Anti-anxiety agents, Sleep disturbances SE: Sedation, ↓ arousal or alertness, Motor control dysfunction implications: –Plan therapy session depending if drug is beneficial or non-beneficial for therapy –Education about risks of fall especially in older adults

Question 40

Antipsychotic drugs & lithium - what they do, SE, implications

Answer 40

Used to treat Schizophrenia, other psychoses or agitated states & bipolar disorders SE: Sedation, Orthostatic hypotension, Bradykinesia, tremor, rigidity, Balance and posture problems Implications for rehab: –Be careful with positional changes –Be aware of any changes in posture, balance or involuntary mvts –Monitor psychosocial factors

Question 41

Antidepressants - used for, SE, implications

Answer 41

- mood improvement and to treat chronic pain SE: Sedation, hypotension, Hypertensive crisis Implications for rehab: –Be careful with positional changes –Monitor BP during exercise –Monitor psychosocial factors

Question 42

Drugs for thyroid dysfunction - use, SE, implications

Answer 42

Hypo or hyperthyroidism SE: Exercise intolerance, Intolerance to temperature changes Implications for rehab –May have ↓ capacity for aerobic activities

Question 43

Diabetic patients- medication, implications for rehab

Answer 43

use Insulin injections or Oral hypoglycemics SE: Hypoglycemia (mainly from insulin), Nausea and vomiting, Weight gain, MI and heart failure Implications for rehab: –Watch for signs of hypoglycemia during therapy: Confusion, visual disturbances, seizures (uncommon), loss of consciousness (uncommon), heart palpitations, shakiness, anxiety, sweating, hunger, tingling sensation around the mouth –Monitor blood glucose, blood pressure and HR prior to exercise

Question 44

Antibacterial agents - side effects and implications for rehab

Answer 44

SE: –Most common: hypersensitivity or allergic reactions and GI problems –Many have drug interactions –IV infusion of certain drugs may cause phlebitis –Fluoroquinololes may cause tendonitis –Inhibition of red blood cells, white blood cells, platelets –Dizziness & vertigo Implications: –Do some research on drugs that pt is taking –Be aware of signs of phlebitis (imflammed walls of veins) –Avoid high intensity RT ex’s in pt taking fluoroquinololes (risk of tendon rupture)

Question 45

Drugs for upper airway problems - SE and implications

Answer 45

rpe = rating of perceived exertion