Medications play an integral role in the treatment of patients with cardiovascular and pulmonary disorders. Drugs can be used to prevent or treat various pathologies and impairments in the heart, lungs, and circulation, and thereby reduce the functional limitations and disabilities associated with cardiopulmonary disease. Medications can likewise have a synergistic effect with physical therapy interventions. Drugs, for example, that improve cardiac pumping ability, may enable patients to participate more effectively in interventions that improve aerobic capacity and endurance. All medications likewise produce side effects that can have a direct impact on physical therapy interventions. For instance, drugs that lower blood pressure (antihypertensives) may produce dizziness and incoordination if they cause excessive hypotension. It, therefore, makes sense that physical therapists should have a basic understanding of the common cardiovascular and pulmonary medications and how these medications can affect patients receiving physical therapy.
In this chapter, pharmacologic agents are grouped according to the preferred practice patterns as listed originally in Chapter 6 of the Guide to Physical Therapist Practice, 2nd edition (revised).1 For each preferred practice pattern, medications that specifically address cardiovascular or pulmonary problems will be discussed as they relate to that practice pattern. It is, of course, not possible to describe all medications that might be related to each pattern. For example, medications used to control infection, treat cancer, and so forth, may help improve the patient’s overall health, thereby helping the patient to participate in aerobic conditioning, respiratory exercises, and other activities that will ultimately lead to better cardiovascular and pulmonary function. This chapter, however, will focus only on the medications that directly affect the heart, circulation, or lungs and describe how these medications relate to the physical therapy interventions described in the preferred practice patterns. This chapter will likewise present an overview of these medications, their side effects, and the potential impact of these medications on patients receiving physical therapy. For more information about specific drugs, the reader is also encouraged to consult one of the resources listed at the end of this chapter.2-4
MEDICATIONS RELATED TO PREFERRED PRACTICE PATTERN A: PRIMARY PREVENTION/RISK REDUCTION FOR CARDIOVASCULAR/PULMONARY DISORDERS
Many medications are designed to control specific aspects of cardiovascular function so that the risk of cardiac and related diseases is reduced. Controlling blood pressure, for example, can reduce the risk of myocardial infarction, cerebrovascular accident, kidney disease, and so forth. In some cases, drug therapy can be initiated to prevent the first episode of a cardiovascular incident (primary prevention), or drug therapy can be used to prevent the reoccurrence of a specific problem (secondary prevention). Four primary pharmacological strategies that can be used to reduce cardiovascular risks include controlling high blood pressure (antihypertensives), decreasing plasma lipids (antihyperlipidemia drugs), treatment of overactive blood clotting (anticlotting agents), and cessation of cigarette smoking. These drug categories are described here.