23a Pathology: Medications Knowing the effects of medications allows - - PowerPoint PPT Presentation

23a Pathology: Medications

Knowing the effects of medications allows us to properly modify massage treatments.

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

Quizzes:

• 29b Kinesiology Quiz

– Supraspinatus, infraspinatus, teres major, subscapularis, pec minor, & serratus anterior

• 31a Written Exam Prep Quiz (20a, 20b, 21b, 22a, 23a, 24b, 29b, and 30a)
• 32a Written Exam Prep Quiz (24a, 25a, 26a, 27a, 28a, 29a, 30b, and 31b)

Assignments:

• 30a Review Questions

– Packet A: 123-140 Preparation for upcoming classes:

• 24a A&P: Muscular System: Organization of Skeletal Muscle

– Trail Guide: infraspinatus and teres minor – Salvo: Pages 432-436 – Packet E: 35-37 – Packet A-132

• 24b Hydrotherapy: Theory and Technique Demo

– Salvo: Pages 241-246 – Packet G: 1-14 – Packet A-133

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.

“Will the general parasympathetic changes that massage brings about carry any concern or risk in the presence of medications?”

Anti-anxiety Add stimulating strokes to combat lethargy and risk of falling.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications 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
• Fatigue
• Add stimulating

strokes throughout the session

• Assist client

when getting up to avoid falls

Anti-depressant Add stimulating strokes to bring the client back to full alertness.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Anti-depressant Tricyclics

• Depression

MAOIs

• Depression

SSRIs / SNRIs

• Depression
• Anxiety
• Eating disorders

Imipramine Nardil Prozac Zoloft Paxil Lexapro Effexor Cymbalta

• Prolongs availability of

various neurotransmitters in the brain.

• Anxiety (first 4 weeks)
• Headaches (first 4 weeks)
• Insomnia (first 4 weeks)
• Constipation
• Increased heart rate
• Headaches
• Excessive dizziness
• Excessive drowsiness
• Add gently

stimulating strokes at the end of the session to bring the client to full alertness

Anti-inflammatory and analgesic Do not overtreat: use light pressure and short session durations. Avoid deep tissue or myofascial techniques to prevent damage.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Anti-inflammatory and Analgesic Salicylates

• Inflammation
• Fever
• Anticoagulant

Acetaminophen

• Pain
• Fever

NSAIDs

• Inflammation

Steroidals

• Inflammation

Narcotics

• Pain
• Cough
• G.I. tract

slugishness Aspirin Tylenol Advil Aleve Vioxx Celebrex Prednisone Methotrexate Codeine Demerol Oxycontin Percocet Vicodin Dilaudid Morphine

• 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
• Lethargy
• Chills
• Massage

conservatively and avoid

• vertreatment

by avoiding deep tissue and myofascial techniques that may cause tissue damage

Autonomic Nervous System Depends on the subclass of medications. See tables below for more details.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Autonomic Nervous System (ANS) Cholinergics

• Gastrointestinal
• Urinary
• Cardiac
• Respiratory

Anti-cholinergics

• Various, ask your

client Adrenergic

• Gastrointestinal
• Urinary
• Cardiac
• Respiratory

Adrenergic blockers

• Blocking various

receptor sites, ask your client Urecholine Atropine Scopolamine Dopamine Epinephrine Albuterol Flomax

• Stimulate parasympathetic

nervous system

• Dizziness
• Deep parasympathetic

lethargy

• Stimulate OR suppress

parasympathetic nervous system

• Various, ask your client
• Stimulate sympathetic

nervous system

• Difficulty inducing a

parasympathetic response in the client

• Suppress sympathetic

nervous system

• Dizziness
• Deep parasympathetic

lethargy

• Add stimulating

strokes throughout the session to bring the client to full alertness

• If stimulating,

then use longer slower strokes and avoid tapotement and friction

• If suppressing,

then use stimulating strokes

• Use longer,

slower strokes and avoid tapotement and friction.

• Add stimulating

strokes throughout the session to bring the client to full alertness

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Cardiovascular Beta blockers

• Angina
• Hypertension
• Anxiety

Calcium channel blockers

• Hypertension
• Long-term angina

ACE inhibitors

• Hypertension
• Heart failure

Digitalis

• Arrhythmia
• Heart failure

Levatol Norvasc Lotensin Digitek

• Blocks beta receptors from

triggering high blood pressure

• Low blood pressure
• Vasodilation and increased

cardiac efficiency

• Low blood pressure
• Flushing
• Dizziness
• Reduces cardiac load by

promoting the excretion of sodium and water

• Excessively low blood

pressure

• Fatigue
• Dizziness
• Lethargy
• Increased cardiac force
• Decreased cardiac rate
• Inability to respond to

rigorous massage

• Assist client

when getting up to avoid falls

• Emphasize short

strokes

• Avoid long,

draining circulatory strokes

• If suppressing,

then use stimulating strokes

• Use longer,

slower strokes and avoid tapotement and friction.

• Use non-

circulatory techniques

• End the session

with invigorating strokes to support alertness

Cardiovascular Depends on the subclass of medications. See tables below for more details.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Cardiovascular, continued Anti-lipemic

• High cholesterol

Diuretics

• Heart failure
• Hypertension
• Kidney disease

Anti-angina

• Acute angina

Lipitor Crestor Zocor Thalidone Lasix Nitroglycerin

• Promotes excretion of bile

in stool so that the liver must use more cholesterol in bile manufacturing

• Constipation
• Increased urine production
• Kidneys unable to adapt to

increased circulatory load

• Low blood pressure
• Excessive potassium loss
• Reduced myocardial
• xygen demand
• Increased myocardial
• xygen supply
• Hypotension
• Flushing
• Dizziness
• Medical

emergencies:

• Abdominal

pain

• No bowel

movement in 4 days

• Muscle

soreness, cramping, and weakness

• Muscle

wasting

• Use non-

circulatory techniques

• Assist client

when getting up to avoid falls

• Avoid

transdermal patch area

• Use invigorating

strokes to support alertness

• Assist client

when getting up to avoid falls

Cardiovascular Depends on the subclass of medications. See tables below for more details.

Cancer Wear gloves to protect against excreted medications. Consult physician about interaction of massage, medications, and treatment.

Classes Subclasses Examples Effects / Side Effects Modifications Cancer Alkylating Anti-metabolite Antibiotic anti- neoplastics Hormonal anti- neoplastics Natural anti- plastics 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

Clot management Only use the very lightest pressure. A known clot is an absolute

• contraindication. Avoid injection sites for 24 hours.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Clot management Anti-coagulants

• Atrial fibrillation
• Risk of deep vein

thrombosis

• Users of

hemodialysis Anti-platelets

• Risk of embolism

Injections: Heparin Lovenox Oral: Coumadin Aspirin Plavix

• Prevent formation of new

clots

• Do not dissolve pre-

existing clots

• Bruising, even with light

massage

• Prevent the clumping

together of platelets to form a clot

• Only use the

lightest forms of massage

• Absolutely

contraindicated if a clot is present

• Avoid injection

sites for 24 hours

• Same as anti-

coagulants

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.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Diabetes Insulin

• Hyperglycemia

Oral glucose management

• Hyperglycemia

Injection: Humulin Humalog Lantus Novolog Novolin Diabinase Glucotrol Glyburide Glucophage Precose

• 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

• Inhibit production of sugar

in the liver

• Improve output of insulin

from the pancreas

• Increase sensitivity of

insulin receptors on target cells

• 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

• Same as insulin

except no injection site caution

Muscle relaxant Invigorating strokes to support alertness. Do not attempt to increase

• ROM. Massage conservatively by using light pressure.

Classes Subclasses

• Uses

Examples Effects / Side Effects Modifications Muscle relaxants CNS skeletal muscle

• Muscle cramps

related to trauma or anxiety Peripheral skeletal muscle

• Muscle spasm

Valium Soma Skelaxin Norflex Dantrium

• Depress the CNS by

enforcing a parasympathetic state

• Suppress reflexes that

would tighten muscles in response to stretching or damage

• Exhaustion
• Compromised stretch

reflex

• Interferes with calcium

release from the sarcoplasmic reticulum of muscle cells, leading to weaker skeletal muscle contractions

• Compromised stretch

reflex

• Falsely hypotonic muscles
• Use invigorating

strokes to support alertness

• Do not attempt

to increase ROM

• Massage

conservatively by using light pressure

• Do not attempt

to increase ROM

Thyroid supplement There are no implications for massage, but massage can address the initial and temporary side effects of nervousness, agitation, and insomnia.

Classes Subclasses Examples Effects / Side Effects Modifications Thyroid supplement Levothyroxine sodium

• Hypothyroidism

Dessicated extract

• Hypothyroidism

Liothyronine

• Hypothyroidism

Synthyroid Eltroxin Levothyroid Levoxyl Cytomel Triostat Armour Thyroid Nature- Thyroid Thyroid USP Westhroid Cytomel Triostat

• Boost protein synthesis in

cells

• Promote the use of

glycogen stores

• Increase heart rate and

cardiac output

• Increased urine output
• New users may experience

nervousness, agitation, and insomnia

• Same as Levothyroxine

sodium

• Symptom fluctuations due

to varying potency of dosages

• Same as Levothyroxine

sodium

• Massage can

address nervousness, agitation, and insomnia

• No other

implications for massage

• Same as

Levothyroxine sodium

• Same as

Levothyroxine sodium

23a Pathology: Medications

Knowing the effects of medications allows us to properly modify massage treatments.