Knowing Drug Side Effects is Important
My pharmacology class has barely started and I've already realized something. PTs don't pay enough attention to the medications our patients are taking. Because I practice in a hospital, I've always had the luxury of having physicians, nurses and pharmacists to keep tract of various medications and drug interactions that could affect my patients. When I looked at medication lists I scanned for the big red flags such as beta blockers, ACE inhibitors, Coumadin and the like. It never occurred to me to consider OTC meds.
When I worked in OP settings, my new evaluations would fill out a medication list. I looked for those same drugs. Their presence could affect exercise tolerance and therapy. Since pain is one of the primary reasons patients seek OP therapy, I expected I would see OTC pain meds. I now know that over 100,000 hospitalizations occur annually due to GI complications associated with OTC anti-inflammatory or aspirin use. That figure assumes normal use and dosages. Too much Tylenol can cause liver damage. Too much aspirin can contribute to decreased clotting.
Anti-depressives are another commonly prescribed drug. MAO inhibitors can elevate resting BP. Others are associated with drowsiness and slowed response time. Wellbutrin and Zyban can cause insomnia. Any of these side effects will directly affect performance during therapy. The danger of mixing benzodiazepines and alcohol are well known.
Lasix is commonly prescribed for any patient who retains fluid. Overuse of lasix leads to dehydration, which in turn increases the demand on the cardiovascular system. Dehydration can also cause orthostatic hypotension. Less blood volume means it takes more effort to pump the blood upward resulting in a drop in BP when attempting to stand.
Compliance with meds is also important. I've lost count of the number of stroke patients I've seen who were non-compliant with anti-hypertensives or stopped taking their Coumadin for some reason. Inconsistency with other cardiac meds can also have disastrous results. Failure to control blood sugars via insulin is another common problem. Every OP setting I ever worked at kept orange juice and hard candy on hand for patients with low blood sugars. High blood sugar is associated with many diabetic complications. Many of us have worked with patients who haven't taken their pain meds prior to therapy. We all know how difficult that can be.
PTs aren't pharmacists. We don't need to know the many details involved in pharmacology. We do need to know the side effects and possible interactions of commonly prescribed meds in our treatment populations. That knowledge enables us to monitor our patients more effectively.