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842 ACUH CARl I-IANf)800� fOR PIIY\ICAI HII-RAPI\I\
Table IV-l. Adrenocortical Steroids (Glucocorricoids)·
Indications: To decrease cerebral edema or mflJmmatlon In neoplastic or
inflammarory diseases, or both
Mechanism of action: Prevent the accumulation of mflammator)· cells at the
infection site, inhibit lysosomal en7_yme release and chemical medi.1tors of
inflammatory res-ponse, reduce capillary dilatation and permeability
General side effects: Headache, vertigo, diaphoresilj, nausea, vomiting.
congestive heart failure in susceptible patienrs, euphoria, insomnia, seizure,
muscle weakness, cushingoid features, osteoporoSIS, derm3tlti':t, decreased
wound healing, thromboembolism, aggravation of hyperten<;ion
Generic name (trade name): Dexamethasone ( Decadron, Dexone, Ilcxadrol),
dexamethasone sodium phosphate (Cortastat, Dalalonc, Dccadron Phosphate, Decaject, Dexone, Hexadrol Phosphate, Solurex), methylprednisolone (Medrol), prednisone ( Deltasone, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred), predni�olone ( Delta-Cortef, Prclone), predniSOlone acetate (Key-Pred, Predcar, Predalone), prednisolone �odium phosphare (Hydelrrasol, Ker-Prcd-SP, Pcdiapred)
• For neuroscience patients.
Sources: Data from Drug I:acts and ComparlSoJl!. 2000 (541h cd). \t. LOlll�: Woller ..
Kluwer, 2000; and Drug Facis and Compansons 2001 (.Ulh cd). \t. I.OUl'i: Wolrer ...
Kluwer, 200 I.
Table rV-2. Angiotensin-Converting Enzyme Inhibitors
Indication: Heart failure
Mechanism of action: Inhibit conversion of angiorcnsin I to angiorensin II
and therefore act to decrease excess water and "iodlum rerentlon while also
preventing vasoconstriction
General side effects: Edema, cough, hyporcnsion, skill rash, renal failure, [a�re
disturbances
Generic (trade name): Captopril (Capmen), enalapril ( Vasorec). lisllloprd
(Prinivil, Zestfll)
Source: Data from K Grlmcs, M Cohen. Cardiac Medu..:auotl!l. In FA 1IIIlcgas!l. HS
Sadowsky (cds). Essentials of Cardiopulmonary I)hysical Therapy (2n� cd). Philadelphia: Saundcr!l. 2001 ;537-58S.
APPENDIX IV: PHARMACOLOGIC AGENTS
843
Table IV-3. Antiarrhythmic Drugs
Indications: Arrhythmia, ischemia, hyperrension
Mechanism of anion
Class I: Sodium channel blockers-slow the fast sodium channels, thereby
controlling rate of depolarization
General side effects: Gastrointestinal or urinary retention, or both,
central nervous system abnormality
Class 11: Beta blockers-block sympathetic stimulation of cardiac muscle
General side effects: Smooth m uscte spasm, exaggeration of therapeutic
acrions (bmdycardia), fatigue, insomnia, masking hypoglycemic
symptoms in diabetics, impaired glucose rolerance, decreased highdensiry lipoprOtein cholesterol
Class III: Refractory period alrerations-prolong refractory period of
cardiac tissue
General side effects: May rransiently increase pacemaker (sinoatrial
node) activity
Class IV (calcium channel blockers): Block slow calcium channels
General side effects: Negative inorrope at high doses
Sodium channel blockers (gcneric name Itradc name!): Disopyramide
(Norpace, Rythlllodan), encainide (Enkaid), flecainide (Tambocor"
lidocaine (Xylocaine), mcxiletine (Mexitil), moricizine (Ethmozine),
phenytoin (Dilanrin), procainamide (Pronesryl), propafenone (Rhythmol),
quinidine (Biquin. Cardioq uin), toea in ide (Tonocard)
Bera blockers: Refer ro Table I V- 1 2
Refractory period alterations: Amiodarone (Cordarone), brerylium rosylate
(Bretylol), ibutilide fumarate (Corven)
Calcium channel blockers: Refer ro Table IV-14
Source: Data from K Grimes, M Cohen. Cardiac Medications. In EA Hillegass, I-IS
Sadowsky (cds). Essentials in Cardiopulmonary Physical Therapy (2nd cd). Philadelphia: Saunders. 2001;562.
844
AClITE CARE HANDBOOK FOR PHY SICAL TI-tERAPlffi
Table I V-4. Anricoagulams
Low-molecular-weight hep
Indications: Prophylaxis or rreatmenr of
arin, enoxaparin sodium
thromboembolic complications after sur
(Lovenox), dalteparin
gery; for ischemic complications of unstable
sodium ( Fragmin), ardeangina, NQWMI, or cardiovascular acciparin sodium ( Normiflo)
demj prophylaxis of DVT after roral knee
replacement .•
Mechanism of action: Enhances inhibition of
factor Xa and thrombin by binding CO and
accelerating antithrombin III activity.
General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or other
tracts; thrombocyropenia.
Danaparoid sodium
Indication: Prophylaxis of DVT after tOtal hip
( Orgaran)
replacement.
Mechanism of action: See Low-molecularweight heparin.
General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or
other tracts; thrombocytopeniaj fever;
nausea.
Heparin sodium
Indications: Prophylaxis or trearmem of
venous thrombosis, PE, peripheral arterial
embolism, atrial fibrillation, acute myocardial infarction, disseminated intravascular coagulopathy.
Mechanism of action: Prolongs clotting time
by inhibiting the conversion of prOthrombin to thrombin.
General side effects: Bleeding from gastrointestinal, genitourinary, respirarory, or
other tracts; hemorrhagej thrombocytopenia.
Lepirudin (Refludan)
Indication: Thrombus prophylaxis in heparininduced thrombocytopenia.
Mechanism of action: Directly inhibits thrombin.
General side effects: Bleeding from gastrointestinal, genitourinary, respiratory, or
other tracts; anemia; hem3coma.