Unit 7-8 (E4)

What are respiratory agents divided into?

1.) Drugs that treat acute & relatively minor probs

(Ex. nasal congestion, coughing, or a seasonal allergy)

2.) Drugs that treat more chronic & serious airway obstructions

(Ex. bronchial asthma, chronic bronchitis, & emphysema)

What are antitussive agents used for?

-To treat Respiratory Tract Irritation & Control Respiratory Secretions

What are the drugs used to treat Respiratory Tract Irritation & control Respiratory Secretions? (4)

1.) Antitussives

2.) Decongestants

3.) Antihistamines

4.) Mucolytics & Expectorants

What are the suffixes for antitussive agents?

-deine

-done

-phan

-phone

-tate

Deen Done Phat Phone Tate (DDPPT)

What are the suffixes for nasal decongestants?

-drine

-oline

-phedrine

-phrine

-zoline

Drill Oil Pod Print Zone (DOPPZ)

What are the suffixes for antihistamines?

-dine

-mine

-nate

-tine

-zine

Dine Mine Nate, Time Zyn (DMNTZ)

What is the primary mucolytic drug currently in use?

What does it do?

-Acetylcysteine (Mucomyst, Mucosil)

-Used to reduce mucus production

What is the primary adverse effects associated with Acetylcysteine?

-Nausea & vomiting

-Inflammation of oral mucosa (stomatitis)

-Rhinorrhea.

What is Guaifenesin? What does it do?

-The only expectorant currently. (help clear mucus (phlegm) from your airway)

-Acknowledged by FDA to have evidence of therapeutic effects

What is the primary adverse effect associated with guaifenesin?

-GI upset

(Via excessive dose or if it is taken on an empty stomach)

What do beta-adrenergic bronchodilators treat?

-Prevent or inhibit airway obstruction in bronchospastic diseases

(Ex. bronchial asthma, chronic bronchitis, & emphysema)

How do beta-adrenergic bronchodilators work?

-Stimulate beta-2 adrenergic receptors to produce bronchodilation

(via beta-adrenergic agonists)

What are two disorders usually grouped under chronic obstructive pulmonary disease (COPD)?

-Chronic bronchitis & emphysema

What are the suffixes for beta-adrenergic bronchodilators?

-aline

-enol

-erol

Align enough Erin (AEE)

What do theophylline & several theophylline derivatives treat?

-Produce bronchodilation in asthma & other forms of airway obstruction

(Ex. bronchitis, emphysema)

What are the suffixes for Xanthine Derivative bronchodilators?

-phylline

Why are corticosteroids used for in obstructive pulmonary disease?

-Bc of powerful anti-inflammatory effects

-Controls inflammation-mediated bronchospasm & are the most effective agents for controlling asthma

What are the suffixes for corticosteroids used for COPD?

-lide

-lone

-nide

-sone

Linda Longs Needs Sun (LLNS)

Can glucocorticoids be combined with a long-acting beta-2 agonist? What does it do?

What does glucocorticoids do?

What does beta 2 do?

-Yes, to produce a greater effect

-Glucocorticoids decrease inflammatory response causing airway hyperresponsiveness

-Beta-2 maintains bronchodilation w/ asthma

What are special concerns PTs should have with pts on respiratory drugs?

-Prevent mucus accumulation

-Administer drug 30 mins to 1 hour before PT

-Portable aerosol bronchodilator needs to be brought

-Recognize side effects (toxicity)

-No overstress on bones & musculotendinous structures (glucocorticoids)

How can PTs prevent mucus accumulation?

-Pharmacotherapeutic effects of muscolytic & expectorant drugs

-Encourage pt to cough & raise secretions for expectoration

What can happen if bronchial secretions accumulate? 3

-Decreases gas exchange

-Atelectasis

(collapse of lung)

-Additional infection

(Ex. pneumonia)

What are some side effects of respiratory drugs? 5

-Cardiac arrhythmias

-Nervousness

-Confusion

-Tremors

-Weakened bones & musculotendinous structures (catabolic breakdown)

What are histamine receptor blockers used to treat? 3

1.) Peptic ulcers

(ulcerations of mucosal lining of esophagus, stomach, & duodenum)

2.) Probs related to indigestion & epigastric pain (dyspepsia)

3.) Heartburn via leakage of gastric acid into distal esophagus, called gastroesophageal reflux

How do histamine receptor blockers work?

-Via prevention of histamine-activated released during gastric acid under basal conditions & during stimulation by food

When are histamine receptor blockers used?

-To decrease damage from gastric acid via NSAIDs & other factors that increase acid secretion

What are the suffixes for histamine receptor blockers?

-tidine

How do drugs classified as proton pump inhibitors (PPIs) work?

-Suppress H+ & K+-ATPase enzyme

-To decrease transport of H+ ions & formation of gastric acid

What are the suffixes for proton pump inhibitors?

-prazole

What do laxatives do?

-Promote evacuation of bowel & defecation when normal bowel movements are impaired but no obstruction exists in GI system

What are cathartics or purgatives used for?

-Promote lower GI evacuation, but in a more rapid fashion than typical laxatives

What happens if the transit time of food through the GI tract is too fast?

-Diarrhea occurs, resulting in poor food absorption & dehydration

What happens if diarrhea is sustained for even a few days?

-Dehydration can be a serious problem (especially in infants or debilitated pts)

Diarrhea is often a temporary symptom of many relatively minor GI disorders, what are more serious conditions it can occur w/? 3

-Dysentery

-Ulcerative colitis

-Cholera

How many grams of fiber should you have a day?

25-30g

Which type of fiber promotes bathroom use?

-Insoluble

• Whole wheat and whole grains (brown rice, whole grain bread)

• Nuts and seeds (especially with skins)

• Vegetables like:

  • Cauliflower

  • Green beans

  • Zucchini

• Wheat bran

• Skins of fruits (e.g., apple peel, grape skin)

Which type of fiber lowers LDL?

-Both, but mostly soluble

• Oats and oatmeal

• Barley

• Beans and lentils

• Apples

• Citrus fruits (like oranges)

• Carrots

• Flaxseeds

• Psyllium husk

Will Wheat brand or oatmeal make you go?

-Wheat brand bc it has insoluble fiber

-While Oats have soluble so it is better to lower LDL

When do we usually see the use of PPIs & histamine receptor blockers used for stress ulceration syndrome?

pt's that have:

-Burns

-Multiple traumas

-Renal failure

-CNS trauma

When do we usually see the use of laxatives for constipation?

-Inactive pts & prolong best rest

Why would pts w/ cancer be given antiemetic drugs?

-Bc chemotherapy often cause nausea & vomiting

-Also causes chronic indigestion & diarrhea

GI ISSUES

What are the special concerns PTs should have with pts on GI drugs? 7

-Secondary, stress ulceration syndrome

-Inactive/bed written pts

-Chemotherapy pts

-Increase water intake

-Bathroom use during rehab (can contribute to pt probs)

-Mild side effects

-Educate pt on laxative dependency

What side effects do GI drugs have?

-Mild dizziness & fatigue (dehydration)

[opiates + H blockers}

-GI disturbances (constipation)

What is the clinical use of endocrine drugs?

1.) Replacement therapy

2.) Treat excessive endocrine function

3.) Alter normal endocrine function

4.) Diagnose endocrine disorders

What are the two primary types of adrenal steroids produced by the adrenal cortex?

1.) Glucocorticoids

2.) Mineralocorticoids

What do glucocorticoids (cortisol, corticosterone) primarily do?

-Control glucose metabolism & body's ability to deal w/ stress

-Decreases inflammation & suppresses immune system

What do Mineralocorticoids, such as aldosterone, do?

-Maintain fluid & electrolyte balance in body

What is a physiological dose with use of adrenal steroids?

-Administration of hormonal replacement therapy is equivalent to normal endogenous production

What pharmacological dose with use of adrenal steroids?

-Larger dose to differentiate them from amount used to maintain normal endocrine function

-Ex.) Glucocorticoids as anti-inflammatory

What are the suffixes for glucocorticoids?

-bate

-lide

-lone

-nate

-nide

-sone

-sol

Bate Lives Lone Naturally Needing Some Soul (BLLNNSS)

What are the suffixes for Mineralcorticoids?

-spironolactone

-eplerenone

Spiral Episode (SE)

What are the desired effect with glucocorticoids for treatment of non-endocrine disorders? 4

-Decrease inflammation & edema

-Immunosuppression

-Anti-lymphocyte effects

-Inhibit free radical induced neuronal damage

What are the two clinically used mineralocorticoid antagonists?

1.) Spironolactone

2.) Eplerenone

What is a side effects of mineralocorticoid antagonists? 4

-Increase in plasma potassium levels (hyperkalemia)

-Could be life threatening if severe or prolonged

-Gastrointestinal disturbances

(Ex. diarrhea, stomach pain, gastric ulcers)

-CNS effects

(Ex. drowsiness, lethargy, confusion, headache)

What do Spironolactone, mineralocorticoid antagonists, interfere with?

-Increased body hair

-Deepening of voice

-Decreased libido

-Menstrual irregularities

-Breast enlargement in men

-CNS effects

(Ex. drowsiness, lethargy, confusion, headache)

What do eplerenone, mineralocorticoid antagonists, interfere with?

-Has lower incidence of sexual side effects

-Suppress mineralocorticoid function w/o affecting sex hormones

What are the special concerns of PTs when working with pts on andrenocorticosteroids?

-Catabolic effect

(breakdown of structures)

-Strengthening helps

(muscle mass, musculotendious wasting & mobility)

-Caution w/ weakened structures

-Aware of sodium & water-retaining

(hypertension)

-Increase susceptibility to infection

-Toxicity: mood changes & psychoses

What catabolic effect do glucocorticoids have?

-Breakdown of muscle, bone, skin, & other collagenous structures

-Inactivity, poor nutrition, & effects of aging are all contributing factors.

Which pts do we often work with that take glucocorticoids?

-RA

-Ankylosing spondylitis

-Lupus Erythematosus

-Acute bursitis

-Tenosynovitis

How can the PT increase joint movement w/o causing injury to the joint if pt is on glucocorticoids?

-Low-intensity, long-duration stretching

-Physical agents, massage, & other manual techniques

-Gradual strengthening as drugs exert anti-inflammatory effects

-Strengthening muscles around knee

How long can the effects of a single injection affect E.M.'s joints?

-3 months or so

-They are highly lipid soluble & can be retained w/in fat & other intra- + peri-articular joint tissues

-If took too frequently causes weakening of structure.

How are glucocorticoids and mineralocorticoids synthesized?

-Via cholesterol w/in cells of adrenal cortex

What is the primary glucocorticoid produced in humans?

-Cortisol (hydrocortisone)

What is the primary mineralocorticoid produced in humans?

-Aldosterone

What are the principal functions of male and female hormones?

-Control reproductive function & secondary sexual characteristics in their respective gender groups

What are male hormones, such as testosterone, are usually referred to as?

-Androgens

What are the two principal groups of female hormones?

1.). Estrogens

(estradiol)

2.) Progestins

(progesterone)

What steroid hormones are similar to those of primary steroid groups, glucocorticoids and mineralocorticoids?

-Androgens, estrogens, & progestins

What are the primary indications for clinical use of androgens?

1.) Endometriosis

2.) Benign fibrocystic disease

3.) Hereditary angioedema

4.) Androgen deficiency

5.) Breast cancer

6.) Delayed puberty in boys

7.) Anemia of renal insufficiency

8.) Catabolic states

How are anabolic androgens usually took?

-Either injected or orally

What are the suffixes for androgen drugs?

-azol

-lone

testosterone

Azzy Lines Tests (ALT)

What are the estrogen drugs?

-estradiol

-estrogens

-estropipate

What are the suffixes for Progestins drugs?

-rel

-rol

progesterone

Real rolling Pro (RRP)

What are the primary indications for clinical use of estrogens?

-Estrogen replacement

-Antineoplastic

-Prevention of osteoporosis

-Prevention of abnormal uterine bleeding

What are the primary indications for clinical use of progestins?

-Contraceptive

-Amenorrhea or secondary amenorrhea

-Dysfunctional uterine bleeding

-Maintain pregnancy & decrease risk of preterm birth

-Breast or endometrial carcinoma

-Anorexia/cachexia associated w/ AIDS

-Support of embryo implantation & early pregnancy

-Endometriosis

What are most of the hormonal contraceptives made out of?

-Estrogen & progesterone

What risk do you run if you are taking contraceptives and are a cigarette smoker?

-Deep vein thrombosis (DVT)

What are some concerns for PTs when pts are on male or female hormone drugs?

-Motor blood pressure

-Salt & water retention

-Hypertension

-Educate pt on androgen abuse & side effects

(Liver, cardiovascular, & reproductive abnormalities)

What does treatment for hyperthyroidism consist of?

-Surgical removal of gland

-Administering radio- active iodine to gland

-Pharmacological agents to manage

What pharmacological agents are used to treat hyperthyroidism?

-Antithyroid drugs

-Iodide

-Radioactive iodine

-Beta-adrenergic blockers

What are the Beta-adrenergic blockers used for hyperthyroidism?

-Acebutolol

-Atenolol

-Metoprolol

-Nadolol

-Oxprenolol

-Propranolol

-Sotalol

-Timolol

(They all end in -olol)

What are the Antithyroid drugs used for hyperthyroidism?

-Propylthiouracil (Propyl-Thyracil)

-Methimazole (Tapazole)

What are the primary syms for hyperthyroidism?

-Nervousness

-Weight loss

-Diarrhea

-Tachycardia

-Insomnia

-Increased appetite

-Heat intolerance

-Oligomenorrhea

-Muscle wasting

-Goiter

-Exophathalmos

What are the primary syms for hypothyroidism?

-Lethargy/slow cerebration

-Weight gain

-Constipation

-Bradycardia

-Sleepiness

-Anorexia

-Cold intolerance

-Menorrhagia

-Weakness

-Dry, coarse skin

-Facial Edema

What are the suffixes for hyperthyroidism?

-nine

-trix

-xine

thyroid

Nine tricks xeros thighs (NTXT)

What are the primary methods of treatment for hypothyroidism?

-T3 (liothyronine)

-T4 (levothyroxine)

-or both

What is the primary drug treatment for metabolic disease?

-Calcium supplements

-Vitamin D

-Biphosphonates

-Calcitonin

-Intermittent parathyroid hormone

-Estrogen

-SERMS

-Usually treated surgically by partial or complete resection of glad

What are the drugs used to control bone mineral homeostasis?

-Biphosphonates

-Calcitonin

-Calcium supplements

-Estrogens

-Vitamin D analogs

What is the suffix for Biphosphonates?

-dronate

What are the special concerns for PTs when pts are taking thyroid gland drugs?

-Syms of opp. disorder is sign of overdose

-Signs of thyroid dysfunction (inappropriate dose)

-Decreased cardiac output & hypotension (via hypothyroidism)

-Cardiac arrhythmias (via excessive calcium supp)

-Exercise & weight bearing activities

(stimulate bone function)

-Vit D facilitates calcium absorption (via sun, ultraviolet light)

What is a common side effect of Vit D and magnesium?

-Diarrhea

What are the characteristics of Type I diabetes?

What are the characteristics of Type II diabetes?

What are the 4 types of insulin drugs?

1.) Rapid acting

2.) Short acting

3.) Intermediate acting

4.) Long acting

What are some rapid acting insulin drugs?

1.) Aspart

2.) Lispro

3.) Glulisine

Assess Live Glide (ALG)

What is a short acting insulin drug?

-Regular insulin

What is an intermediate acting insulin drug?

-Isophane insulin

What is a long acting insulin drug?

1.) Glargine

2.) Detemir

Glows Determine (GD)

What are the two classifications of type II Diabetes M drugs?

1.) Drugs that stimulate insulin integration & supply

2.) Insulin sensitizers

How is type I diabetes management administered?

-Injected or device