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APPENDIX IV: PHARMACOLOGIC AGENTS

853

Table IV-12. Beta Blockers

Indications: Ischemia, hypertension, arrhythmias

Mechanism of action: Decreases myocardial oxygen demand by decreasing

sympathetic input ro myocardium, therefore decreasing heart rate and

contractility

General side effects: Smooth muscle spasm (bronchospasm), exaggeration of

therapeutic cardiac actions (bradycardia), fatigue, insomnia, masking of

hypoglycemic symproms in diabetics, impaired glucose rolerance,

decreased high-density lipoprotein cholesterol

Selective agents

Beta I selective·: Aceburolol (Sectral), alprenolol, atenolol (Tenormin),

esmolol (Brevi bloc), metoprolol (Lopressor)

Beta 2 selective: Alpha and beta antagonisrs-bbetalol (Normodyne,

Trandate), butoxamine, carvedilol (Coreg)

Nonselective agents: Carteolol (Carrol), laberalol (Normodyne), nadolol

(Corg.rdl. pindolol (Viskenl. ptop.nolol (Inderall. timolollBlocadrenl

·Selcctive refers to blockade of beta- I , beta-2, or alpha receptors. Nonselective means

not selective in blocking receptors.

Source: Data from K Grimes, M Cohen. Cardiac Medications. In fA Hillegass, HS

Sadowsky (cds), Essenrials of Cardiopulmonary Physical Therapy (2nd ed). Philadelphia: Saunders, 200 1 ;537-585.

Table IV-13. Bronchodilators

Indications: To relieve bronchospasm associated with obstructive pulmonary

disease, including exercise-induced bronchospasm

Mechanism of action: Smooth muscle relaxation of the bronchi or

bronchioles

General side effects: Headache, dizziness, irrit:1bility, nervousness, tremor,

tachycardia, dysrhythmia, hypotension

Generic name (trade name); Sympathomimetics-albuterol (Airet, Provenril,

Vemolin, Vol max), bitolterol mesylate (Tornalate), ephedrine sulfate, epinephrine (Adrenaline chloride, Ana-Guard, AsthmaHaler Mist, AsthmaNefrin, microNefrin, Primatene Mist, Sus-Phrine), isocrharine hydrochloride, levalburerol hydrochloride (Xopenex), metaproterenol sulfate (Alupenr), pirbuterol acetate (Maxair), salmeterol (Serevent), terburaline sulfate (Brethaire, Brethine, Bricanyl); xanthine derivatives-aminophylline (Phyllocontin, Truphyllinel. dyphylline (Dilor. Lufyllinl. oxtriphylline (Choledyl SAl. theophylline (Accurbron, Aquaphyllin, Asmalix, Bronkodyl, Elixomin, Elixophyllin, Lanophyllin. Quibron-T/SR Dividos<. Respbid. Sio-bid. Sio-Phyilin. Sustaire.

Theobid, Theostat, Theovenr, Theo-Dur, T-Phyl, Uni-Dur, Uniphyl)

Source: Data from Drug Faces and Comparisons 2000 (54th ed). Sr. Louis: Wolters

Kluwer, 2000.

854

ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table IV-14. Calcium Channel Blockers

Indications: Ischemia, arrhythmias, hyperrension

Mechanism of action: Decrease myocardial oxygen demand and increase

supply of myocardial oxygen by slowing down transport of calcium on

smooth muscle and myocardial cells, therefore reducing contractility and

afterload

General side effects: Negative inotfope at high doses, orthostatic hypotension,

peripheral edema, dizziness, gastrointestinal upset, headache

Generic name (trade name): Amlodipine (Lotrel, Norvasc), bepridil (Vascor),

diltiazem (Cardizem), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Procardia, Adalat), nimodipine (Nimorop), nisoldipine (Sular), vcrapamil (Isoptin, Calan)

Source: Data from K Grimes, M Cohen. Cardiac Medications. In EA Hillegass, HS

Sadowsky (eds), Essentials of Cardiopulmonary Physical Therapy (2nd cd). Philadelphia: Saunders, 2001 ;537-585.

Table l V-1 S.A. Alkylating Agents (Chemotherapy Agents)

Indications: Malignant neoplasms, metastatic disease

Mechanism of action: Inhibit DNA function and replication

Generic Name (Trade Name)

Side Effects

Busulfan (Myleran)

Myelosuppression, pulmonary fibrosis, anemia, leukopenia, thrombocytopenia, fatigue,

weight loss

Carboplatin (Paraplatin)

Myelosuppression, nausea, vomiting, neurotoxicity

Carmustine (BiCNU)

Nausea; vomiting; pain; tissue necrosis;

pulmonary. renal, and hepatotoxicity

Chlorambucil (leukeran)

Nausea, vomiting, stomatitis, thrombocytopenia, myelosuppression, neutropenia,

anemia, interstitial pneumonitis, exfoliative

dermatitis, hyperuricemia

Cisplatin (Platinol)

Peripheral neuritis, tinnitus, nausea, vomiting,

leukopenia, thrombocytopenia, anemia,

renal tOxicity

Cyclophosphamide

Cardioroxicity, leukopenia,

(Cyroxan)

thrombocyropenia, anemia, pulmonary

fibrosis

Dacarbazine (OTIC-Dome)

Nausea, leukopenia, thrombocytopenia, fever,

malaise

APPE.NDIX IV: PHARMACOLOGIC AGE.NTS

855

Generic Name (Trade Name)

Side Effects

Ifosfamide (Ifex)

Lethargy, somnolence, confusion, depressive

psychosis, ataxia, coma, seizures, nausea,

vomiting, hemorrhagic cystitis, hematuria,

leukopenia, thrombocytopenia, myelosuppression, alopecia

Lomustine (CeeNU)

Nausea, vomiting, anemia, leukopenia, thrombocytopenia

Mechlorethamine

Headache, weakness, tinnitus, nausea, vomit

(Musrargen, Nitrogen

ing, m yelosuppression, metallic taste in the

Mustard)

mouth

Melphalan (Alkeran)

Thrombocytopenia, agranulocytosis, pneumonitis, pulmonary fibrosis, anaphylaxis

Procarbazine

Nausea; vomiting; pain; tissue necrosis; pulmonary, renal, and hepatotoxicity

Streprozocin (Zanosar)

Nausea, vomiting, diarrhea, anemia, leukopenia, thrombocytopenia, anemia, hyperglycemia

Thiotepa (ThiOtepa)

Headache, dizziness, nausea, leukopenia,

thrombocytopenia, anemia

Uracil mustard

Irritability, nervousness, nausea, thrombocyropenia, anemia, hyperpigmentation of skin

Sources: Data from C Ciccone (cd). Cancer Chemotherapy. Philadelphia: FA Davis,

1 996; and D Moreau (ed). Nursing '96 Drug Handbook. Springhouse, PA: Springhouse, 1996; and LM Tierney, SJ McPhee, MA Papadakis (cds). Current Medical Diagnosis and Treatment. New York: McGraw-Hili, 2000.

Table IV-IS .B. Antibiotics (Chemotherapy Agents)

Indicadons: Malignant neoplasms, metastatic disease

Mechanism of action: Disrupt {he DNA and RNA synthesis

Generic Name

(Trade Name)

Side Effects

Bleomycin

Nausea, vomiting, fever, chills, anaphylaxis, alopecia,

(Slenox.ne)

sromaritis, erythema, pulmonary tOxicity (interstitial

pneumoniris), general weakness and malaise, headache, leukocytosis, pulmonary fibrosis, joint swelling

Dactinomycin

(Cosmegen)

Nausea, vomiring, myelosuppression, tissue necrosis,

alopecia, mucositis