Pharm Outline

Cholinergic Drugs

cholinomimetics and indirect cholinomimetics

Direct Cholinomimetics

bethanechol, muscarine, pilocarpine, nicotine

Indirect Acting Cholinomimetics

neostigmine, pyridostigmine, carbaryl

Cholinomimetic Rehab Relevance

• Dyspnea
• Increased urination frequency
• Prevents pupil dilation (fall risk)
• Nicotine decreases performance

Anticholinergic Drugs

direct cholinergic blockers and indirect ACh blockers

Direct Cholinergic Blockers

atropine, scopolamine, oxybutynin, tolterodine, ipratropium, tiotropium, benztropine

Indirect ACh Blockers

Botox

Anticholinergic Rehab Relevance

• Hyperthermia (sweat inhibition)
• Increased HR
• Decreased pupil constriction (light sensitive)
• Sedation
• Decreased cognitive activity

Presynaptic Adrenergic Drugs

cocaine, amphetamine

Postsynaptic Adrenergic Drugs

Epi, NE, oxymetazoline, prazosin, metoprolol, albuterol

Glucocorticoids

cortisol, hydrocortisone, prednisone, methylprednisolone, triamcinolone, dexamethasone

Glucocorticoid Rehab Relevance

• Easier bleeding
• Monitor hyperglycemia
• Thin skin, avoid shear
• Aseptic necrosis (imaging)
• Weakness
• Delayed wound healing
• Lack of understanding

RA Drugs

Anti-TNF-a: adalimumab, etanercept

DMARD: methotrexate

Gout Drugs

Dianostic / Acute: colchicine

Chronic: allopurinol, probenecid

Antihistamines

epinephrine, first gen, second gen

First Gen Antihistamines

diphenhydramine, dimenhydrinate, hydroxyzine, promethazine

Second Gen Antihistamines

fexofenadine, loratadine, cetirizine

Pain Relievers

NSAIDs, non-specific COX inhibitors, COX-2 inhibitors

NSAIDs

ibuprofen, aspirin

Non-Selective COX Inhibitors

naproxen, acetaminophen

COX-2 Selective Inhibitors

celecoxib, meloxicam

Upper Airway Dysfunction Drugs

antihistamines, decongestants, expectorants, antitussives

Pulmonary Antihistamines

diphrenhydramine, cetirizine

Decongestants

pseudoephedrine, oxymetazoline, phenylephrine

Decongestant Rehab Relevance

• Increased BP
• Increased afterload and preload
• Angina may worsen
• Monitor perceived exertion

Expectorants

Guaifenesin

Antitussives

dextromethorphan, codeine

Asthma and COPD Drugs

bronchodilators, glucocorticoids, leukotriene inhibitors, omalizumab, methylxanthines

Bronchodilators

beta-2 agonists (asthma) and muscarinic antagonists (COPD)

Beta-2 Agonists for Asthma

albuterol, formoterol, salmeterol, indacarol

Beta-2 Agonist Rehab Relevance

tachycardia, arrythmia, angina

Muscarinic Antagonists for COPD

ipratropium, tiotropium

Pulmonary Glucocorticoids

beclomethasone, budesonide, fluticasone

Pulmonary Glucocorticoid Rehab Relevance

• Rinse mouth after inhaler
• Monitor blood glucose
• Osteoporosis with chronic use

Leukotriene Inhibitors

zileuton, Montelukast

Sedatives and Hypnotics

barbs, benzos, z-drugs, atypical agents

Barbiturates

phenobarbital

Barbs Rehab Relevance

• Increased fall risk
• Difficulty learning
• Confusion and lethargy (especially in the elderly)

Benzodiazepines

diazepam, lorazepam, alprazolam

sleep aids: triazolam, temazepam, flurazepam

Benzos Rehab Relevance

dose must be tapered, withdrawal can occur

Z-Drugs

zaleplon, zolpidem

Atypical Agents for Sedation

antihistamines, melatonin agonists, anxiolytics

Antihistamines for Sedation

diphenhydramine, doxylamine, hydroxyzine

Melatonin Agonists

Ramelteon

Anxiolytic for Sedation

Buspirone

Antipsychotic Agents

first generation, second generation (atypical)

1st Gen Antipsychotics

haloperidol

2nd Gen Antipsychotics (Atypicals)

aripiprazole, clozapine, olanzapine, quetiapine

Atypical Antipsychotic Rehab Relevance

• Parkinsonism (tx: anticholinergics)

• Acute dystonia (tx: anticholinergics)

• Akathisia (tx: reduce dose)

• Neuroleptic Malignant Syndrome (ER!!)

• Tardive Dyskinesia (tx: prevention)

Antidepressants

SSRIs, SNRIs, atypical SSRIs

SSRIs

citalopram, escitalopram, sertraline, fluoxetine, paroxetine

SSRI Rehab Relevance

serotonin syndrome (hyperreflexia, unstable BP and HR, tremors, clonus, hyperthermia, sweating)

SNRIs

duloxetine, venlafaxine

Atypical SSRIs

bupropion, mirtazapine

Local Anesthetics

esters and amides

Ester Anesthetics

procaine, tetracaine, benzocaine, cocaine

Amide Anesthetics

lidocaine, bupivacaine

LA - Rehab Relevance

• Decreased proprioception

• Muscle weakness

• Topical: systemic toxicity

• Intrathecal: sedation, fall risk, cognitive issues, spinal headache

• Spinal Anesthesia with Lidocaine: dysesthesia, pain without motor deficits

-Peripheral Nerve Block: quad weakness, falls

• Spinal Block: bradycardia, hypotension, respiratory depression, urinary retention, spinal headache

• Continuous Lidocaine Infusion: transient neurological syndrome

Skeletal Muscle Relaxants

neuromuscular blockers, antispasticity agents, antiaspasm agents

Neuromuscular Blockers

non-depolarizing (rocuronium, cisatracurium)

depolarizing (succinylcholine)

Antispasticity Agents

central: baclofen, diazepam, tizanidine

peripheral: botox, dantrolene

Antispasticity - Rehab Relevance

• Discontinuing intrathecal baclofen causes withdrawal
• Weakness inherent
• CNS effects
• Tolerance and misuse

Antispasm Agents

cyclobenzaprine, carisoprodol (soma)

Opioids

ordered by agonism

Strong Opioid Agonists

fentanyl, morphine, hydrocodone

Moderate/Mild Opioid Agonists

oxycodone, codeine, tramadol

Partial Agonist / Mixed Opioids

buprenorphine

Opioid Antagonists

naloxone, naltrexone

Other Opioids

dextromethorphan

Opioid Rehab Relevance

• Falls, improper thinking
• Hypotension
• Blunted exercise response
• Non-accurate pain understanding
• Withdrawal (sympathetic surge)

Neuropathic Pain Agents

gabapentenoids, tricyclic antidepressants, SNRIs

Gabapentenoids

gabapentin, pregabalin

Tricyclic Antidepressants (TCAs)

amitriptyline

SNRIs - Neuropathic Pain

duloxetine (mainly), venlafaxine

Diuretics

PCT diuretics, loop, thiazide, potassium-sparing

PCT Diuretics

acetazolamide, mannitol

Loop Diuretics

furosemide

Thiazide Diuretics

chlorthalidone, indapamide, hydrochlorothiazide

Potassium-Sparing Diuretics

Na+ channel blockers and aldosterone antagonists

Na+ Channel Blockers

triamterene and amiloride

Aldosterone Antagonists

spironolactone

Antihyperlipidemics

statins, niacin, fibrates, bile acid binding resins, ezetimibe, PCSK9 inhibitors

Bile Acid Binding Resins

cholestyramine, colestipol

PCSK9 Inhibitors

evolocumab

Antihypertensives

reduce blood volume, inhibit sympathetic tone, alter RAAS system, vasodilators, calcium channel blockers

Antihypertensive -- Reduction of Blood Volume

diuretics (thiazides)

Antihypertensive -- Inhibit Sympathetic Tone

alpha blockers, beta blockers, central a2 agonists

Alpha Blockers

prazosin, doxazosin, tamsulosin

Beta Blockers

metoprolol, propranolol, carvedilol

Central Alpha-2 Agonists

clonidine, guanfacine, methyldopa

RAAS Drugs

ACE inhibitors and AngII Receptor Blockers

ACE Inhibitors

captopril, lisinopril

Angiotensin II Receptor Blockers (ARBs)

losartan

Antihypertensive -- Vasodilators

hydralazine, minoxidil, sodium nitroprusside

Antihypertensive -- Calcium Channel Blockers

dihydropyridines (amlodipine, nifedipine)

non-dihydropyridines (verapamil, diltiazem)

PDE5 Inhibitors

sildenafil, vardenafil, tadalafil

Hypothyroidism Drugs

levothyroxine (t4)

Hyperthyroidism Drugs

propylthiouracil (PTU), methimazole

thyroid storm: propranolol and cholestyramine

Osteoporosis Drugs

antiresorptive agents and bone anabolic drugs

Antiresorptive Agents

bisphosphonates, denosumab, raloxifene, calcitonin, estrogen