NPTEFF- Pharmacological effects

Opioids- morphine, oxycodone, hydrocodone

• Pain relief, postoperative pain, cough relief (antitussive)

• Take medication 30 min prior to therapy

• Side effects

  • respiratory and CNS depression, bradycardia, constipation, slowed breathing, dizziness, drowsiness, slowness, addiction, tolerance

NSAIDS- Asprin, acetaminophen, ibuprofen, naproxen, celecoxib

• pain relief: analgesic, anti-inflammatory, antipyretic, and anti-thrombotic effects

• no sedation unlike opioids

• Side effects

  • GI disturbances, diarrhea, constipation, nausea, vomiting, reduced appetite, ulcers, bleeding, perforations

  • Acetaminophen overuse causes liver damage, leading to jaundice, clay colored stools → no more than 6 tablets (500mg) per day for adults

Antiarthritic agents- Auranofin (Ridaura), etanercept (Enbrel), hyaluronic acid injections (synvisc)

• prevent and surpess arthritis

• Side effects: dermatitis, pruritius, allergic reactions that may lead to anaphylactic shock

• Diarrhea, stomatitis, pharyngitis, laryngitis, colitis

• Bronchitis, interstitial pneumonitis

• vaginitis, nephrotic syndrome

Anti-rheumatic drug- Methotrexate

• disease-modifying anti-rheumatic drug (DMARDS)

• Used to slow the disease process in inflammatory forms of arthritis

Anticonvulsant drugs- carbamazepine, clonazepam, diazepam, phenobarbital, phenytoin

• used to control seizures; generalized CNS depression

• Side effects

  • drowsiness, ataxia, sedation, GI disturbances, rash, weakness, hypotension

Skeletal muscle relaxants- carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), Orphenadrine (Norflex)

• reduce muscle spasms

• Side effects

  • sedation, dizziness, dry mouth

Anti-parkinsons agents- levodopa/ carbidopa (Sinemet)

• PT session should be scheduled to coincide with maximal effectiveness of drugs

  • Levodopa should be administered 1hr before PT session

• Side efect

  • orthostatic hypotension, nausea, dry mouth, dizziness, fluctuations and “wearing off” of benefits b/t doses

  • dyskinesia

Anti-epileptic drugs- pregabalin (Lyrica)

• used to treat peripheral neuropathy & epilepsy

• Side effects

  • CHF, lymphedema, difficulty walking for long distances

Loop diuretics- furosemide (Lasix)

• antihypertensive

• Inhibits reabsorption of water and electolytes from the loop of henle

• Side effects

  • Hypokalemia, hypocalcemia, hyponatremia, dehydration, orthostatic hypotension, reflex tachycardia, dizziness, lethargy

Potassium-sparing diuretics: spironolactone

• antihypertensive

• Binding of receptors at the aldosterone- dependent sodium-potassium exchange site at the distal convoluted renal tubule

• Side effects

  • hyperkalemia, dizziness, orthostatic hypotension, dehydration reflex tachycardia, gynecomastia

Diuretics- Thiazides: HCTZ

• Antihypertensive

• Blocks the sodium and chloride channels at the distal involuted tubule of the nephron

• Inhibits sodium and water reabsorption

• Side effects

  • hypercalcemia, hypokalemia, hyperuricemia, hyperlipidemia (avoid with the elderly), dehydration, orthostatic hypotension, reflex tachycardia, dizziness, lethargy, DM, renal dysfxn

ACE inhibitors- Captopril, lisinopril, enalapril, benazepril (PRILs)

• Antihypertensive

• Angiotensin increases BP → ACE inhibitors inhibit the biosynthesis of angiotensin 2 and, thus inhibit increased BP

• Lower BP, decrease fluid retension and peripheral resistance

• Side effects:

  • Orthostatic hypotension, headaces, dizziness, hyonatremia, hyperkalemia, dry hacking cough, decreased taste perception, angioedema

Vasodilators- nitrates (nitroglycerine)

• used for angina pectorsis: short-term use only

• Given sublingually, with 3 doses given 5 min apart; if no relief after 3 doses, call EMS

• Pt. must be sitting or lying down when taking nitroglycerine

• Side effects

  • Dizziness, lightheadedness, orthostatic hypotension, flushing, reflex tachycardia

Antiarrythmic drugs- quinidine

• antihypertensive

• Side effect

  • vomiting, heartburn, rash, fever, dizziness, fatigue, weakness, headache

anticoagulants- warfarin, heparin

• decrease the risk of blood clots and prevent existing clots from growing larger

• Indications: DVT prophylaxis, stroke prevention, peripheral vascular disease

• Side effects

  • increased risk of bleeding and hemorrhage, hematomas

Bronchodilators

• Beta 2 agonist

  • Short acting: salbutamol, albuterol

  • Long acting: Salmetrol, formoterol

Antimuscarinic (anticholinergic)

• relax muscles and decrease bodily secretions

  • Short- acting: ipratropium

  • Long acting: tiotropium

Theophylline

• a prescription bronchodilator used to treat asthma, chronic bronchitis, and emphysema

• Side effects

  • tremors, palpations, GI disturbances, dry mouth

Hypnotics

• Cause sedation, sleep, partial loss of conciseness, used to treat insomnia

• Side effects

  • burning/ tingling in the UE/ LE, gas, diarrhea, constipation, appetite changes, dizziness, drowsiness, dry mouth, heartburn, headache, mental slowing, memory and attention problems, weakness

Antidepressants- SSRI (prozac, zoloft), monoamine oxidase inhibitors, tricyclics

• Used to control depression

• Side effects

  • anxiety, tremor, insomnia, nausea

Antipsychotic agents

• side effects

  • extrapyramidal motor s/s → abnormal movement patterns (changes in posture and balance; involuntary mvmts

Antihistamines

• Block histamine receptors (H1 receptors)

• Alergic conditions

• Diphenhydramine

• Anticholinergic effects

  • dry mouth and skin, blurred vision, constipation, urinary hesitancy

Laxatives (Psyllium fibers, docusate)

• Treat constipation

• Side effects

  • sedation, dry mouth, blurred vision, dry skin, contact lens intolerance, constipation, urinary hesitancy (more pronounced in the elderly)

Antacids

• Neutralize stomach acidity

• Side effects

  • Loss of appetite

  • Constipation or diarrhea

Chemotherapy

• Drugs can be given orally, subcutaneously, intramuscularly or intrathecally

• Side effects: fatigue, GI tract syndrome, bone marrow suppression leading to leukopenia, anemia, thrombocytopenia, skin rashes, phlebitis, neuropathies and hair loss

Radiation therapy

• to destroy cancer cells, inhibit their growth and division. can be given pre or post operatively

• Side effects: pain, fatigue, radiation sickness, burns, delayed wound healing, immunosuppression, ROM deficits around the joints and neuropathy

Immunotherapy

• To strengthening the ability to fight cancer cells using interferons, interleukins-2, and cytokinin. Also includes bone marrow transplant and hormonal therapy

• Side effects: fatigue, weight loss or gain, fever, chills, nausea, anorexia, fluid retention, GI tract s/s, hot flashes, steroid induced diabetes, muscle atrophy