This book is based on what healthcare professionals in rehabilitation
need to know about pharmacology. Three licensed physical therapists (Drs.
Jobst, Panus, and Tinsley) who are also professional pharmacologists worked
together with three authors previously involved in medical pharmacology
texts (Drs. Katzung, Masters, and Trevor) to provide a broad base of
information. We believe this text offers a complete but focused presentation
of pharmacology as it affects patients in rehabilitation and will be useful
to all professionals in this field.
The
information follows the sequence of traditional pharmacology textbooks and
integrated 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 are organized around organ systems and include
the autonomic and central nervous systems, cardiovascular and pulmonary
systems, endocrine system, and drugs acting on the musculoskeletal system. A
separate section discussing anti-infective drugs is included. Finally, a
glossary is provided as a student reference for defining many of the terms
used in this textbook.
Chapters 21 and 30 are of
particular importance to all therapists. Chapter 21 concerns the use of
licit drugs such as tobacco and
alcohol, and the illicit use of drugs for
either mind-altering or bodybuilding effects. The use of these drugs by
patients in rehabilitation is often hidden from healthcare professionals.
The manifestations and adverse clinical effects resulting from use of these
drugs are complicated by the diverse types of drugs being abused by
patients. Chapter 30 involves the using of antiseptics and disinfectants to
minimize the transfer of pathogens between patients. Their use in
rehabilitation should be standard practice due to the extensive equipment
utilized by therapists, and the extraordinary potential of therapists to
inadvertently facilitate pathogen transmission when equipment is not
properly disinfected or sterilized.
Each chapter
follows a similar general outline. A brief synopsis of pathophysiology is
followed by a discussion focused on the drug classes used clinically, and
commonly recognized prototypes for each drug class. Within each drug class,
the important chemistry, relevant pharmacokinetics, and mechanism(s) of
action, as well as physiologic effects, clinical use, and potential adverse
effects are presented. At the end of each chapter are sections designed to
emphasize the importance of the drugs in the rehabilitation setting
(Rehabilitation Focus) and the effects of drug classes on rehabilitation
outcomes (Clinical Relevance for Rehabilitation). A clinical study (Problem
Oriented Patient Study POPS) presenting the rehabilitation process
and potential drug interactions is also included. Each chapter also contains
a list of many of the available preparations for drugs discussed in the
chapter, and those currently available in the United States (Preparations
Available). The authors believe that this format will provide the reader
quick access to pertinent information when required.
An accurate medical history for a patient is required
prior to a correct clinical diagnosis and effective treatment regimen. An
essential component of the medical history is the current medication list
for the patient. The drugs a patient takes have the potential to
significantly influence medical and functional outcomes, either positively
or negatively, regardless of whether the professional currently treating the
patient is prescribing the drugs. Thus, all healthcare professionals have a
responsibility to determine whether a patient's current medications have the
potential to influence any component of the interaction between the
professional and the patient. We hope this textbook will assist all
healthcare professionals, especially those in physical therapy in that
process.