Chapter 9: Pharmaceuticals and Physical Therapy: Movement with Medication 4 CE Hours
By: Andrew Hodgdon, PT Learning objectives Following completion of this continuing education course, the learner can expect to: Describe and critique U.S. federal law regarding pharmaceuticals. Recognize chemical and physiologic components of pharmacology. Recall and sequence pharmacodynamic physiology. Describe and assess fundamental pharmacokinetic processes. Compare pharmaceutical and physiologic variability. Justify concern regarding biological antibiotic resistance. Distinguish pharmaceutical effects upon the autonomic and central nervous systems. Physical therapy and pharmacology have operated alongside each other for thousands of years. Physical therapy has been traced to ancient Greek civilizations, with Hippocrates in particular promoting medical treatment with massage application, manual therapy and hydrotherapy dating back to around 400 B.C. (Wharton, 1991). As a professional entity, physical therapy has existed for approximately 200 years, dating back to Per Henrik Ling and the Royal Institute for Gymnastics in Sweden. Pharmacology has also developed alongside humanity since ancient times, with recorded application on or before 1550 B.C., across a number of cultures around the world. The term pharmacology means “the study of medicine or the study of remedy and poison” (Watkins, 2013, p. 4). Over the course of human history, “healers,” also known as shamans , witch doctors, and/or medicine men and women, were sought after due to their knowledge of the medicinal properties of plants. Modern pharmacology is earmarked around 1800, when scientists were able to sequester the pure chemicals needed from specific plants. Mass production of medicine began in the primary half of the 20th century, denoted by mass production of penicillin during World War II. Official physical therapy organizations were formed and developed during this time, with specific historical documentation observed in Great Britain, New Zealand and the United States (Physiopedia, 2015). Physical therapists must be able to exhibit magnanimous biological and physiological scholarship and practice. The second half of the 20th century ushered in preference for synthetic medicines, developed in sterile laboratory settings. Only over the last 50 years has relative interest for natural medicinal sources resurfaced, often referred to as “homeopathic” or “alternative” medicines (Watkins, 2013, p. 5). Pharmacology is the study of substances used to treat illness. Pharmaceutical sources are broad and may include plants, domestic animals, minerals and toxins, as well as genetically engineered synthetics. Common plant-based pharmaceuticals include digoxin, which is derived from the foxglove plant. Others such as lanoline, are made from sheep’s wool. In addition, mineral supplements such as calcium, iron, zinc, magnesium, copper and selenium are applied to treat observed biological deficiencies. Toxins such as radioactive iodine are applied in diagnostic as well as medicinal contexts to treat tumors (Watkins, 2013, p. 7). Synthetic medications allow for preservation of natural resources as well as decreased risk of disease contraction from animal sources. They are also entwined with efforts to map the human genome and further specify individual pharmaceutical application.
Summarize multi-modal pharmaceutical management of hypertension. Determine the role of vasodilators in multi-modal medical care. Interpret pharmaceutical intervention for cardiopulmonary pathologies. Construct the role of physical rehabilitation in the context of sedatives, hypnotics and multi-modal anesthetics. Assess the role and objective danger associated with opioid prescription.
INTRODUCTION
The effects of a drug on the body, termed pharmacodynamics , can be categorized as curative, prophylactic, diagnostic, palliative, replacement or destructive. Curative drugs help to advance the body out of a pathological state. Prophylactic drugs are used to prevent pathological development and may include application of antibiotics post-surgery to prohibit potential infections. Diagnostic drugs include barium sulfate ingestion prior to computerized tomography (CT) scans. Palliative drugs are applied for treatment of specific symptoms, as well as to make an individual relatively more comfortable. Replacement drugs are used to supplement impaired biological and physiologic processes. Finally, destructive drugs are used to destroy tumors and/or microbes (Watkins, 2013, pp. 8-9). Currently, the American Physical Therapy Association (APTA) describes the physical therapist’s role as that of a “case manager” with regards to pharmaceuticals. The APTA defines the physical therapist’s duties with regards to medication management as “screening, evaluation, collection of information, identification of adverse events/reactions, and education” (APTA Official Statement). Collective efforts between physical therapists and pharmacists have been formalized under the term “medication therapy management” (MTM), which has been adopted by 11 national pharmacy organizations. MTM is defined as “a distinct service or group of services that optimized drug therapy with the intent of improved therapeutic outcomes for individual patients.” MTM is collaborative between pharmacists, physicians and other health professionals. Although traditional points of physical therapy interest revolve around medication management in the home/health setting and topical/transdermal pharmaceutical application in outpatient settings, the concept of medication management in physical therapy is essential for modern practice standards. Components of MTM include thorough medication review, examining safety and efficacy of medication therapy, applying education and enablement to enhance medication adherence, as well as documenting and communicating with prescribers for the purpose of comprehensive patient care (APTA, 2013). MTM is a product of the central role of pharmaceuticals in medical care. This approach considers the reality of modern medicine, including chronic pharmaceutical application, multiple prescribers and transition of the care environment, depending on patient medical status. As well, Medicare regulations require that completing a full patient intake include a detailed inquiry of a patient’s medical records as well as communication with other members of the care team.
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