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APPENDIX IV: PHARMACOLOGIC AGENTS

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Table IV-26. Osmotic Diuretics

Indication: To reduce intracranial pressure by reducing cerebral edema and

Inrerstltial pressure

Mechanism of action: Increase plasma osmolarity of [he glomerular filtrate,

rhus hindering rubular reabsorprion of warer

General side effects: Headache, nausea, vomiting, fever, confusion, blurred

visIOn, tachycardia. hypo- or hypertension, congestive heart failure,

electrolyte imbalance

Generic name (brand name): Mannirol (Osmitcol), glycerin (Osmoglyn),

urea (Ureaphil)

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

Kluwer, 2000.

Table IV-27.A. Posirive Inotropes: Cardiac Glycosides (Digitalis)

Indicarion: Heart failure

Mechanism of action: Increase contractility

General side effects: Decreased heart rate, conduction delay, digitalis [Qxiciry

Genenc name(trade name): Digiroxin (Crystodigin), digoxin (Lanoxin),

deslanoside (Cedilanid-DI V )

Source: 0.113 from K Grimes, M Cohen. Cardiac Medications. I n E A Hillegass, HS

Sadowsky (cdsl. E.ssenti:l\s of Cardiopulmonary Physical Therapy (2nd cd). Philadelphia: Saunders. 2001 ;5.17-585.

Table IV-27.B. POSItive Inotropes: Sympathomimetics

Indicarion: Heart failure

Mechanism of action: Increase contr3ctility by mimicking the effects of the

sympi.uhctic nervous system

General side effects: Smooth muscle dilation (bronchodilation and vasodilation),

prolonged use may decrease scnsitization of beta receptors (decreased

inotropism). Bipyridines may exacerbate ischemia, may worsen ectopy.

Beta I -selective: Generic name (trade name)-doburamine (Doburrex),

prenalterol

Nonseleaive: EpInephrine (Adrenaline Chloride), isoproterenol (Isuprel)

Dopamlnergic: Dopamine (Intropin, Dopastat)

MIxed alpha and beta: Norepinephrine (Levophed)

Bipyridlnes: Amnnone (Inocor)

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

Sadowsky (cds), Esscnrials of Cardiopulmonary Physical Therapy (2nd ed). Philadelphia: Saunders, 2001 ;B7-S8S.

868 ActJfE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table lV-2S. Skeletal Muscle Relaxants

Indication: To decrease muscle spasticity

M echanism of action: Depress mono- and polysynaptic afferent spinal reflex

activity or alter calcium ion activity within muscle

General side effects: Nausea, vomiting, fatigue, drowsiness, weakness,

insomnia, ataxia, confusion, hypotension, hyperglycemia, urinary

frequency

Generic name (brand name): Sadofen (Lioresal), dantrolene sodium (Dantrium), diazepam (Valium), rizanidine hydrochloride (Zanaflex) Source: Data from Drug Facts and Comparisons 2000 (54th cd). Sr. Louis: Wolters

Kluwer, 2000.

Table lV-29. Thrombolytic Agents (Fibrinolytics)

Alteplase (Activase),

Indications: Acute MI," ischemic e VA, or

reteplase (Reravase)

massive PE

Mechanism of action: Tissue plasminogen

activaror; binds [0 fibrin in a thrombus and

converts plasminogen to plasmin co degrade

(fibrinolysi ) the fibrin mattix of a thrombus

General side effects; Alteplase-bleeding of

gastrointestinal, genitourinary, or respiratory

tracts, or intracranial bleeding; cerebral

edema (in the setting of e VA), reperfusion

arrhythmia; reteplase-bleeding and

arrhythmia as above, heart failure,

m yocardial reinfarction, hypotension

Anisrreplase (Eminase),

Indications: Anistreplase--acute MI;

streptokinase

streprokinas�volving MI, PE, deep vein

(Kabikinase, S treptase),

thrombosis, occluded arteriovenous cannula;

urokinase (Abbokinase)

urokinase-acute massive PE, evolving Mi,

intravenous catherer clearance

Mechanism of action: Thrombolytic enzyme;

acts with plasminogen ro convert it ro

plasmin ro degrade the fibrin matrix of a

thrombus

General side effects: See Alteplase; hypotension,

fever, allergic reactions

CVA = cerebrovascular accidcm; MI = myocardial infarction; PE = pulmonary embolism.

-The only indication for rCfeplase.

Source: Dafa from Drug Facts and Comparisons 2000 (54th ed). St. Louis: Wohers Kluwer, 2000; and Anticoagulant, Antipl:ttelet, and Thrombolytic Drugs. In RA Lehne (ed), Pharmacology for Nursing Care (4th ed). Philadelphia: Saunders, 200 1 .