33. Pharmacology

Cardiac Drugs:

• What drugs are:

  • Anti-arrhythmic Drugs + Antihypertensives (2)

    • Function:

  • ONLY Antihypertensives (3)

    • Function:

• Anti-arrhythmic Drugs + Antihypertensives » Dec HR and BP

  • Beta Blockers

  • Ca Channel Blockers

• ONLY Antihypertensives » Dec BP

  • Diuretics

  • ACE Inhibitors

  • ARB Blockers

Beta Blockers:

• Suffix:

• Common Drug Names:

• Mechanism: (2)

• Effects: (3)

• Indications: (3)

• Suffix:

  • “-olol”

• Common Drug Names:

  • Atenolol, Metoprolol, Carvedilol, Labetalol, Propranolol

• Mechanism:

  • Block Beta-Adrenergic Receptors

  • Block Action of SNS (Inc HR/BP, Bronchodilation, Vasoconstriction)

• Effects:

  • Dec HR and BP

  • Bronchoconstricton

  • Vasodilation

• Indications:

  • Coronary Artery Disease

  • HTN

  • Arrhythmia

Beta Blockers:

• Adverse Effects: (6)

• ECG Findings:

• Considerations: (3)

• Effects on Preload and Afterload:

• Adverse:

  • Orthostatic Hypotension

  • Dizziness

  • Lightheadedness

  • Ringing of Ears

  • Venous Pooling

    • Blood accumulates in LE d/t Vasodilation

  • Bradycardia

• ECG:

  • PR Interval Increases

• Considerations:

  • Use RPE for exercise prescription

  • DO NOT use in Asthma, COPS, or any other Pulmonary Dx

    • D/t bronchoconstriction

  • No Abrupt Withdrawal

• Effects on:

  • Preload: Slightly reduce

  • Afterload: Reduce

Ca Channel Blockers:

• Suffix:

• Common Drug Names:

• Mechanism:

• Effects: (2)

• Indication: (3)

• Suffix:

  • “-Pines and -Zems”

• Common Drug Names:

  • Amlodipine, Verapamil, Diltiazem

• Mechanism:

  • Blocks entry of Ca in cardiac tissue » reducing cardiac contractility and vasoconstriction

• Effects:

  • Decrease HR and BP

  • Vasodilation

• Indication:

  • CAD

  • HTN

  • Arrhythmias

NOTE: Can be given to pts c Pulmonary Conditions d/t not causing bronchoconstriction

Ca Channel Blockers:

• Adverse Effects: (5)

• Considerations:

• ECG Changes:

• Adverse Effects:

  • Orthostatic Hypotension

  • Dizziness

  • Lightheadedness

  • Ringing of the Ears

  • Venous Pooling

• Considerations:

  • Use RPE for Exercise Prescription

• ECG Changes:

  • Prolonged QT Interval

Practice Q 1:

A patient is taking B blockers for three years post myocardial infarction. Which of the following is the MOST LIKELY response to exercise seen in this patient?

A. Rapid increase in HR

B. Decreased exercise tolerance

C. Blunted response of HR with exercise

D. Increased BP

C. Blunted response of HR with exercise

---

B: Improves exercise tolerance

Duretics » LOOP DIURETICS

• Suffix:

• Common Drug Names:

• Mechanism:

• Use: (4)

• Suffix:

  • “-Ide”

• Common Drug Names:

  • Furosemide (Lasix)

• Mechanism:

  • Inhibits reabsorption of water and electrolytes from Loop of Henle

• Use:

  • HTN

  • CHF

  • Edema

  • Pulmonary Edema

Duretics » LOOP DIURETICS

• Side Effects: (8)

• Effects on Preload and Afterload

• Side Effects

  • REFLEX TACHYCARDIA

    • In response to Dec BP and Inc HR (Compensation)

  • Hypokalemia

  • Hypocalcemia

  • Hyponatremia

  • Dehydration

  • Orthostatic Hypotension

  • Dizziness

  • Lethargy

• Effects on:

  • Preload: Dec

  • Afterload: Dec

Diuretics: POTASSIUM SPARING DIURETICS

• Suffix:

• Common Drug Name:

• Mechanism:

  • Through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the…

• Use: (3)

• Potassium Sparing Diuretics are preferred over Loop Diuretics when?

• Side Effects: (3)

• Effects on Preload and Afterload:

• Suffix:

  • “-Tone”

• Common Drug Name:

  • Spironolactone (Aldactone)

• Mechanism:

  • Distal Convoluted Renal Tubule

    • Sparing Potassium

• Use:

  • CHF

  • HTN

  • Combined with other drugs causing Hypokalemia

• Preferred when pt already has Hypokalemia

• Side Effects:

  • HYPERKALEMIA

  • Gynecomastia

  • Similar to Loop Diuretics

• Effects on:

  • Preload: Dec

  • Afterload: Dec

Diuretics: THIAZIDES

• Suffix

• Common Drug Names:

• Mechanism:

• Use: (3)

• Side Effects: (5)

• Thalazides must be avoided in what pop? (5)

• Effects on Preload and Afterload:

• Suffix:

  • “-Thiazide”

• Common Drug Names:

  • Hydrochlorothiazide (HCT)

• Mechanism:

  • Blocks Sodium and Chloride Channels in Distal Convoluted Tubule

  • Inhibit Reabsorption of Sodium and Water

• Use:

  • HTN

  • CHF

  • Edema

• Side Effects: CLUG

  • Hypercalcemia

  • Hyperuricemia

  • Hyperlipidemia

  • Hyperglycemia

  • Same as Loop Diuretics

• Avoided:

  • Elderly

  • DM

  • Renal Dysfunction

  • Gout

  • Hyperlipidemia

• Effects on:

  • Preload: Dec

  • Afterload: Dec

ACE Inhibitors:

• Suffix:

• Common Drug Names:

• Mechanism:

• Use: (4)

• Administered:

• Suffix:

  • “-Pril”

• Common Drug Names:

  • Captopril, Enalapril, Lisinopril

• Mechansim:

  • Blocks ACE » Reducing BP

• Use:

  • CHF

  • HTN

  • Edema

  • Pulmonary Edema

• Administered:

  • Orally

ACE Inhibitors:

• Side Effects: (6)

• ACE may react c Diuretics and cause…

• ACE may react c Potassium Sparing Diuretics and cause…

• Effects on Preload and Afterload:

• Side Effects:

  • HYPERKALEMIA

  • DRY HACKING COUGH

  • Orthostatic Hypotension

  • Hyponatremia

  • Decreased Taste Perception

  • Angioedema

• Hypotension

• Hyperkalemia

• Effects:

  • Preload: Dec

  • Afterload: Dec

Angiotensin Receptor Blockers (ARB) Blockers:

• Suffix:

• Common Drug Names:

• Mechanism: (2)

• Use: (3)

• Administered:

• Side Effects: (6)

• Effects on Preload and Afterload:

• Suffix:

  • “SARTANS”

• Common Drug Names:

  • Losartan, Telmisartan, Candesartan

• Mechanism:

  • Blocks Angiotensin 2 receptors » Decreasing effects of Angiotensin 2

  • Decreased Angiotensin 2 will decrease BP

• Use:

  • HTN

  • CHF

  • Intolerant to ACE

• Administered:

  • Orally

• Side Effects:

  • HYPERKALEMIA

  • Hyponatremia

  • Orthostatic Hypotension

  • Dizziness

  • Lightheadedness

  • Fatigue

• Effects:

  • Preload: Dec

  • Afterload: Dec

NOTE: ARB does NOT produce Dry Hacking Cough like ACE

Practice Q 2:

The physical therapist is educating a patient on the potential side effects from the medication Ramipril. Which of the following side effects will MOST LIKELY correlate with this drug?

A. Increased fluid retention

B. Causes hyperkalemia

C. Increases blood Pressure

D. Enhanced myocardial contractility

B. Causes hyperkalemia

---

D. ACE has no effect on heart

Practice Q 3:

The physical therapist is educating a patient on the potential side effects from the medication Candesartan. Which of the following side effects will MOST LIKELY correlate with this drug?

A. Hypokalemia

B. Dry hacking cough

C. Hypotension

D. Prevents the recurrence of atrial fibrillation

C. Hypotension

Cardiac Glycosides:

• Common Drug Names:

• Mechanism: (2)

• ECG Changes: (2)

• Use: (3)

• Common Drug Names:

  • Digitalis, Digitoxin, Digoxin (Lanoxin)

• Mechanism:

  • Decreases HR BUT Increases Strength of Contraction (Increase CO)

  • Fewer and better contractions/beats

• ECG Changes:

  • Prolonged PR Interval

  • Shortened QT Interval

• Use:

  • Systolic Dysfunction in patients c Congestive Heart Failure

    • Acute Signs of Decompensated HF

    • Short Term Drug

    • EF < 55%

Cardiac Glycosides:

• Side Effects: (9)

• DIGOXIN TOXICITY

• Arrhythmias

• Palpitations

• Fatigue

• GI Disturbances

• Visual Disturbances

• Hyperkalemia

• Confusion

• Delirium

Practice Q 4:

A patient with congestive heart failure is taking Digoxin since the last few weeks. Which of the following is an EXCEPTION to common side effects of digoxin toxicity?

A. Disorientation and delirium

B. Ringing in the ears

C. Fatigue and palpitations

D. Gastrointestinal disturbances

B. Ringing in the ears

Nitrates:

• Common Drug Name:

• Mechanism:

• Use:

• Administered:

• Dose/Position:

• If there is no relief, patient may be having…

• Common Drug Name:

  • Nitroglycerin (NTG)

• Mechanism:

  • Vasodilation of Arterial and Venous Vessels

• Use:

  • Angina Pectoris

    • Levine Sign

• Administered:

  • Sublingually

• Dose/Position:

  • Dose: 3 doses every 5 min

  • Pos:

    • Must sit/lay when taking NTG

• MI » Call EMS

Nitrates:

• Side Effects: (7)

• Only used ___ term

• What 2 drugs are appropriate long term drugs to prevent angina?

• Side Effects:

  • Dizziness

  • Lightheadedness

  • Orthostatic Hypotension

  • HA

  • Flushing

  • Reflex Tachycardia

  • Venous Pooling

• Short term

• Beta Blockers and Ca Channel Blockers

Nitrates:

• Call EMS if: (3)

• Angina:

  • Stable:

  • Unstable:

  • Variant (Pizmental):

• Angina:

  • Stable: Exercise 9YES NTG)

  • Unstable: Rest (NO NTG)

  • Variant (Pizmental): Vasospasm (YES STG)

Practice Q 5:

A patient with angina pectoris has been advised to use sublingual nitroglycerin for stable angina. This drug will MOST LIKELY cause which of the following?

A. Lower preload and afterload

B. Increase myocardial oxygen demand

C. Increase preload and afterload

D. Hypertension and bradycardia

A. Lower preload and afterload

Blood Thinners » ANTICOAGULANTS

• Common Drug Names:

• Mechanism:

• Use: (3)

• Side Effects: (5)

• Common Drug Names:

  • Warfarin (Coumadin), Heparin

• Mechanism:

  • Inhibits Vitamin K formation » Prevents synthesis of clotting factor

  • Heparin: Inhibits formation of clotting factor

• Use » Immediate resolution of blood clot

  • DVT

  • MI

  • CVA

• Side Effects:

  • Bleeding

  • Easy bruising

  • Hemorrhage

  • Hemarthrosis (Bleeding in Joints)

  • Lightheadedness

Blood Thinners » ANTICOAGULANTS

• Internatonal Normalized Ration:

  • Normal:

  • Taking Anticoagulants:

  • > 2.5:

  • > 3.0:

  • > 4.0:

  • > 6.0:

• Avoid what foods when taking Warfarin: (2)

• Avoid:

  • High in Vitamin K

  • High Sugar Food/Drink

Blood Thinners » ANTIPLATELET

• Common Drug Name:

• Mechanism:

• Use:

• Side Effects: (3)

• Common Drug Name:

  • Aspirin, Clopidogrel

• Mechanism:

  • Prevents Aggregation of Platelets

• Use:

  • Prevent CVA and MI

• Side Effects

  • Peptic Ulcers

  • Gastritis

  • Risk of Internal Bleeding

---

NOTE: Antiplatelets are not as strong as Warfarin and Heparin

• Can be taken to prevent blood clot formation

Practice Q 6:

Which of the following is an INAPPROPRIATE statement regarding the drug Coumadin?

A. It should not be given to a patient with an active GI ulcer

B. Adverse effects of Coumadin can be hematuria and bleeding gums

C. It inhibits the formation of thrombin and fibrin in the clotting process

D. It should be given to a patient undergoing a surgery for liver transplant

D. It should be given to a patient undergoing a surgery for liver transplant

Pain Receivers » NSAIDS

• COX 1 =

• COX 2 =

• Selective NSAIDS vs NON Selective NSAIDS:

• COX 1 = Produces Healthy Prostaglandins >> Maintaining gut health

• COX 2 = Causes Inflammation 

Pain Receivers » ACETAMINOPHEN

• Common Drug Name:

• Mechanism:

• Use: (3)

• NOT…

• Administered:

• Side Effects: (2)

• Common Drug Name:

  • Tylenol

• Mechanism:

  • Block sensation of pain

• Use:

  • Antipyretic

  • Analgesic

  • HA

• NOT ANTI-INFLAMMATORY

• Administered:

  • Orally

• Side Effects:

  • Overuse can cause liver damage leading to Jaundice and Clay Colored Stools

  • No more than 6 Tablets (500mg)/day

Pain Relievers » OPIODS ANALGESICS

• Common Drug Names:

• Mechanism:

  • Works c ___

  • It interacts c receptors that causes… (2)

• Use: (3)

• Common Drug Names:

  • Morphine, Oxycodone, Hydrocodone, Fentanyl, Methadone

• Mechanism:

  • CNS

  • Decreased Neuronal Excitability and Altered Synaptic Transmission in pain specific pathways

  • Use:

    • Severe Pain

    • Post Op Pain

    • Antitussive (Cough)

Pain Relievers » OPIODS ANALGESICS

• Side Effects: (9)

• Take Medication __ min prior to PT

• Antidote for overdose is __

• Side Effects:

  • ADDICTION

  • CONSTIPATION

  • Resp and CNS Depression

  • Bradycardia

  • Slowed Breathing

  • Slowness

  • Dizziness

  • Drowsiness

  • Tolerance

• 30 min

• Naloxone (Narcan)

Benzodiazepines:

• Suffix:

• Common Drug Names:

• Mechanism:

• Use: (5)

• Side Effects: (8)

• Suffix:

  • “-Pams and “-Lams”

• Common Drug Names:

  • Diazepam (Valium), Clonazepam (Klonopin), Alprazolam (Xanax)

• Mechanism:

  • Potentiates inhibitory effects of GABA in CNS

• Use:

  • Muscle Spasms

  • Anxiety

  • Alcohol Withdrawal

  • Acute Epileptic Attacks

  • Insomnia

• Side Effects:

  • Tolerance

  • Dizziness

  • Hallucinations

  • Drowsiness

  • Sedation

  • Fatigue

  • Hypotonia

  • Increased Fall Risk

Skeletal Muscle Relaxant » CYCLOBENZAPRINE (FLEXERIL)

• Mechanism: (2)

• Administered:

• Use: (3)

• Side Effects: (10)

• Mechanism:

  • Increases serotonin activity at the brainstem level

  • Increasing the inhibitory influence of serotonin on Alpha Motor Neuron Activity

• Administered:

  • Orally

• Use:

  • Reduce Muscle Spasms

  • Myofascial Pain Syndrome

  • Fibromyalgia

• Side Effects:

  • N/V

  • DRY MOUTH

  • Tolerance

  • Dizziness

  • Hallucinations

  • Drowsiness

  • Sedation

  • Fatigue

  • Hypotonia

  • Increased Fall Risk

Skeletal Muscle Relaxant » BACLOFEN

• Mechanism:

• Use:

• Administered:

• Side Effects: (8)

• Mechanism:

  • Works on CNS

• Use:

  • Reduce muscle spasticity seen c SC lesions » MS, SCI vs Cerebral lesions

• Administered:

  • Orally or Intrathecally

• Side Effects:

  • Hypotonia

  • Hallucination

  • Confusion

  • Nausea

  • Dizziness

  • Drowsiness

  • Inc Fall Risk

  • Shallow Breathing

Skeletal Muscle Relaxant » BOTULINUM TOXIN (BOTOX)

• Mechanism:

• Use:

• Mechanism:

  • Works on CNS

  • Blocks Release of Acetylcholine

• Use:

  • Muscle Spasticity

  • Seen c CP

Practice Q 7:

An intrathecal Baclofen pump has been put for a child with spastic cerebral palsy. The physical therapist observes that the child is very drowsy, tone appears floppy and is not breathing well. What is the MOST LIKELY cause of the above symptoms?

A. Overdose of Baclofen

B. Child is experiencing fatigue

C. Dosage of Baclofen is less

D. Child is not interested in therapy

A. Overdose of Baclofen

Bronchodilator Drugs:

• Beta 2 Agonist:

  • Short Acting:

  • Long Acting:

• Antimuscarinic (Cholinergic):

  • Short Acting:

  • Long Acting:

• Corticosteroids:

  • (2)

• Beta 2 Agonist:

  • Short Acting: Salbutamol, Albuterol (Ventolin)

    • Crisis Drug

  • Long Acting: Salmeterol, Formoterol

    • Maintenance Drug

• Antimuscarinic (Cholinergic):

  • Short Acting: Ipratropium

  • Long Acting: Tiotropium

• Corticosteroids:

  • Budensonide

  • Prednisolone

Bronchodilator Drugs:

• Administered: (2)

• Uses:

• Side Effects: (4)

• Administered:

  • Inhalation

  • Oral

• Uses:

  • Bronchodilation in Bronchial Asthma and COPD

• Side Effects:

  • Tremors

  • Palpitations (Inc HR)

  • GI Disturbances

  • Dry Mouth

    • Specifically Anticholinergic Drugs

---

NOTE: Works c SNS so symptoms will be similar to SNS function

Antibacterial Drugs:

• Common Drug Names:

• Use:

• Administered:

• Adverse Effects: (5)

• Common Drug Names:

  • Penicilin. Cepalosporin, Vanomycin, Gentamicin

• Use:

  • Treat Bacterial Infection

• Administered:

  • Orally

• Adverse Effects:

  • OTOTOXICITY (BPPV)

  • Hypersensitivity (Skin Rashes)

  • GI Disturbances (N/V)

  • Nephrotoxicity (Esp Gentamiacin)

  • CNS Confusion

Other Drugs:

Practice Q 8:

Which of the following is an EXCEPTION to the medications commonly used to lower blood pressure in patients with hypertension?

A. Thiazide diuretics

B. ACE inhibitors

C. Calcium channel blockers

D. Digitalis

D. Digitalis

Practice Q 9:

A patient has just started using Ventolin for management of their condition. What is the patient MOST LIKELY to experience as a side effect of the drug?

A. Tachycardia

B. Hypotension

C. Lightheadedness

D. Increased risk of falls

A. Tachycardia

Practice Q 10:

A patient reports pain in the right groin and upper thigh region, which was gradual in onset. They have a medical history of ulcerative colitis for which they have been taking Prednisolone. Which of the following is MOST LIKELY diagnosis for this patient?

A. Meralgia paresthetica

B. Trochanteric bursitis

C. Osteomyelitis of hip

D. Osteoporosis of hip

D. Osteoporosis of hip

---

A. Lateral Cutaneous Nerve Compression