23a Pathology: Medications
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
23a Pathology: Medications � Class Reminders Practical Exams: 23b Swedish: Practical Exam � – Packet A: 91-94 – 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: 141-158) � Preparation for upcoming classes: 24a A&P: Muscular System - Organization of Skeletal Muscle � – Trail Guide: infraspinatus and teres minor – Packet E: 37-40 – RQ Packet A-148 24b Hydrotherapy: Theory and Technique Demo � – Packet G: 1-14 – RQ Packet A-149
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.
23a Pathology: Medications � E-27 Knowing the effects of medications allows us to properly modify massage treatments.
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.
Anti-anxiety Add stimulating strokes to combat lethargy and risk of falling. Classes Subclasses Examples Effects / Side Effects Modifications • Uses • Suppression of “fight or • Add stimulating Anti-anxiety flight” sympathetic strokes Benzodiazepines Valium response can lead to a throughout the • Short-term anxiety Ativan deep parasympathetic session • Seizures Xanax lethargy • Insomnia • Assist client • Convulsions • Poor reflexes when getting up to avoid falls • Unusually exhausted Buspirone HCL BuSpar • Short-term anxiety • Orthostatic hypotension • General anxiety • Dizziness • Fatigue
Anti-depressant Add stimulating strokes to bring the client back to full alertness. Classes Subclasses Examples Effects / Side Effects Modifications • Uses • Add gently Anti-depressant stimulating • Prolongs availability of Tricyclics Imipramine strokes at the • Depression various neurotransmitters end of the in the brain. session to bring the client to full • Anxiety (first 4 weeks) MAOIs Nardil alertness • Depression • Headaches (first 4 weeks) • Insomnia (first 4 weeks) • Constipation SSRIs / SNRIs Prozac • Depression • Increased heart rate Zoloft • Anxiety • Headaches Paxil • Eating disorders • Excessive dizziness Lexapro • Excessive drowsiness Effexor Cymbalta
Anti-inflammatory and analgesic Do not overtreat: use light pressure and short session durations. Avoid deep tissue or myofascial techniques to prevent damage. Classes Examples Effects / Side Effects Modifications Subclasses • Uses Anti-inflammatory • Changes the tissues’ ability • Massage and Analgesic to respond to stimulus by conservatively inhibiting inflammation and avoid Salicylates Aspirin and altering pain overtreatment • Inflammation perception by the CNS by avoiding • Fever deep tissue and • Anticoagulant • Inability to accurately myofascial perceive pain techniques that may cause • Hypotension Acetaminophen Tylenol tissue damage • Pain • Fever • Dizziness • Lethargy NSAIDs Advil • Inflammation Aleve • Chills Vioxx Celebrex Steroidals Prednisone • Inflammation Methotrexate Narcotics Codeine • Pain Demerol • Cough Oxycontin • G.I. tract Percocet Vicodin slugishness Dilaudid Morphine
Autonomic Nervous System Depends on the subclass of medications. See tables below for more details. Classes Subclasses Examples Effects / Side Effects Modifications • Uses Autonomic Nervous System (ANS) Cholinergics Urecholine • Stimulate parasympathetic • Add stimulating • Gastrointestinal nervous system strokes • Urinary throughout the • Cardiac • Dizziness session to bring • Respiratory • Deep parasympathetic the client to full lethargy alertness • Stimulate OR suppress • If stimulating, Anti-cholinergics Atropine • Various, ask your Scopolamine parasympathetic nervous then use longer system slower strokes client and avoid • Various, ask your client tapotement and friction • If suppressing, then use stimulating strokes Adrenergic Dopamine • Stimulate sympathetic • Use longer, • Gastrointestinal Epinephrine nervous system slower strokes • Urinary Albuterol and avoid • Cardiac • Difficulty inducing a tapotement and • Respiratory parasympathetic response friction. in the client Flomax • Suppress sympathetic • Add stimulating Adrenergic blockers • Blocking various nervous system strokes receptor sites, ask throughout the • Dizziness session to bring your client • Deep parasympathetic the client to full lethargy alertness
Cardiovascular Depends on the subclass of medications. See tables below for more details. Classes Subclasses Examples Effects / Side Effects Modifications • Uses Cardiovascular • Blocks beta receptors from • Assist client Beta blockers Levatol • Angina triggering high blood when getting up • Hypertension pressure to avoid falls • Anxiety • Low blood pressure • Vasodilation and increased • Emphasize short Calcium channel Norvasc blockers cardiac efficiency strokes • Hypertension • Avoid long, • Long-term angina • Low blood pressure draining • Flushing circulatory • Dizziness strokes Lotensin • Reduces cardiac load by • If suppressing, ACE inhibitors • Hypertension then use promoting the excretion of • Heart failure stimulating sodium and water strokes • Excessively low blood • Use longer, pressure slower strokes • Fatigue and avoid • Dizziness tapotement and • Lethargy friction. Digitalis Digitek • Increased cardiac force • Use non- • Arrhythmia • Decreased cardiac rate circulatory • Heart failure techniques • Inability to respond to • End the session with rigorous massage invigorating strokes to support alertness
Cardiovascular Depends on the subclass of medications. See tables below for more details. Classes Subclasses Examples Effects / Side Effects Modifications • Uses Cardiovascular, continued • Promotes excretion of bile • Medical Anti-lipemic Lipitor • High cholesterol Crestor in stool so that the liver emergencies: • Abdominal Zocor must use more cholesterol in bile manufacturing pain • No bowel • Constipation movement in 4 days • Muscle soreness, cramping, and weakness • Muscle wasting • Increased urine production Diuretics Thalidone • Use non- • Heart failure Lasix circulatory • Hypertension • Kidneys unable to adapt to techniques • Kidney disease • Assist client increased circulatory load • Low blood pressure when getting up • Excessive potassium loss to avoid falls • Reduced myocardial • Avoid Anti-angina Nitroglycerin • Acute angina oxygen demand transdermal • Increased myocardial patch area • Use invigorating oxygen supply strokes to • Hypotension support • Flushing alertness • Dizziness • Assist client when getting up to avoid falls
Cancer Wear gloves to protect against excreted medications. Consult physician about interaction of massage, medications, and treatment. Classes Examples Effects / Side Effects Modifications Subclasses • Kill cancer cells • Wear gloves to Cancer avoid excreted • Block cancer cell growth Alkylating Cytoxan medications Dacarbazine • Block vascular feeding of • Client should Anti-metabolite DIC CCNU cancer cells consult doctor Antibiotic anti- TSPA to know how • Medications can be neoplastics Cisplatin massage should Methotrexate excreted through the skin be modified Hormonal anti- 5-FU based on the • Radioactive elements may neoplastics Actinomycin medications and Tamofen be implanted in the body treatments Natural anti- Teslac administered plastics Vinblastine Vincristine Interleukin-2
Clot management Only use the very lightest pressure. A known clot is an absolute contraindication. Avoid injection sites for 24 hours. Classes Subclasses Examples Effects / Side Effects Modifications • Uses Clot management • Prevent formation of new • Only use the Anti-coagulants Injections: • Atrial fibrillation Heparin clots lightest forms of • Risk of deep vein Lovenox massage • Do not dissolve pre- thrombosis • Users of Oral: existing clots • Absolutely hemodialysis Coumadin contraindicated • Bruising, even with light if a clot is massage present • Avoid injection sites for 24 hours • Prevent the clumping • Same as anti- Anti-platelets Aspirin • Risk of embolism Plavix together of platelets to coagulants form a clot
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