pain modulation. Opioids are administered in a wide variety of clinical presentations that involve pain perception in terms of sensory and affective (emotional) components. Typical effects also include subjective euphoria; sedation; depression of cough, respiratory, renal and uterine function; truncal rigidity; nausea/ vomiting; decreased percentage of stage 3 and 4 sleep states; and constipation. General duration of effects vary from one to eight hours. Maximum efficacy is relative to drug design and dosage. Common opioids also include hydromorphone, oxymorphone, methadone, fentanyl, codeine, hydrocodone and oxycodone. In the acute inpatient setting, opioids are commonly used to manage variable acute and chronic complaints. Opioids are commonly associated with tolerance and dependence, the nature of which is currently hypothetical. In addition, opioids may also induce hyperalgesia, most often in the context of chronic pain. Physical therapy media and culture has developed a strong campaign against habitual prescription use and abuse of opioids. Incidents of opioid-induced respiratory failure and death are significant. Opioid addiction is considered to be a crisis in the United States. It is estimated that the United States consumes approximately 80 percent of the world’s opioids (Katzung, 2018, p. 569). Anticoagulants Anticoagulant drugs limit blood coagulation, and are commonly applied in clinical presence of thromboembolic disease, chronic atrial fibrillation, deep vein thrombi, pulmonary emobili, and cerebral vascular accidents (strokes). Heparin is a common anticoagulant administered via intravenous or subcutaneous injection to enhance the physiologic function of endogenous antithrombin, which effectively inhibits clot formation. While Heparin is more commonly applied to induce rapid anticoagulation, it presents poor bioavailability in parenteral form. In contrast, warfarin (aka Coumadin) is chemically structured to present with 100 percent bioavailability and a 36-hour half-life when administered orally, making it one of the most commonly prescribed drugs (Katzung, 2018, p. 614). Fibrinolytic drugs form the serine protease known as plasmin , which effectively lyses thrombi in rapid fashion, and may be invoked by endogenous activation of tissue plasminogen activators (t-PAs). Fibrinolytic pharmaceuticals, such as alteplase, reteplase and tenecteplase, are administered within clinically defined therapeutic windows in the presence of cerebral vascular Conclusion Familiarity and interest regarding pharmaceutical therapy presents a point of relative naivety in relation to physical therapy. While cognizant of relative pharmaceutical effects, physical rehabilitation has yet to develop a firm understanding of pharmacokinetics and pharmacodynamics in relation to functional movement. This dynamic relationship presents opportunities for functional progression as well as potential pitfalls. The presence of pharmaceuticals in medical care requires continued efforts by physical therapist to be steadfast American Physical Therapy Association (2013, May 30). Medication management and physical therapists. Retrieved January 22, 2018, from physical therapy medication management. American Physical Therapy Association. The role of physical therapists in medication management. Retrieved January 22, 2018, from www.apta.org/uploadedFiles/APTAorg/ Payment/Medicare/Coding_and_Billing/Home_Health/Comments/Statement_ MedicationManagement_102610.pdf Amiji M., Cook T., Mobley, W. (2014). Applied physical pharmacy; second edition. New York: McGraw-Hill. Amin, M. L. (2013). P-glycoprotein inhibition for optimal drug delivery. Drug target insights, 7, 27. Katzung, B.G. (2018). Basic & clinical pharmacology, 14th edition. San Francisco: McGraw- Hill Education. Pharmacology and physical therapy; Where pharm meets function. Retrieved January 22, 2018, from https://pharmacologyandpt.com Physiotherapy / Physical Therapy (2017, June 6). Physiopedia, Retrieved January 15, 2018, from www.physiopedia.com/index.php?title=Physiotherapy_/_Physical_ Therapy&oldid=172012 Radhakrishnan, S., Iwach, A. (2016). Glaucoma medications and their side effects. Glaucoma Research Foundation. Retrieved January 25, 2018, from www.glaucoma.org/gleams/ glaucoma-medications-and-their-side-effects.php Wharton M. A. Health Care Systems I, Slippery Rock University. 1991. Watkins, C. J. (2013). Pharmacology clear and simple: A guide to drug classifications and dosage calculations; second edition. Philadelphia: F. A Davis Company. References
accidents, in order to lyse cerebral thrombi and potentially reduce local brain tissue ischemia. In addition, anti-platelet agents, such as aspirin, prohibit cyclooxygenase-thromboxane interactions, and are a commonly prescribed anti-coagulant following myocardial infarction and/or stroke. Anti-coagulants inherently present increased risk of bleeding, whether spontaneous or due to trauma, relative to pharmaceutical dosage and duration of use. Primary concerns of physical therapist who may treat patients taking anti-coagulants in both inpatient and outpatient settings include negating fall risk, recognizing potential signs of acute hemorrhage, and enacting emergency response systems. Corticosteroids Synthetic corticosteroids are applied in general presentation of a wide variety of inflammatory and immunologic disorders. Synthetic corticosteroids enact anti-inflammatory and immunosuppressive activity by inhibiting function of physiologic immunity mediators such as lymphocytes, macrophages, neutrophils, eosinophils and basophils (Katzung, 2018, p. 708). Local effects, such as those induced by dexamethasone, include vasoconstriction when applied at the dermal level. While dexamethasone has been commonly employed by physical therapists in outpatient clinical settings, general consideration of decreased immune function for patients taking this class of drug is of value in rehab settings, and may present for patients who suffer from chronic pathologies of immune disorder such as lupus and rheumatoid arthritis. Diabetic pharmaceuticals Pharmaceutical management of diabetes seeks to optimize the physiologic presence of insulin for the purpose of glucose uptake. Human insulin is manufactured and applied via subcutaneous administration in a variety of formats. Common administration formats include syringe, insulin pens and continuous subcutaneous infusion devices. In contrast, metformin controls blood glucose levels by reducing hepatic glucose production (Katzung, 2018, p. 759). With regards to physical therapy, patients prescribed diabetic pharmaceuticals present increased risk for blood glucose variability. Blood glucose instability can lead to diabetic ketoacidosis in the presence of hyperglycemia and/or insufficient insulin replacement, versus acute critical hypoglycemia. Both presentations constitute medical emergencies, as they can lead to regression into coma if left untreated. in professional examination practices, and prioritize patient safety relative to pharmaceutical therapy efforts. Future scholastic endeavors would do well to increase dialogue between movement-based clinicians and those prescribing pharmaceuticals. Currently, physical therapy evaluation, regardless of setting, should include thorough understanding of a patient’s pharmaceutical regimen, and the potential effects on activity tolerance and functional capability.
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