PHARMACOLOGY PTA

PHARMACOLOGY

NPTE Prep

START

Index

Methods of Admin

Musculoskeletal

Pharmacokinetics

Neuromuscular

Cardiovascular

Pulmonary

the one singular test question

Other Systems

the chart that Leslie posted a few quaters ago

METHODS OF ADMINISTRATION

(NOT via GI tract)

• Inhalation
• Topical
• Transdermal
• Injection
• Intravenous
• Intra-arterial
• Subcutaneous
• Intramuscular

ENTERAL

PARENTERAL

(USES GI TRACT)

• Oral
• Sublingual

• Rectal

WEIGHT

DISEASE

GENETICS

FACTORS THAT AFFECT PHARMACOKINETICS

FOOD

(what happens to the drug(s) in the patients body after administered)

EXERCISE

AGE

MEDICATIONS

We Must All Gather Doors For Education

MUSCULOSKELETAL

Scorebuilders: pg 122-123, 511

OPIOID ANALGESICS

LOCAL ANESTHESIA

Avoid physical agents if imp. sensationExercise cautiously

Look for signs of tolerance/dependenceSchedule therapy >30 minutes after dose

NONOPIOID ANALGESICS

CORTICOSTEROIDS

Ensure patient is not exceeding max. daily dose. Schedule therapy 60-90 minutes after dose

Wear a mask if on glucocorticoid therapyKnow signs of toxicity

NEUROMUSCULAR

Scorebuilders: pg 246, 511

DOPAMINE REPLACEMENT

ANTI-EPILEPTIC

Schedule therapy one hour after administration of levodopa

Pt may be more sensitive to environmental surroundings

MUSCLE RELAXANT

ANTI-SPASTICITY

Once spasticity is reduced, focus on promoting overall mobility

Maximize potential for relaxation during treatment

NEUROMUSCULAR SYSTEM

SCI MUSCLE SPASM SEIZURE ACTIVITY PARKINSON'S DISEASE

CARDIOVASCULAR

Scorebuilders: pg 371-373, 511

ANTI-COAGULATION

ANTI-HYPERTENSIVE

Increased risk for bleeding - prevent tissue trauma

Orthostatic hypotension. May have diminished heart rate, use RPE

CONGESTIVE HEART FAILURE AGENTS

ANTI-ANGINAL

Orthostatic hypotension Sublingual administration

Monitor HR during activity

ANTI-ARRHYTHMIC

ANTI-HYPERLIPIDEMIA

If beta blockers or calcium channer blockers, orthostatic hypotension

Aerobic exercise to increase HDL

PULMONARY

Scorebuilders: pg 373-374, 511

EXPECTORANT

ANTI-HISTAMINE

Perform airway clearance within one hour of drug administration

Orthostatic hypotensionClosely monitor during exercise

MUCOLYTIC

ANTI-INFLAMMATORY

Instruct rinsing mouth out after usePt ed: NOT for acute asthma attack

Perform airway clearance within one hour of drug administration

BRONCHODILATOR

Advise pt to take meds before therapy, bring rescue meds with them

OTHER SYSTEMS

Scorebuilders: pg 512

THYROID AGENTS

ANTI-ANXIETY

Avoid interventions that can exacerbate sx of thyroid dysfunction

Increased fall risk. Therapist can implement alt. stress reduction methods

INSULIN REPLAEMENT THERAPY

ANTI-DEPRESSANT

Be aware of side effectsMonitor BP for irregularities

Watch for signs of hypoglycemia

ANTI-PSYCHOTIC

CHEMOTHERAPY

Monitor for motor side effects, changes in pts posture, balance, mov pattern

Fatigue levels can vary greatly day to day

ANTIDEPRESSANTS

Attempt to normalize neurotransmissioin activity.Indications:

• depression, certain agents also treat anxiety

Side effects:

• *vary by class and specific agent: sedation, blurred vision, tachycardia, dry mouth, insomnia, weight gain, sexual dysfunction

AGE

As age increases, incidence of adverse drug reactions tends to increase due to:

• decrease in lean body mass
• decrease in serum proteins
• reduction in renal and liver fx
• interactions with other drugs

Infants and young children require alterations to avoid adverse reactions since their organs are not fully developed and are unable to metabolize drugs in the same manner.

ANTIHYPERTENSIVE

TYPES OF MEDICATIONS

• ACE inhibitors

• Beta blockers

• Calcium channel blockers

• Diuretics
• watch for sxs of electrolyte imbalance

• Angiotensin II blockers

• Alpha Adrenergic Antagonist

*note: many of these medications are used to treat various cardiopulmonary issues, not just hypertension

MUSCLE RELAXANT AGENTS

Promote relaxation in muscles that typically present with spasm that is a continuous, tonic contraction. *secondary to musculoskeletal or peripheral nerve injuryIndications:

• muscle spasm

Side effects:

• sedation, drowsiness, dizziness, nausea, vomiting, headache, tolerance, depenence

MUCOLYTIC AGENTS

Decrease viscosity of mucus secretions, making them easier to expectorate.<< Administered by a nebulizerIndications:

• viscous mucus secretions due to pneumonia, emphysema, chronic bronchitis, and cystic fibrosis

Side effects:

• pharyngitis, oral mucosa inflammation, rhinitis, chest pain

EXERCISE

Exercise can affect many factors that have an influence on drug activity (ex. blood flow, pH, etc). Effect can vary based on type and intensity of exercise type of drug, method of admin, and dosing schedule.

DOPAMINE REPLACEMENT AGENTS

Assist to relieve symptoms of Parkinson's diseaseIndications:

• Parkinson's disease, Parkinsonism

Side effects:

• arrhythmias (levodopa), GI distress, orthostatic hypotension, dyskinesias, mood and behavioral changes, tolerance

*levodopa is found in these medications

GLUCOCORTICOID AGENTS (CORTICOSTEROIDS)

Hormonal, anti-inflammatory, metabolic effects including suppression of articular and systemic diseases, will likely have weakened immune system.Signs of toxicity: moon face, buffalo hump, personality changes.Indications:

• replacement therapy for endocrine dysfunction, anti-inflammatory and imminosuppressive effects; treatment of rheumatic, respiratory, and various other idsorders

Side effects:

• muscle atrophy, GI distress, glaucoma, adrenocortical supporession, drug-induced Cushing's syndrome, weakening with breakdown of supporting tissues (bone, ligament, tendon, skin), mood changes, hypertension

NONOPIOID AGENTS

Pain relief, anti-inflammatory, reduce fever. Indications:

• mild-mod pain of various origins, fever, headache, muscle ache, inflammation (except acetaminophen), promary dysmenorrhea, reduction of risk of myocardial infarction (aspirin only)

Side effects:

• nausea, vomiting, vertigo, abdominal pain, GI distress or bleeding, ulcer formation, potential for Reye syndrom in children (aspirin only)

FOOD

Presence of food in stomach can slow the rate of absorption of a drug.

• Empty stomach= speed up absoption into bloodstream
• In combination with food= avoid gastric irritation

*Food or drinks that are acidic may affect absorption (ex. grapefruit juice)

OPIOID AGENTS (NARCOTICS)

Analgesia for acute severe pain managementIndications:

• mod-severe pain of various origins, induction of conscious sedation prior to a diagnostic procedure, management of opioid dependence, relief of severe and persistent cough (codeine)

Side effects:

• mood swings, sedation, cofusion, verigo, dulled cognitive function, orthostatic hypotension, constipation, incoordination, physical dependence, tolerance

ANTIEPILEPTIC

Reduce or eliminate seizure activity within the brain.Indications:

• seizure activity

Side effects:

• ataxia, skin issues, behavioral changes, GI distress, headache, blurred vision, weight gain

ANTI-HISTAMINE

Result in decrease in nasal congestion, mucosal irritation, and symptoms of the common cold, sinusitis, conjunctuvitis, and allergies.Indications:

• Respiratory seasonal allergies, rhinitis and sneezing from the common cold, allergic conjunctuvitis, motion sickness, Parkinson's disease

Side effects:

• arrhythmias, postural htn, gastrointestinal distress, dizziness, drowsiness, headache, blurred vision, fatigue, nausea, thickening of bronchial secretions

ANTIHYPERLIPIDEMIA AGENTS

Inhibit enzyme action in cholesterol synthesis, break down low dnesity lipoproteins, decrease triglyceride levels, increase HDL levels.Indications: hyperlipidemia, atherosclerosis, prevent coronary events in patients with exisiting coronary disease, diabetes or peripheral vascular disease Side effects: headache, GI distress, myalgia, rash

DISEASE

Disease of kidneys or liver can result in reduced ability to metabolize or eliminate a drug and may cause toxic effects. Viral infections may also affect a drug's half-life.

ANTISPASTICITY AGENTS

Promote relaxation in spastic muscle*secondary to CNS damageIndications:

• increased tone, spasticity, SCI, CVA, MS

Side effects:

• drowsiness, confusion, headache, dizziness, generalized muscle weakness, hepatotoxicity potential with Dantrium, tolerance, dependence

NITRATE AGENTS

Decrease ischemia through smooth muscle relaxation and dilation of peripheral nerves.Indications:

• angina pectoris

Side effects:

• headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting

ANTI-INFLAMMATORY AGENTS

Help prevent inflammatory-mediated bronchoconstriction. Indications:

• bronchospasm, asthma

Side effects:

• Corticosteroids: Osteoporosis, decreased bone density, glaucoma, delayed growth.
• Leukotriene modifier: Liver dysfunction
• Mast cell stabilizer: bronchospasm, throat and nasal irritation, cough, gastrointestinal distress.

WEIGHT

Dosages are typically based on a 150-pound individual. Patients who fall far above or below this value may need their drug dosage altered to achieve the desired therapeutic effect.

MEDICATIONS

Effectiveness of a drug may be altered when taken in combination with other drugs.

• antagonistic: reduce effectiveness
• synergistic: result in excessive overfunctioning of drug

ANTICOAGULANT AGENTS

Inhibit platelet aggregation and thrombus formation.Indications:

• Coronary angioplasty, CABG, thromboembolism prevention

Side effects:

• hemorrhage, bleeding, GI distress

BRONCHODILATOR AGENTS

Relieve bronchospasm (when the muscles that line your bronchi tighten)Indications:

• bronchospasm, wheezing, SOB in asthma and COPD

Side effects:

• Paradoxical bronchospasm, dry mouth, gastrointestinal distress, chest pain, palpitation, tremor, nervousness

LOCAL ANESTHETICS

Nerve blockIndications:

• decrease pain, local anesthesia

Side effects:

• Respiratory depression, slurred speech, drowsiness, dizziness, seizures

GENETICS

Genetic mutations may result in an abnormal response to the administration of a drug. Differences in drug effectiveness or the elimination of a drug may be seen among different ethnic groups.

ANTIANXIETY

Targets dopamine and serotonin receptors in the brain.Indications:

• general anxiety disorder, social anxiety, panic disorder, OCD, PTSD

Side effects:

• drowsiness, sedation, withdrawal symptoms

EXPECTORANT AGENTS

Helps loosen mucus and provide more efficient cough and removal of accumulated secretions.Indications:

• cough associated with respiratory tract infections, sinusitis, pharyngitis, bronchitis, and asthma

Side effects:

• gastrointestinal distress
• drowsiness

ANTIPSYCHOTICS

Reduce overactivity of dopamine in limbic system.Indications:

• schizophrenia, various psychotic disorders, Alzheimer's

Side effects:

• increased motor effects, tardive dyskinesia, pseydoparkinnsonism, sedation, constipation, dry mouth, atypical agents cause DM, hyperlipidemia, and substantial weight gain