Physical Therapy Pharmacology.

Eddy L. St Louis, MO 63146-3318, Mosby-Year Book Inc, 1992, paperback, 192 pp, $29.95.

The author indicates that this text is an overview of therapeutic agents commonly used by patients who have chronic medical conditions that are often seen by physical therapists. No background in pharmacology is assumed; however, a working knowledge of physiology and pathophysiology is expected. The text consists of 21 chapters that are divided into seven parts.

Part 1, "Introduction to Pharmacology," addresses some of the general concepts of drug kinetics and drug actions in simple, easy-to-read language. This simplification, however, results in incomplete and uneven coverage, some misleading statements, and a few errors throughout the text. In the first chapter, for example, the author states that the condition of "equilibrium" is referred to as "steady-state," then confuses the reader by providing very different descriptions of these two conditions. The median lethal dose is described as "the dose that is lethal to 50% of individuals," instead of animals. The routes of drug administration utilized by physical therapists (iontophoresis and phonophoresis) are omitted completely. The second chapter reviews selected autonomic nervous system receptors and actions and the effects of autonomic drugs. The author states that alpha adrenergic agents should not be used by patients with hypertension, but later describes the current use of these drugs in the treatment of hypertension.

Each remaining chapter begins with a review of the physiology and pathophysiology of specific disorders. There follows, with no consistent organization or inclusion of content, an explanation of each drug or class of drugs, which may or may not include indications, rationale for use, effects, kinetics, plasma half-life, mechanism of action, precautions, adverse effects, and interactions with other drugs. Although the author indicates in the preface that a physical therapist has no reason to learn the dosages of specific drugs, this information is consistently included in tables within each chapter. Special considerations for drug selection in children and the elderly are often given. Learning objectives and additional readings are listed at the end of each chapter; specific references for text information are not included.

Part 2, "Cardiovascular Pharmacology," is the longest section of the text and introduces the drugs that are commonly used to treat heart failure, hypertension, arrhythmias, and vascular disease and ischemia. Again, simplification of the information produces problems. Contractility is incorrectly defined, for example. The vascular disorders addressed include cardiac, cerebral, and peripheral disorders but do not include vascular ulcers or venous disorders. The physiology of lipid metabolism and pathophysiology of cardiac disorders and atherosclerosis, however, are presented in some depth.

Part 3, "Neuropharmacology," reviews central neurotransmitters and provides information about mental disorders and the drugs used to treat them. This is the best section in the text. Adverse effects of some drugs, including effects of long-term use and withdrawal, are covered under separate headings, making them easy to locate.

Part 4, "Disorders of Movement," is the shortest section and includes a chapter on Parkinson's disease, a chapter on antiepileptic drugs, and a three-page chapter entitled "Spasticity and Skeletal Muscle Relaxants." This section emphasizes the pathophysiology and different types of disorders. The rationale for changing the drugs prescribed during the progression of Parkinson's disease is well presented.

Part 5, "Inflammatory/Immune Diseases," includes chapters on nonnarcotic analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (narcotic analgesics are omitted from the text); glucocorticoids; and drugs used in the treatment of arthritic diseases, neuromuscular immune/inflammatory diseases, and respiratory diseases. Information regarding the variability in patients' responses to NSAIDs is well done and would have been welcomed with regard to other drugs in the text.

Part 6, "Digestion and Metabolism," consists of two chapters, "Gastrointestinal Pharmacology," and "Drugs Used in Treatment of Diabetes Mellitus." Special attention is given to the effects of exercise on patients with diabetes.

Part 7, "Geriatrics," includes polypharmacy and changes that occur with aging, which require drugs or affect drug kinetics. This section ties together information provided elsewhere in the text regarding side effects and interactions among drugs that are commonly used by the elderly, and is a well-written summary.

"Physical Therapy Notes" at the end of each chapter are primarily descriptions of the treatment given to the patients. Selected effects that drugs may have on physical therapy interventions are also briefly mentioned at the end of some chapters. An index is included, but it is incomplete. Pain, analgesics, and asthma are not listed, for example. The page reference for steroids refers the reader to a different chapter for information. The trade name of a drug refers the reader to the generic name of the drug in the index, rather than to a page number.

The author states that antibiotics are omitted from the text because their use is generally of an acute (10-day) treatment duration, thus overlooking the longer-term use of antibiotics in the treatment of osteomyelitis and other disorders. No reason is given for the omission of narcotic analgesics and drugs used to treat open wounds or cancers or for the very brief coverage of muscle relaxants.

This text may be appropriate as a beginning student's introduction to pharmacology, if the instructor is prepared to clarify some of the content. It is generally quite readable and relatively inexpensive, and the author has attempted to simplify information as much as possible. Case studies would have been valuable, as would an emphasis on the influence of drugs on physical therapy evaluation and treatment. Drug interactions, when included, are helpful. Reviews of physiology and pathophysiology are uneven, with some topics covered more extensively than others. The lack of consistent inclusion of content about each drug or class of drugs, the lack of organization to the included content, and an incomplete index make it difficult to locate desired information. This text would not be useful as a reference for more advanced students or for practicing physical therapists.

Carol Weaver, PbD, PT West Virginia University Morgantown, WVa