Preface

According to the Patient-Centered Primary Care Collaborative, medications are involved in approximately 80% of all treatments and impact every aspect of a patient's life. Understanding how the effects of drugs may influence the outcome measures and interventions provided by physical therapists provided the impetus for the first edition of this textbook more than 10 years ago. For example, therapists perform comprehensive assessments of the visual, vestibular, and proprioceptive inputs that control balance to predict an individual's risk of falling. However, this prediction will fall short if the therapist fails to inquire what medications the patient is taking, as many medications—both prescription and over-the-counter—negatively affect balance.

The goal of this book is to provide a comprehensive—yet focused—foundation in pharmacology to help rehabilitation professionals understand how medication use may alter the clinical presentation of our patients as well as their responses to therapeutic interventions. In this second edition, two licensed physical therapists (Drs. Jobst and Panus) with extensive training in pharmacology worked closely with Dr. Marieke Kruidering-Hall, a pharmacologist previously involved in medical pharmacology texts.

The information follows the sequence of traditional pharmacology textbooks and integrated organ systems-based curricula. The initial section is a synopsis of the nature of drugs, basic principles of pharmacodynamics and pharmacokinetics, and an overview of the drug development and approval process in the United States. Subsequent chapters include drugs that affect the autonomic and central nervous systems; cardiovascular and pulmonary systems; and the endocrine, gastrointestinal, and musculoskeletal systems. A chemotherapeutic section includes chapters covering anti-microbial drugs, cancer chemotherapy agents, and drugs that modify the immune system.

Each chapter follows a similar outline. A Case Study that illustrates how the patient's medications can affect the physical therapy encounter opens the chapter, while the explanation of how the therapy might need to be adjusted closes the chapter. An introductory Rehabilitation Focus section highlights the importance of the drugs in the rehabilitation setting. Next, a brief synopsis of relevant pathophysiology is followed by a discussion on the drug classes. Within each drug class, common prototypes, important chemistry, relevant pharmacokinetics, and mechanism(s) of action, as well as physiologic effects, clinical uses, and potential adverse effects are presented. At the end of each chapter, the Rehabilitation Relevance section provides a quickly accessible bullet-pointed summary of the adverse drug reactions for the therapist working with patients using these drug classes. End-of-chapter Questions are provided to quiz the reader's recall and comprehension.

An accurate medical history is required to provide a correct clinical diagnosis and effective treatment regimen. An essential component of the medical history is the patient's current medication list. The drugs an individual takes have the potential to significantly influence both medical and functional outcomes. Rehabilitation therapists often have the privilege of spending more time with patients than other healthcare providers. This privilege comes with the responsibility of understanding patients' responses to medications, recognizing the potential for interactions between responses to medications and therapy interventions, and communicating with key members of the healthcare team and/or the patient when questions or concerns arise regarding potential adverse drug reactions and medication nonadherence. We hope this textbook will assist all healthcare professionals—especially those in physical therapy—in that process.