Pharmacology For The Physical Therapy Clinician
MU PT 6620 Case Management: Acute & Chronic Medical & Surgical Conditions
General Principals of Pharmacology
A. Pharmacokinetics - the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body. What the body does to the drug.
1. Route of Administration
• Enteral = alimentary canal
o Oral: subject to “first pass”: portal vein to the liver
o Sublingual: directly to venous return. No first pass e.g. nitroglycerin
o Buccal: directly to venous return. No first pass
o Rectal: given if vomiting or unconscious. Poor absorption
Advantages: Non invasive; Ease of drug administration; Mouth and the GI tract have a rich blood supply for pancorporeal dispersal of the medication; Avoids large fluctuations in drug delivery
Disadvantages: Drugs must be lipid soluble; Drugs can be irritating to the mucosa of the mouth and the gut.
• Parenteral = outside alimentary canal
o IV
o intramuscular (IM): vaccines, botulinum (prolonged release into venous circulation)
o subcutaneous (SQ): insulin, Norplant (contraceptive)
o transdermal patch: e.g. nitro patch or fentanyl-opiod patch
o transdermal iontophoresis and phonophoresis: lidocaine or dexamethasone are driven through dermal layer to local tissue
o intrathecal, epidural: for administering analgesic, anesthetic, or antispasmodic (botulinum)
Advantages: Fast delivery of the medications (IV, inhalation); Efficient maintenance of therapeutic ranges (IV); More predictable; Can give large quantities of medication
Disadvantage: Invasive
• Topical- creams, eye/ear drops, nasal sprays (NS), inhalers (INH)
(sometimes topical is lumped under parenteral)
2. Bioavailability: amount of drug that actually makes it to the intended downstream target. Influenced by route of administration and how easily it can cross cell membrane barriers (size, shape, charge, lipid soluble or protein-bound)
3. Metabolism / Biotransformation: deactivation by the liver, the “Great Detoxifier”
(hydrolysis, oxidation, reduction, conjugation)
4. Elimination / Excretion: primarily by kidneys.
minor roles played by: GI tract (bile salts), lungs (inhaled drugs), sweating, saliva, breast milk
B. Pharmacodynamics – What the drug does to the body
C. Pharmacotherapeutics - is using drug therapy to stimulate or depress certain biochemical or physiological functions in our patient to provide relief of symptoms or ideally to favorably alter the course of their disease.
Therapeutic Index (TI) = Toxic dose / Effective dose
This indicates the relative safety of a drug. For example:
Acetominophen 27
Valium 3
Methotrexate, vincristine 1
Digitalis and Coumadin also have low (narrow) TI. Frequent blood draws needed to monitor levels.
E. Mechanism of Action –
1. Agonist - drug mimics an endogenous substance that would normally stimulate a receptor
2. Antagonist - drug which binds a receptor site, doesn't stimulate it, but does block other substances from
stimulating it
F. Drug Nomenclature
1. Chemical name - example - n-acetyl-para-amino phenol
2. Generic drug name - example – acetaminophen. The FDA catalogs the drug by its generic name
3. Trade name / Brand name- example Tylenol. This is the name the manufacturer gives to the drug that
distinguishes it from the same (generic) drug made by other drug companies.
G. Off-label use
A prescription drug may be prescribed for a purpose / diagnosis that is not approved by the FDA. No clinical trials have been done to study this off-label use.
Example: gabapentin, Neruontin is an antiseizure medicine. It is commonly prescribed off-label for the pain of peripheral neuropathy.
References:
• Bill Morrissey PharmD R.Ph, Kilgore’s Medical Pharmacy, Columbia MO
• Ciccone, C. (2007). Pharmacology in Rehabilitation. (4th ed.). Philadelphia: F. A. Davis Company.
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