By Janis Henricksen, PT, DPT, Sc.D., COMT, CEEAA; Brad Allen, PT, Sc.D., CHT, COMT; Jean-Michel Brismée, PT, Sc.D., OCS, FAAOMPT; Matthew D. Geddie, OTR, Ph.D., MBA

Address correspondence to Janis Henricksen, Plano, TX. Email: janis.henricksen@gmail.com

The presence of chronic conditions increases with age. Eighty percent of older adults have at least one chronic disease, 68% have at least two1. The most common conditions for Americans 65 years of age and older are osteoarthritis, hypertension, diabetes mellitus, pulmonary disease, cancer, and osteoporosis6. Hypertension with diabetes and hypertension with osteoarthritis represent two of the most common disease clusters6. When considering combinations of comorbidities, the symptoms of depression are commonly noted7. Depression prevalence among older adults ranges from one to four percent and the presence of depressive symptoms ranges between 15-32%5. The chronic diseases themselves, as well as the medications to treat them, often impact provision of conservative musculoskeletal care. As therapists treat older adults or those with multiple comorbidities, awareness of medication indications and side effects plays a significant role in assessment and treatment.

The following reference sheet, taken from the course New Trends in Conservative Musculoskeletal Management of Older Adults, provides common medication classes, their indications, and side effects influencing therapy services for common chronic conditions4,2. Conditions included on this reference sheet are cardiovascular diseases, pulmonary disorders, osteoarthritis, diabetes mellitus, depression and osteoporosis3.


Common Medications and Side Effects for Chronic Disease

Medication Indication/Diseases Common Generic (and Brand) Names Side Effects
Anti-anginal Chest pain

  • Coronary Artery Disease
Nitrates

isosorbide dinitrate (Isordil, Dilatrate-SR, Isochron, IsoDitrate), isosorbide mononitrate (Ismo, Imdur, Monoket), nitroglycerin (NitroQuick, Nitrostat, Nitro-Bid, Nitrolingual, Nitro TD Patch-A)

Exaggerated response to systemic heat

Orthostatic hypotension

Dizziness

Anti-arrhythmic Elevated blood pressure

  • Arrhythmias
  • Angina
  • Coronary Artery Disease
  • Hypertension
  • Reynaud’s Disease
Cardiac specific Beta Blockers (-olol):

acebutolol (Sectral),

atenolol (Tenormin), bisoprolol (Zebeta), metoprolol (Kapspargo Sprinkle, Lopressor, Toprol-XL), nebivolol (Bystolic)

Non-cardiac specific Beta Blockers (-olol):

carvedilol (Coreg), labetalol (Trandate, Normodyne), nadolol (Corgard), pindolol (Visken), propranolol (Hemangeol, Inderal, InnoPran), timolol (Blocadren)

Calcium Channel blockers:

amlodipine (Katerzia, Norvasc), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Diltzac, Matzim, Taztia, Tiazac), felodipine (Plendil), nicardipine (Cardene IV, Cardene, SR, Cardene), nifedipine (Adalat, Afeditab, Nifediac, Procardia), verapamil (Calan, Isoptin, Verelan, Covera-HS)

Swelling of feet and ankles

Altered heart rate (may not control dysrhythmias during exercise)

Bronchoconstriction

Mask hypoglycemia

Reflex tachycardia

Reduce heat tolerance and premature fatigue

Anti-coagulants Blood clotting disorders

  • Arrhythmias
  • Cerebrovascular Disease/Accident
  • Coronary Artery Disease
  • Deep Vein Thrombosis
  • Lupus
  • Myocardial Infarction
  • Recent surgery
Coumarins:

warfarin (Jantoven, Coumadin)

Factor Xa inhibitors: apixaban (Eliquis), betrixaban (Bevyxxa), edoxaban (Savaysa), fondparinux (Arixtra), rivaroxaban (Xarelto)

Heparins:

dalteparin (Fragmin), enoxaparin (Lovenox)

Thrombin Inhibitors:

bivalirudin (Angiomax), dabigatran (Pradaxa)

Increased risk of:

Bleeding

Bruising

Dizziness

Headache

Stomach upset

Anti-depressants Depression

  • Anxiety
  • Fibromyaliga
  • Hot flashes
  • Obsessive-Compulsive Disorder
  • Panic Disorder
  • Post-Traumatic Stress Disorder
Selective serotonin reuptake inhibitors (SSRIs)

citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Selfemra, Rapiflux), paroxetine (Brisdelle, Paxil, Pexeva), fluvoxamine (Luvox), sertraline (Zoloft)

Exacerbate hyponatremia

Ataxia

Impaired psychomotor function

Increased risk of bleeding

Depression, Chronic Pain

  • Anxiety
  • Bipolar Depression
  • Chronic Pain
  • Depression
  • Diabetic Neuropathy
  • Fibromyalgia
  • Panis Disorder
  • Social Phobia
Serotonin-norepinephrine reuptake inhibitors (SNRIs)

desvenlafaxine (Pristiq, Khedezla), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), venlafaxine (Effexor), milnacipran (Savella)

Orthostatic hypotension

Increased heart rate

Decreased blood pressure

Increased risk for arrhythmias

Increased risk of bleeding

Depression, Chronic Pain

  • Anxiety
  • Chronic nerve-related pain
  • Migraine prevention
  • Obsessive-compulsive Disorder
  • Panic Attacks
  • Post-Traumatic Stress Disorder
Tricyclic anti-depressants (TCAs)

amitriptyline (Vanatrip, Elavil, Endep), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor, Aventyl HCL)

Orthostatic hypotension

Falls

Sedation

Urinary retention

Bradycardia

Dry mouth

Anti-hypertensives Elevated blood pressure

  • Chronic kidney conditions
  • Coronary Artery Disease
  • Heart Failure
  • Hypertension
ACE inhibitors (-pril):

benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec),

lisinopril (Prinivil, Zestril), ramipril (Altace)

Angiotensin receptor blockers (-artan):

azilsartan medoxomil (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan)

Blunt rise of blood pressure during exercise

Orthostatic hypotension

Kyperkalemia – cardiac dysrhythmia, dehydration, kidney dysfunction

Anti-inflammatory Inflammation, pain

  • Allergies
  • Asthma
  • Chronic Obstructive Pulmonary Disease
  • Crohn’s Diease
  • Lupus
  • Multiple Sclerosis
  • Organ Transplants
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Skin Conditions
  • Tendinitis
Glucocorticoids / corticosteroids budesonide (Entrocort, Uceris), dexamethasone (Baycadron, Decadron, DexPak, TaperDex, Zema-Pak, ZoDex, Zonacort), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisolone (Flo-Pred, Millipred, Orapred, Pediapred, Medicort, Predicort), prednisone (Rayos, Sterapred, Daltasone), triamcinolone (Aristocort) Steroid myopathy

Muscular atrophy

Tendon rupture

Osteoporosis

Elevated blood sugar

Fluid retention

Pain, inflammation

  • Colds/flu
  • Fever
  • Headache
  • Musculoskeletal Pain/Injury
  • Osteoarthritis
Non-steroidal anti-inflammatory drugs (NSAIDS)

diclofenac (Cambia, Zipsor, Zorvolex, Cataflam, Voltaren, Dyloject), etodolac (Lodine), ibuprofen (Advil, Midol, Motrin), indomethacin (Indocin, Tivorbex), ketorolac (Toradol), meloxicam (Mobic), naproxen (Aleve, Naprosyn, Flanax, Midol ER, Anaprox)

Gastrointestinal disturbance

Hypertension

Leg swelling

Liver or kidney problems

Increased risk of myocardial infarction or cerebrovascular accident

Headache

Dizziness

Bronchodilators Bronchoconstriction

  • Asthma
  • Chronic Obstructive Pulmonary Disease (Chronic Bronchitis and Emphysema)
Adrenergic:

albuterol (ProAir, Proventil, Ventolin, AccuNeb), arformoterol (Brovana), epinephrine inhalation (Primatene), formoterol (Perforomist, Foradil), isoproterenol (Isuprel), levalbuterol (Xopenex), racepinephrine (Asthmanefrin, S2 inhalant, Nephron, Micronefrin), salmeterol (Serevent)

Anticholinergic:

ipratropium (Atrovent), aclidinium (Tudorza Pressair), tiotropium (Spiriva)

Combinations:

albuterol/ipratropium (Combivent, DuoNeb), flucticasone/salmeterol (Advair, AirDuo, Wixela), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo Ellipta)

Methylxanthines:

theophylline (Elixophyllin, Theo-24, Respbid etc)

Dysrhythmia

Premature ventricular contraction

Increased heart rate

Increased blood pressure

Diabetes Type I/II Elevated blood glucose

  • Diabetes Type I
  • Diabetes Type II (Diabetes Mellitus)
Biguanides (non-sulfonylureas)

metformin (Glumetza, Riomet)

Hypoglycemia

Gastrointestinal upset

B12 deficiency

Insulin:

Insulin aspart and insulin aspart protamine (NovoLOG), insulin degludec (Tresiba), insulin detemir (Levemir), insulin glargine (Lantus, Basaglar, Toujeo), insulin lispro (Admelog, HumaLOG), insulin isophane (Humalin N, NovoLIN N, ReliOn/NovoLIN), insulin regular (Humalin R, Myxredlin, NovoLIN R)

Sulfonylureas:

glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Glynase, Micronase)

Hypoglycemia

Weight gain

Thiazolidinediones pioglitazone (Actos), rosiglitazone (Avandia) Fluid retention

Weight gain

Bone fractures

Heart failure

Diuretics Elevated blood pressure

  • Heart Failure
  • Hypertension
  • Liver Failure
  • Tissue swelling (edema)
Thiazide Diuretics:

chlorthaliadone (Hygroton, Thalitone), hydrochlorothiazide (Aquazide H, Esidrix, HydroDiuril, Microzide), indapamide (Lozol)

Loop Diuretics:

Furosemide (Lasix, Diaqua-2, Lo-Aqua), torsemide (Demadex)

Potassium-sparing diuretics:

amiloride (Midamor), eplerenone (Inspra),

spironolactone (Aldactone, CaroSpir)

Orthostatic hypotension

Fluid depletion

Muscle cramping

Impaired glucose and lipid metabolism

Hypo- or hyperkalemia

Altered sodium content

Hyperlipidemia Elevated cholesterol

  • Hyperlipidemia
Statin Medications atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor, Altocor), pitavastatin (Livalo, Zypitamag), pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor) Myopathy

Weakness

Liver damage

Muscle cramping

Osteoporosis Bone loss

  • Osteoporosis
Parathyroid hormone and analogs:

abaloparatide (Tymlos),

parathyroid hormone (Natpara), teriparatide (Forteo)

Bone resorption inhibitors:

romosozumab (Evenity), denosumab (Prolia)

Parathyroid hormone and analogs: Dizziness, vertigo, muscle cramp, arthralgia, hypotension, hyperuricemia, hypercalcemia,

Bone resorption inhibitors: Dyspnea, arthralgia, hypocalcemia, atrial fibrillation

Bone loss

  • Osteoporosis
  • Paget’s Disease
Bisphosphonates: alendronate (Fosamax, Binosto), ibandronate (Boniva, Bondronat), pamidronate (Aredia), risedronate (Actonel, Atelvia), zoledronic acid (Reclast, Zometa, Aclasta)

Selective Estrogen receptor modulators (SERMs):

raloxifene (Evista)

Bisphosphonates: Muscle and joint pain, osteonecrosis of the jaw, muscle cramps, increased serum calcium, increased atypical femoral fractures

SERMs: Muscle cramps, arthralgia, peripheral edema, increased blood pressure, sinusitis

References

1. Chronic Disease Self-Management – Programs & Resources. NCOA. https://www.ncoa.org/healthy-aging/chronic-disease/. Accessed June 2, 2019.

2. Ciccone C. Pharmacology in Rehabilitation. 5th ed. Philadelphia: F.A.Davis Company; 2016.

3. Prescription Drug Information, Interactions & Side Effects. Drugs.com. https://www.drugs.com/. Accessed April 21, 2020.

4. Henricksen J. Comorbidities and Medications. November 2019.

5. Kvelde T, Lord SR, Close JCT, et al. Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning. Arch Gerontol Geriatr. 2015;60(1):190-195. doi:10.1016/j.archger.2014.09.003.

6. Quiñones AR, Markwardt S, Botoseneanu A. Multimorbidity Combinations and Disability in Older Adults. J Gerontol A Biol Sci Med Sci. 2016;71(6):823-830. doi:10.1093/gerona/glw035.

7. Sinnige J, Braspenning J, Schellevis F, Stirbu-Wagner I, Westert G, Korevaar J. The Prevalence of Disease Clusters in Older Adults with Multiple Chronic Diseases – A Systematic Literature Review. PLoS ONE. 2013;8(11). doi:10.1371/journal.pone.0079641.

 

Registration Expires -
00 Days
00 Hrs
00 Mins
00 Secs
Expired
Webinar - 3 pm CT - Clinical Testing for Stability of the Wrist
Register Now