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842 ACUH CARl I-IANf)800� fOR PIIY\ICAI HII-RAPI\I\

Table IV-l. Adrenocortical Steroids (Glucocorricoids)·

Indications: To decrease cerebral edema or mflJmmatlon In neoplastic or

inflammarory diseases, or both

Mechanism of action: Prevent the accumulation of mflammator)· cells at the

infection site, inhibit lysosomal en7_yme release and chemical medi.1tors of

inflammatory res-ponse, reduce capillary dilatation and permeability

General side effects: Headache, vertigo, diaphoresilj, nausea, vomiting.

congestive heart failure in susceptible patienrs, euphoria, insomnia, seizure,

muscle weakness, cushingoid features, osteoporoSIS, derm3tlti':t, decreased

wound healing, thromboembolism, aggravation of hyperten<;ion

Generic name (trade name): Dexamethasone ( Decadron, Dexone, Ilcxadrol),

dexamethasone sodium phosphate (Cortastat, Dalalonc, Dccadron Phosphate, Decaject, Dexone, Hexadrol Phosphate, Solurex), methylprednisolone (Medrol), prednisone ( Deltasone, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred), predni�olone ( Delta-Cortef, Prclone), predniSOlone acetate (Key-Pred, Predcar, Predalone), prednisolone �odium phosphare (Hydelrrasol, Ker-Prcd-SP, Pcdiapred)

• For neuroscience patients.

Sources: Data from Drug I:acts and ComparlSoJl!. 2000 (541h cd). \t. LOlll�: Woller ..

Kluwer, 2000; and Drug Facis and Compansons 2001 (.Ulh cd). \t. I.OUl'i: Wolrer ...

Kluwer, 200 I.

Table rV-2. Angiotensin-Converting Enzyme Inhibitors

Indication: Heart failure

Mechanism of action: Inhibit conversion of angiorcnsin I to angiorensin II

and therefore act to decrease excess water and "iodlum rerentlon while also

preventing vasoconstriction

General side effects: Edema, cough, hyporcnsion, skill rash, renal failure, [a�re

disturbances

Generic (trade name): Captopril (Capmen), enalapril ( Vasorec). lisllloprd

(Prinivil, Zestfll)

Source: Data from K Grlmcs, M Cohen. Cardiac Medu..:auotl!l. In FA 1IIIlcgas!l. HS

Sadowsky (cds). Essentials of Cardiopulmonary I)hysical Therapy (2n� cd). Philadelphia: Saundcr!l. 2001 ;537-58S.

APPENDIX IV: PHARMACOLOGIC AGENTS

843

Table IV-3. Antiarrhythmic Drugs

Indications: Arrhythmia, ischemia, hyperrension

Mechanism of anion

Class I: Sodium channel blockers-slow the fast sodium channels, thereby

controlling rate of depolarization

General side effects: Gastrointestinal or urinary retention, or both,

central nervous system abnormality

Class 11: Beta blockers-block sympathetic stimulation of cardiac muscle

General side effects: Smooth m uscte spasm, exaggeration of therapeutic

acrions (bmdycardia), fatigue, insomnia, masking hypoglycemic

symptoms in diabetics, impaired glucose rolerance, decreased highdensiry lipoprOtein cholesterol

Class III: Refractory period alrerations-prolong refractory period of

cardiac tissue

General side effects: May rransiently increase pacemaker (sinoatrial

node) activity

Class IV (calcium channel blockers): Block slow calcium channels

General side effects: Negative inorrope at high doses

Sodium channel blockers (gcneric name Itradc name!): Disopyramide

(Norpace, Rythlllodan), encainide (Enkaid), flecainide (Tambocor"

lidocaine (Xylocaine), mcxiletine (Mexitil), moricizine (Ethmozine),

phenytoin (Dilanrin), procainamide (Pronesryl), propafenone (Rhythmol),

quinidine (Biquin. Cardioq uin), toea in ide (Tonocard)

Bera blockers: Refer ro Table I V- 1 2

Refractory period alterations: Amiodarone (Cordarone), brerylium rosylate

(Bretylol), ibutilide fumarate (Corven)

Calcium channel blockers: Refer ro Table IV-14

Source: Data from K Grimes, M Cohen. Cardiac Medications. In EA Hillegass, I-IS

Sadowsky (cds). Essentials in Cardiopulmonary Physical Therapy (2nd cd). Philadelphia: Saunders. 2001;562.

844

AClITE CARE HANDBOOK FOR PHY SICAL TI-tERAPlffi

Table I V-4. Anricoagulams

Low-molecular-weight hep

Indications: Prophylaxis or rreatmenr of

arin, enoxaparin sodium

thromboembolic complications after sur

(Lovenox), dalteparin

gery; for ischemic complications of unstable

sodium ( Fragmin), ardeangina, NQWMI, or cardiovascular acciparin sodium ( Normiflo)

demj prophylaxis of DVT after roral knee

replacement .•

Mechanism of action: Enhances inhibition of

factor Xa and thrombin by binding CO and

accelerating antithrombin III activity.

General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or other

tracts; thrombocyropenia.

Danaparoid sodium

Indication: Prophylaxis of DVT after tOtal hip

( Orgaran)

replacement.

Mechanism of action: See Low-molecularweight heparin.

General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or

other tracts; thrombocytopeniaj fever;

nausea.

Heparin sodium

Indications: Prophylaxis or trearmem of

venous thrombosis, PE, peripheral arterial

embolism, atrial fibrillation, acute myocardial infarction, disseminated intravascular coagulopathy.

Mechanism of action: Prolongs clotting time

by inhibiting the conversion of prOthrombin to thrombin.

General side effects: Bleeding from gastrointestinal, genitourinary, respirarory, or

other tracts; hemorrhagej thrombocytopenia.

Lepirudin (Refludan)

Indication: Thrombus prophylaxis in heparininduced thrombocytopenia.

Mechanism of action: Directly inhibits thrombin.

General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or

other tracts; anemia; hem3coma.