23a Pathology: Medications

Transcription

1 23a Pathology: Medications

2 23a Pathology: Medications! Class Outline 5 minutes Attendance, Breath of Arrival, and Reminders 10 minutes Lecture: 25 minutes Lecture: 15 minutes Active study skills: 60 minutes Total

3 23a Pathology: Medications! Class Reminders Practical Exams:! 23b Swedish: Practical Exam Packet A: Packet F: 35, 45, 55, and 58 Grader evaluated full SOAP notes with date, first and last names. Signatures and dates on intake form Bring A: 93 for grading Assignments:! Hydrotherapy Supplies for classes 25b, 26b, 27b, and 28b Packet G-1! 30a Review Questions (Packet A: ) Preparation for upcoming classes:! 24a A&P: Muscular System - Organization of Skeletal Muscle Trail Guide: infraspinatus and teres minor Packet E: RQ Packet A-148! 24b Hydrotherapy: Theory and Technique Demo Packet G: 1-14 RQ Packet A-149

4 Classroom Rules Punctuality - everybody s time is precious! Be ready to learn at the start of class; we ll have you out of here on time! Tardiness: arriving late, returning late after breaks, leaving during class, leaving early The following are not allowed:! Bare feet! Side talking! Lying down! Inappropriate clothing! Food or drink except water! Phones that are visible in the classroom, bathrooms, or internship You will receive one verbal warning, then you ll have to leave the room.

5 23a Pathology: Medications! E-27 Knowing the effects of medications allows us to properly modify massage treatments.

6 23a Pathology: Medications CLASS OF MEDICATION MASSAGE MODIFICATIONS Anti-anxiety Add stimulating strokes to combat lethargy and risk of falling. Anti-depressant Add stimulating strokes to bring the client back to full alertness. Etc.

7 Anti-anxiety Add stimulating strokes to combat lethargy and risk of falling. Uses Anti-anxiety Benzodiazepines Short-term anxiety Seizures Insomnia Convulsions Buspirone HCL Short-term anxiety General anxiety Valium Ativan Xanax BuSpar Suppression of fight or flight sympathetic response can lead to a deep parasympathetic lethargy Poor reflexes Unusually exhausted Orthostatic hypotension Dizziness Add stimulating strokes throughout the session Assist client when getting up to avoid falls Fatigue

8 Anti-depressant Add stimulating strokes to bring the client back to full alertness. Uses Anti-depressant Tricyclics Depression MAOIs Depression Imipramine Nardil Prolongs availability of various neurotransmitters in the brain. Anxiety (first 4 weeks) Headaches (first 4 weeks) Insomnia (first 4 weeks) Add gently stimulating strokes at the end of the session to bring the client to full alertness SSRIs / SNRIs Depression Anxiety Eating disorders Prozac Zoloft Paxil Lexapro Effexor Cymbalta Constipation Increased heart rate Headaches Excessive dizziness Excessive drowsiness

9 Anti-inflammatory and analgesic Do not overtreat: use light pressure and short session durations. Avoid deep tissue or myofascial techniques to prevent damage. Uses Anti-inflammatory and Analgesic Salicylates Inflammation Fever Anticoagulant Acetaminophen Pain Fever Aspirin Tylenol Changes the tissues ability to respond to stimulus by inhibiting inflammation and altering pain perception by the CNS Inability to accurately perceive pain Hypotension Dizziness Massage conservatively and avoid overtreatment by avoiding deep tissue and myofascial techniques that may cause tissue damage NSAIDs Inflammation Advil Aleve Vioxx Celebrex Lethargy Chills Steroidals Inflammation Prednisone Methotrexate Narcotics Pain Cough G.I. tract slugishness Codeine Demerol Oxycontin Percocet Vicodin Dilaudid Morphine

10 Autonomic Nervous System Depends on the subclass of medications. See tables below for more details. Uses Autonomic Nervous System (ANS) Cholinergics Gastrointestinal Urinary Cardiac Respiratory Urecholine Stimulate parasympathetic nervous system Dizziness Deep parasympathetic lethargy Add stimulating strokes throughout the session to bring the client to full alertness Anti-cholinergics Various, ask your client Atropine Scopolamine Stimulate OR suppress parasympathetic nervous system Various, ask your client If stimulating, then use longer slower strokes and avoid tapotement and friction If suppressing, then use stimulating strokes Adrenergic Gastrointestinal Urinary Cardiac Respiratory Dopamine Epinephrine Albuterol Stimulate sympathetic nervous system Difficulty inducing a parasympathetic response in the client Use longer, slower strokes and avoid tapotement and friction. Adrenergic blockers Blocking various receptor sites, ask your client Flomax Suppress sympathetic nervous system Dizziness Deep parasympathetic lethargy Add stimulating strokes throughout the session to bring the client to full alertness

11 Cardiovascular Depends on the subclass of medications. See tables below for more details. Uses Cardiovascular Beta blockers Angina Hypertension Anxiety Levatol Blocks beta receptors from triggering high blood pressure Low blood pressure Assist client when getting up to avoid falls Calcium channel blockers Hypertension Long-term angina Norvasc Vasodilation and increased cardiac efficiency Low blood pressure Flushing Dizziness Emphasize short strokes Avoid long, draining circulatory strokes ACE inhibitors Hypertension Heart failure Lotensin Reduces cardiac load by promoting the excretion of sodium and water Excessively low blood pressure Fatigue Dizziness Lethargy If suppressing, then use stimulating strokes Use longer, slower strokes and avoid tapotement and friction. Digitalis Arrhythmia Heart failure Digitek Increased cardiac force Decreased cardiac rate Inability to respond to rigorous massage Use noncirculatory techniques End the session with invigorating strokes to support alertness

12 Cardiovascular Depends on the subclass of medications. See tables below for more details. Uses Cardiovascular, continued Anti-lipemic High cholesterol Lipitor Crestor Zocor Promotes excretion of bile in stool so that the liver must use more cholesterol in bile manufacturing Constipation Medical emergencies: Abdominal pain No bowel movement in 4 days Muscle soreness, cramping, and weakness Muscle wasting Diuretics Heart failure Hypertension Kidney disease Thalidone Lasix Increased urine production Kidneys unable to adapt to increased circulatory load Low blood pressure Excessive potassium loss Use noncirculatory techniques Assist client when getting up to avoid falls Anti-angina Acute angina Nitroglycerin Reduced myocardial oxygen demand Increased myocardial oxygen supply Hypotension Flushing Dizziness Avoid transdermal patch area Use invigorating strokes to support alertness Assist client when getting up to avoid falls

13 Cancer Wear gloves to protect against excreted medications. Consult physician about interaction of massage, medications, and treatment. Cancer Alkylating Anti-metabolite Antibiotic antineoplastics Hormonal antineoplastics Natural antiplastics Cytoxan Dacarbazine DIC CCNU TSPA Cisplatin Methotrexate 5-FU Actinomycin Tamofen Teslac Vinblastine Vincristine Interleukin-2 Kill cancer cells Block cancer cell growth Block vascular feeding of cancer cells Medications can be excreted through the skin Radioactive elements may be implanted in the body Wear gloves to avoid excreted medications Client should consult doctor to know how massage should be modified based on the medications and treatments administered

14 Clot management Only use the very lightest pressure. A known clot is an absolute contraindication. Avoid injection sites for 24 hours. Uses Clot management Anti-coagulants Atrial fibrillation Risk of deep vein thrombosis Users of hemodialysis Injections: Heparin Lovenox Oral: Coumadin Prevent formation of new clots Do not dissolve preexisting clots Bruising, even with light massage Only use the lightest forms of massage Absolutely contraindicated if a clot is present Avoid injection sites for 24 hours Anti-platelets Risk of embolism Aspirin Plavix Prevent the clumping together of platelets to form a clot Same as anticoagulants

15 Diabetes Avoid injection sites for 24 hours. Massage during the middle of the insulin cycle. Allow time and privacy for the client to check blood glucose levels before and after the session. Have juice, milk, or candy readily available. Uses Diabetes Insulin Hyperglycemia Injection: Humulin Humalog Lantus Novolog Novolin Decreases blood glucose by helping to deliver it to cells that need it Risk of hypoglycemia due to the combination of insulin medication and massage Avoid injection sites for 24 hours Massage during the middle of the insulin cycle Allow time and privacy for the client to check blood glucose levels before and after the session Have juice, milk, or candy readily available Oral glucose management Hyperglycemia Diabinase Glucotrol Glyburide Glucophage Precose Inhibit production of sugar in the liver Improve output of insulin from the pancreas Same as insulin except no injection site caution Increase sensitivity of insulin receptors on target cells

16 Muscle relaxant Invigorating strokes to support alertness. Do not attempt to increase ROM. Massage conservatively by using light pressure. Uses Muscle relaxants CNS skeletal muscle Muscle cramps related to trauma or anxiety Valium Soma Skelaxin Norflex Depress the CNS by enforcing a parasympathetic state Suppress reflexes that would tighten muscles in response to stretching or damage Use invigorating strokes to support alertness Do not attempt to increase ROM Exhaustion Compromised stretch reflex Peripheral skeletal muscle Muscle spasm Dantrium Interferes with calcium release from the sarcoplasmic reticulum of muscle cells, leading to weaker skeletal muscle contractions Compromised stretch reflex Massage conservatively by using light pressure Do not attempt to increase ROM Falsely hypotonic muscles

17 Thyroid supplement There are no implications for massage, but massage can address the initial and temporary side effects of nervousness, agitation, and insomnia. Thyroid supplement Levothyroxine sodium Hypothyroidism Synthyroid Eltroxin Levothyroid Levoxyl Cytomel Triostat Boost protein synthesis in cells Promote the use of glycogen stores Increase heart rate and cardiac output Increased urine output Massage can address nervousness, agitation, and insomnia No other implications for massage New users may experience nervousness, agitation, and insomnia Dessicated extract Hypothyroidism Armour Thyroid Nature- Thyroid Thyroid USP Same as Levothyroxine sodium Symptom fluctuations due to varying potency of dosages Same as Levothyroxine sodium Westhroid Liothyronine Hypothyroidism Cytomel Triostat Same as Levothyroxine sodium Same as Levothyroxine sodium

18 23a Pathology: Medications Knowing the effects of medications allows us to properly modify massage treatments.