1. Principles of Pharmacology Pharmacology in Physiotherapy INTI University Tay Ju Lee MD http://pharmacointi.myhq.com/links

2. In an ideal world No stress No insecurities Not overworked No accidents No weight problem No wear and tear No aging No need for medications

3. Meditate or Medicate? Physical therapy or Drug therapy? BOTH?

4. Today’s questions What is Pharmacology? Why Should Physiotherapists study Pharmacology? Drug dispensing in Malaysia? What are we going to cover?

5. WHAT IS PHARMACOLOGY?

6. Drug vs Medicine What is a drug? ◦ Chemical substance of known structure, other than food, which when administered intentionally to a living organism, produces a biological effect. What is medicine? ◦ Chemical preparation, usually contains one or more drugs, administered with the intention of producing a therapeutic effect.

7. Why so many names? Drug ◦ Chemical – 2-(Diphenylmethoxy)-N,N- dimethylethylamine hydrochloride ◦ Generic – Diphenhydramine HCl ◦ Trade Name – Benadryl Generics in Malaysia ◦ Previously generic drugs used did not need to be compared to trade. ◦ Now bioequivalence and bioavailability studies being done. http://www.mims.com/

8. What is Pharmacology? Pharmacology can be defined as the study of the effects of drugs on the function of living systems. Born in mid 19 th century – New biomedical science based on principle of experimentation not dogma. Flourished in 20 th century – Synthetic chemistry began to revolutionize pharmaceutical company. History of Pharmacology.pdf

10. What is Pharmacology today?

11. World View of Pharmacology… Every single belief has it’s own world view… What is the worldview of Pharmacology? It’s in your genes Only Matter Matters Military style Double-Blind Randomized Controlled Trials Spare parts analogy

12. WHY STUDY PHARMACOLOGY?

13. Pharmacology for Physiotherapists Drug therapy is pervasive among patients coming for therapy. Some beneficial affects of drugs enhanced by physical therapy. ◦ Massage & strengthening exercises - insulin Physical therapy may exacerbate some of the adverse effects of drugs. Understanding what drugs do to help patients know WHY focus on physiotherapy.

14. Four specific reasons PT’s must understand the patient’s response to different drugs affecting PT ◦ Drugs causing fatigue or sedation Optimal scheduling purposes ◦ Pain medication Drug-therapy interactions ◦ Heat-related modalities – antihypertensives Adverse Drug Reactions ◦ Swiss cheese theory of medical errors

15. Patient Safety Swiss Cheese Theory

16. DRUG DISPENSING IN MALAYSIA?

17. Drug dispensing in Malaysia? Some drugs can be purchased Over the Counter (OTC) from pharmacies. Most doctors dispense drugs from their office. Many patients also take combinations of herbals and supplements on top of their prescribed medicines.

18. A - Group A Can only be sold by a licensed wholesaler to a pharmacist or to another licensed wholesaler or by a licensed wholesaler to be immediately exported to a purchaser outside Malaysia. B - Group B Can be dispensed only against prescription of a Registered Medical Practitioner, Dentist, or Veterinary Surgeon, as the case may be and with the prescription in the correct form as required by the law. C - Group C Can only be sold as a dispensed medicine with entry in the Prescription Book. D - Group D Can only be sold as a dispensed medicine with an entry in the Poisons Book. P 2 - Part II Poisons Retail sale restricted to Poison Licence Holder. Labelling requirements only. NP- Non-scheduled Poisons Non-scheduled poisons or over the counter products for retail sale.

19. WHAT ARE WE GOING TO COVER?

20. What are we going to cover? Basic principles of pharmacology ◦P◦P harmacokinetics ◦P◦P harmacodynamics ◦A◦A dverse Drug Reactions Physiotherapy Pharmacology Course Syllabus Final.pdf

21. After the basics Autonomic and Cardiovascular Pharmacology Treatment for Pulmonary and GI Disorders Pain Control Drugs Affecting the Nervous System Endocrine Pharmacology Psychopharmacology Infectious Disease Drugs Chemotherapeutic Drugs and Agents Acting on the immune System The Relationship between Drug Therapy and Exercise

22. Summary What is Pharmacology? ◦ Studying effect of drugs affecting functions of living systems Why Should Physiotherapists study Pharmacology? ◦ 3 general 4 specific reasons Drug dispensing in Malaysia? ◦ Poison class, Generics vs Brand What are we going to cover? ◦ A lot

23. References Gladson, B (2006) Pharmacology for Physical Therapists. Rang et al (2007) Rang & Dale’s Pharmacology 6 th Ed. http://www.mims.com/