Albuterol (ranked #11 in 2017, Table 17) is a beta-2 receptor agonist (bronchodilator) used to treat breathing difficulties related to asthma and chronic obstructive pulmonary disease [(COPD); (NIH, 2016a)]. Side effects of albuterol are known to include the gastrointestinal, musculoskeletal, cardiovascular, and central nervous systems as well as the integument. When albuterol is used as an aerosol, the topical application minimizes the systemic distribution of the drug and, as a result, the frequency and intensity of side effects are greatly reduced (NIH, 2016a). Fluticasone (ranked #20 in 2017, Table 17) is a corticosteroid often used in aerosol form to treat breathing difficulties related to asthma and COPD (NIH, 2015b). When Fluticasone is used as an aerosol, the topical application minimizes the systemic distribution of the drug and the frequency and intensity of side effects. However, side effects are known to occur in the pulmonary, integumentary, musculoskeletal, and central nervous systems with the use of corticosteroids (NIH, 2015b). Gabapentin (ranked #12 in 2017, Table 17) is an anticonvulsant used for the treatment of seizure disorder (epilepsy). This drug is known to produce side effects in multiple physiological systems, including the central nervous, GI, musculoskeletal, pulmonary, and integumentary systems, as well as causing weight gain. Changes in breathing (pulmonary system) and rashes (integument) are considered to be potentially dangerous and should be reported to a physician as soon as possible (NIH, 2017g). Sertraline (ranked #13 in 2017, Table 17) is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression and generalized anxiety disorder (NIH, 2014, 2017p). Citalopram is an SSRI and was ranked #21. The reader should remember that about 15% of the subjects in Boissonnault’s outpatient study (1999) reported a history of depression, and a history of depression dramatically increases the risk of another bout of depression. These drugs have been associated with a worsening of depression and suicidal ideation, most often when the person first starts taking the medication. In addition to the effects on the CNS, adverse reactions to these drugs are known to occur in the GI, musculoskeletal, pulmonary, and integumentary systems. There are reports of weight gain and sexual dysfunction with the use of these medications (NIH, 2014, 2017p). The antibiotic azithromycin (ranked #16 in 2017, Table 17) is primarily used to treat sinusitis, upper respiratory infections, and ulcers related to infection with H. pylori . This antibiotic can cause adverse reactions in the integument, GI, and pulmonary systems (NIH, 2017e). These side effects and adverse reactions usually result in the patient responding positively to multiple general health questions and the specific physiological screening questions for the integument, GI, and pulmonary systems. A very serious, but rare, side effect of this antibiotic is acute renal failure, which can result in rapid, unexplained weight gain and edema via fluid retention (Belko, Urueta, & Emre, 1995). Elevated risk for an NSAID-induced ulcer is associated with being over 65 years of age, having a history of peptic ulcer, and use of alcohol, tobacco, oral corticosteroid, acid suppressant, or anticoagulant (Goodman et al., 2018). In contrast, OTC acetaminophen, which is neither an aspirin nor any other type of NSAID, is not associated with GI ulcers, but is a known hepatotoxin. As a result, therapists should assess the risk factor profile and screen patients taking aspirin and/or other NSAIDs for: a. Signs and symptoms of a GI disorder. b. Additional risk factors associated with developing a GI disorder. c. Use of other ulcerogenic medications. d. Use of medications to reduce the symptoms of a GI disorder.
been associated with several problems including increased risk for dementia, infections (including Clostridium difficile and pneumonia ), kidney disease, and osteoporosis leading to an increased incidence of hip, wrist, and spine fractures (Ambizas & Etzel, 2017; Ament, DiCola, & James, 2012; Freedberg et al., 2017; Harvard, 2009). However, the quality of evidence in support of these findings is “low to very low” and the odds of these events occurring is very low (<1%/patient year; Freedberg et al., 2017). Hydrocodone , the generic version of Vicodin (ranked #8 in 2017, Table 17) is an analgesic containing a combination of a synthetic opioid and acetaminophen. The number of prescriptions written for opiates peaked in 2014 (Kane, 2017). The drop in the number of prescriptions for hydrocodone in 2017 appears to reflect a change towards the use of opiates for the treatment and control of pain in the U.S. This drug is used for moderate to severe musculoskeletal pain. Opioids are known to have an adverse impact on the drive for ventilation in the CNS and can result in breathing difficulties, hypoventilation, or complete cessation of breathing (Gallagher, 2010; NIH, 2017i). An adverse reaction is more likely when hydrocodone is taken in combination with alcohol or another CNS depressant (e.g., sedatives or tranquilizers). Hydrocodone has additional potential adverse effects that impact the integument, GI system, pulmonary system, and CNS (NIH, 2017i). The use of hydrocodone and other opiates has been linked to problems with addiction. Acetaminophen, an analgesic used in hydrocodone, is generally considered to be safe when taken as directed. However, acetaminophen is known to be highly toxic to the liver when taken in large doses. Side effects related to the acetaminophen in hydrocodone are highly unlikely unless the patient simultaneously uses a second or third source of acetaminophen (e.g., Tylenol or a cold medication containing acetaminophen). Signs indicative of liver toxicity include a jaundiced appearance, edema, and unusual bleeding or bruising. Frequently reported side effects of acetaminophen occur in the integument and pulmonary system (NIH, 2017a). Acetaminophen (ranked #17 in 2017, Table 17) is an analgesic used to treat mild to moderate headaches, musculoskeletal pain, tooth aches, and menstrual cramps, as well as to reduce fever ( antipyretic ). Acetaminophen is available in over-the-counter and prescription grade formulations. Acetaminophen is known to be highly toxic to the liver when taken in large doses. Side effects are highly unlikely unless the patient simultaneously uses a second or third source of acetaminophen (e.g., hydrocodone or a cold medication containing acetaminophen). This risk of liver dysfunction is significantly elevated if the patient has a history of liver disease. Blood tests for liver enzymes can be used to determine if there has been a negative impact on liver function. Signs indicative of liver toxicity include a jaundiced appearance, edema, and unusual bleeding or bruising. The most frequently reported side effects occur in the integument and pulmonary systems (NIH, 2017a). Common over-the-counter medications Any discussion of patient medication usage should include the use of over-the-counter (OTC) medications, as well as prescription medications. About one in ten Americans will suffer from GI ulcers in their lifetimes (Garrow & Delegge, 2010). Gastrointestinal ulcers are believed to result in approximately 1 million hospitalizations and 65,000 deaths per year in the United States (Garrow & Delegge, 2010). Aspirin and the other nonsteroidal anti-inflammatory drugs (NSAIDs) are estimated to produce GI ulcers, perforations, and/ or bleeding in 1% to 2% of people taking these medications (Christensen, Riis, Nørgaard, Thomsen, & Sorensen, 2007; Rahme, Bardou, et al., 2007).
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