Neurologically active drugs in spinal cord injury: a clinical coding system
Halstead, L.S.; Claus-Walker, J.; Hrna, D.
Archives of Physical Medicine and Rehabilitation 59(8): 358-362
1978
ISSN/ISBN: 0003-9993 PMID: 687048 Document Number: 125073
Spinal cord injuries (SCI) resulted in disruption of somatic, sympathetic and parasympathetic neural pathways. Clinical management of SCI patients required a thorough understanding of normal and altered neurophysiology, a basic familiarity with drugs used to compensate for neurologic dysfunction as well as with the neurologic effects of drugs used to treat clinical problems unrelated to SCI dysfunction and a knowledge of the possible interactions among these drugs. To simplify and rationalize the use of neurologically active drugs in the management of SCI patients, a clinical coding system was proposed based on a drug's primary (intended) and secondary (unintended) effects and the final neural structure(s) modified by that drug. This coding system was designed as a quick clinical reference to aid in prescribing the most appropriate medications and as a fail-safe guide to avoid undesirable drug interactions. Prescription experience with 98 SCI patients (50 with quadriplegia and 48 with paraplegia) undergoing comprehensive rehabilitation in 1975 was reviewed for all drugs known to have any clinical effect on the nervous system. The 23 most commonly prescribed drugs with significant neurologic activity [tripolidine/pseudoephedrine, methantheline bromide, diphenhydramine HCl, flurazepam HCl, propoxyphene HCl, meperidine (pethidine) HCl, phenoxybenzamine HCl, brompheniramine/phenylephrine/phenylpropanolamine mist, phenobarbital/hyoscyamine/atropine/hyoscine mist, amitriptyline HCl, mecamylamine HCl, guanethidine sulfate, chlorpheniramine/phenylpropanolamine, acetaminophen/codeine, promethazine HCl, propantheline Br, acetaminophen/phenylpropanola/phenyltoloxamine mist, pentazocine HCl, perphenazine/mitriptyline, bethanecol chloride, diazepam and hydroxyzine pamoate] were listed according to the proposed clinical coding system and their frequency of use. Actual and potential drug interactions were described and implications for establishing appropriate prospective and retrospective drug surveillance by physicians, pharmacists and nursing staff were discussed.