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Analyse and respond to
Client Health Information
Learner Guide
Massage Schools of Queensland Client Health Information Learner Guide
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METHOD OF DELIVERY: Each session is of 3 hours duration. Hand out notes and session review sheets are provided and students are advised that some note taking is recommended. The two way sharing of information and experience is encouraged in all classes.
RESOURCES REQUIRED:
Students are required to bring their own stationary and dress casually to prevent damage to good clothes. Students are also required to bring a towel to each class. You may also like to bring a pillow for comfort. All other required resources to facilitate learning will be supplied by MSQ.
REGARDING CLASSES
All classes will start at scheduled times, if you are delayed for some VITAL reason – be respectful of your fellow students and enter class quietly.
If you need to leave the room during class, please explain and excuse yourself.
The onus is on you to catch up on any missed theory or practical.
If you expect to miss a class – approach a fellow student to collect notes and assist you to assimilate.
Your trainers are available to you at all times – however, as class time is limited to course structure it may be necessary to arrange tutorial time with your trainer.
At the end of class, students are required to disinfect and cleanse tables with cleaner provided and paper towels – replace chairs and tables that have been moved. We aim to finish class 5 minutes ahead of time so that students may attend to correct Workplace Health and Safety processes of cleaning tables and equipment used in class.
Recommended reading and references:
1. Orthopedic Physical Assessment, third edition. David J. Magee, 1997, W.B. Saunders Company
2. Physical examination of the spine extremeties Stanley Hoppenfeld, 1976, Appleton & Lange.
3. Physical Assessment 3rd Edition, Dr. Nikita Vizniak, 2010 4. Professional Health Systems www.prohealthsys.com 5. The Massage Connection Anatomy & Physiology (2nd Edition) 2003 6. Trail Guide to the Body 3rd Ed, Andrew Biel, 2005, Books of Discovery
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CONTENT
Session 1: Review of Certificate IV Musculoskeletal Anatomy knowledge Session 2: Chemical level of organisation Session 3: Cellular level of organisation Session 4: Pharmacology Session 5: Pharmacology Session 6: Upper Limb analysis and palpatory skills Session 7: Lower Limb analysis and palpatory skills Session 8: Vertebral Column Cervical and Thoracic spine Session 9: Vertebral Column Lumbar spine and Sacroiliac joint Session 10: Effects of aging on the body Session 11: Assessment chronic health assessment and massage Session 12: Pathophysiology of chronic diseases
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Advanced Anatomy and Physiology
SESSION 1 : Review of Certificate IV in Massage Therapy Practice Anatomy and Physiology
Timing Content Learning experience used Resources
30min Intro to course
Assessment requirements, required texts Discussion and questions
Handouts
45min
Assessment of knowledge level of anatomy and physiology
Students to work through activities in resource guide on
body planes
directional terms
planes of movement
movement terminology
Student resource session 1
30 min
Review of skeletal surface anatomy
Students to palpate in pairs activity of skeletal landmarks
15 min BREAK
60 min
Physiology of muscles Learn about physiology of muscle contraction and neural stimulation of muscles
If time allows student to spend time practicing palpation skills in body pressure and superficial v.s deep muscles
Review of musculoskeletal system In order to facilitate a starting point for the Diploma we need to establish a minimum of knowledge expectation of the fundamental basics for a Cert IV graduate to know. Directional terms Medial-lateral Superior-inferior Superficial-deep
Planes- frontal, sagittal, transverse. Students to demonstrate knowledge of
each plane
Location of major organs. Students to locate major organs as directed by
teacher.
Axial skeleton. Students to differentiate bones as either axial or
appendicular
Appendicular skeleton
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Movement terminology. Students to demonstrate as directed Abduction Adduction Supination Pronation Inversion Eversion, Plantar flexion Dorsi flexion Protraction (Jaw, scapula) Retraction Flexion Extension Circumduction Rotation
Review of major anatomical landmarks. Locate the following structures on a partner.
Skull:
Frontal bone
Mandible
Maxilla
Occipital Bone
Temporal Bone
Mastoid Process
Parietal Bone
EOP (external occipital protuberance)
Foramen Magnum
Hyoid Bone
Scapula
Acromion
Medial Border of the scapula
Inferior angle
Lateral border of the scapula
Coracoid Process
AC Joint
Superior Angle
Supraspinous Fossa
Infraspinous Fossa
Glenoid Cavity
Subscapula Fossa
Vertebral Column and Ribs
Sternum
True Ribs
False Ribs
Floating ribs
Xiphoid Process
Costal Cartilage
Clavicle
Vertebrae’s
Spinous Process
Transverse Process
Bodies of vertebra
Intervertebral Disks
Sacrum
Coccyx
Sacral Foramen
Arm
Humerus
Greater Tubercle
Lesser Tubercle
Bicipital Groove
Deltoid Tuberosity
Medial Epicondyle
Lateral Epicondyle
Radius
Radial Styloid Process
Radial Tuberosity
Ulna
Ulna Styloid Process
Olecranon Process
Carpals
Metacarpals
Phalanges
Pelvic Girdle
Ilium
Ischium
Pubis
ASIS
PSIS
Acetabulum
Ischial Tuberosity
Pubic Symphysis
Iliac crest
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Iliac Fossa
Lower limb
Femur
Head of Femur
Greater trochanter
Lesser trochanter
Femoral Condyles
Patella
Linear Aspera
Tibia
Fibula
Tibial Tuberosity
Medial malleolus
Lateral malleolus
Talus
tarsals
calcaneus
Metatarsals
Phalanges
Palpation of muscle groups: Identify and palpate the following muscle groups at the origin and insertion. Rhomboids major/minor Levator scapula Quadratus lumborum Extensor carpi radialis brevis/longus Psoas major Iliacus Gluteus medius Serratus anterior Pectoralis minor Brachialis Piriformis Quadratus femoris Scalenes Pes anserinus tendon Levator scapula Subclavius Ilio-tibial band Platysma Rotator cuff muscles – Name them and palpate them O and I
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Sesson 2 –Chemical level of organisation Timing Content Learning experience used Resources
15min Review last week’s class
Musculoskeletal Anatomy
Worksheet with labelling
30min
Basic chemistry
Learn about the chemical level of organisation of the human body
Student resource session 3 PPT Chemical level
30 min
Basic chemistry
Learn about the chemical level of organisation of the human body
Student resource session 3 PPT Chemical level
15 min BREAK
60 min
Review questions p22
As a group answer the review questions
Interactive CD-ROM Marieb Essentials
Assessment 2 Quiz 1
Q&A for quiz 1
Class Powerpoint Outline
• Chapter 2
The Chemical Level of Organization • Matter
– elements – atoms and molecules
• Chemical bonds • Chemical energy • Chemical reactions • Inorganic compounds • Organic compounds • How Matter is Organized • Chemistry is the science of the structure and interactions of matter.
– all living things consist of matter. • Matter is anything that occupies space.
– mass is the amount of matter in any object. – weight is the force of gravity acting on matter.
• In outer space, weight is close to zero, but mass remains the same as on Earth. • Chemical Elements • Elements are substances that can not be split into simpler substances by ordinary means.
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– 112 elements ( 92 occur naturally ) – 26 of naturally occurring elements are in the body – represented by chemical symbols ( first 1-2 letters of name )
• 4 elements form 96 % of the body’s mass – hydrogen, oxygen, carbon and nitrogen
• Trace elements are present in tiny amounts – such as copper, tin, selenium & zinc
• Structure of Atoms • Atoms are the smallest units of matter that retain the properties of an element • Atoms consist of 3 types of subatomic particles
– protons, neutrons and electrons • Nucleus contains protons (p+) & neutrons (neutral charge) • Electrons (e-) surround the nucleus as a cloud (electron shells are designated regions of
the cloud) • Electron Shells • Most likely region of the electron cloud in which to find electrons • Each electron shell can hold only a limited number of electrons
– first shell can hold only 2 electrons – 2nd shell can hold 8 electrons – 3rd shell can hold 18 electrons – higher shells (up to 7) hold many more electrons
• Number of electrons = number of protons • Each atom is electrically neutral; charge = 0 • Atomic Number & Mass Number • Atomic number is number of protons in the nucleus. . • Mass number is the sum of its protons and neutrons. • Isotopes • Atoms of an element with different numbers of neutrons & different mass numbers • All isotopes of an element have same properties
– have same number of electrons (which determine its chemical properties) • Only radioactive isotopes are unstable
– decay over time to a more stable configuration – half-life is time required for half of the radioactive atoms in a sample to decay
• Effects of Radiation • Radioactive isotopes can pose a serious health threat
– break apart molecules & cause tissue damage • Decay of naturally occurring radioactive isotopes releases small amounts of radiation
– radon-222 gas may seep out of soil in basement – increases the risk of lung cancer
• Radioactive isotopes used beneficially in medical imaging procedures & treat cancer • Atomic Mass • Mass is measured as dalton (atomic mass unit)
– neutron has mass of 1.008 daltons – proton has mass of 1.007 daltons – electron has mass of 0.0005 dalton
• Atomic mass (atomic weight) is close to the mass number of its most abundant isotope. • Ions, Molecules, & Compounds • Ions are formed by ionization • an atom that gave up or gained an electron
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• written with its chemical symbol and (+) or (-) • Molecule • when 2 or more atoms share electrons to form a bond can be same atoms i.e O2 • written as molecular formula showing the number of atoms of each element (H2O) • a compound is a substance that results from a combination of two or more different
chemical element s, in such a way that the atom s of the different elements are held together by chemical bonds that are difficult to break
• Free Radicals • Atom with an unpaired electron in its outmost shell • Unstable and highly reactive • Can become stable
– by giving up electron – taking one off another molecule (breaking apart important body molecules) – Free Radicals & Your Health
• Produced in your body by absorption of energy in ultraviolet light in sunlight, x-rays, by breakdown of harmful substances, & during normal metabolic reactions
• Linked to many diseases -- cancer, diabetes, Alzheimer, atherosclerosis and arthritis • Damage may be slowed with antioxidants such as vitamins C and E, selenium & beta-
carotene (precursor to vitamin A) • Chemical Bonds • Bonds hold together the atoms in molecules and compounds • An atom with a full outer electron shell is stable and unlikely to form a bond with another
atom • Octet rule states that biologically important elements interact to produce chemically
stable arrangements of 8 electrons in the valence shell. • Whether electrons are shared, donated or acquired determines the types of bonds formed • Ionic Bonds • Positively and negatively charged ions attract each other to form an ionic bond • In the body, ionic bonds are found mainly in teeth and bones • An ionic compound that dissociates in water into + and - ions is called an electrolyte
– the solution can conduct an electric current – The Ionic Bond in Sodium Chloride
• Sodium loses an electron to become Na+ (cation) • Chlorine gains an electron to become Cl- (anion) • Na+ and Cl- are attracted to each other to form the compound sodium chloride (NaCl) --
table salt • Ionic compounds generally exist as solids • Covalent Bonds • Atoms share electrons to form covalent bonds • Electrons spend most of the time between the 2 atomic nuclei
– single bond = share 1pair – double bone = share 2 pair – triple bond = share 3 pair
• Polar covalent bonds share electrons unequally between the atoms involved • Polar Covalent Bonds • Unequal sharing of electrons between atoms. • In a water molecule, oxygen attracts the hydrogen electrons more strongly
– Oxygen has greater electronegativity as indicated by the negative Greek delta sign. • Hydrogen Bonds
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• Polar covalent bonds between hydrogen and other atoms • Only about 5% as strong as covalent bonds • Useful in establishing links between molecules • Large 3-D molecules are often held together by a large number of hydrogen bonds. • Chemical Reactions • When new bonds form or old bonds are broken • Metabolism is all the chemical reactions in the body • Law of conservation of mass = total mass of reactants equals the total mass of the
products • Energy and Chemical Reactions • Chemical reactions involve energy changes • Two principal forms of energy
– potential energy = stored energy – kinetic energy = energy of motion
• Chemical energy is potential energy stored in the bond of molecules – digestion of food releases that chemical energy so that it can be converted to heat
or mechanical energy • Law of conservation of energy
– energy can neither be created nor destroyed--just converted from one form to another
• Energy Transfer in Chemical Reactions • Forming new bonds releases energy & breaking old bonds requires energy • Chemical reactions usually involve both
– exergonic reactions release more energy – endergonic reactions absorb more energy than they release
• Human metabolism couples exergonic and endergonic reactions, so that the energy released from one reaction will drive the other.
– Glucose breakdown releases energy used to build ATP molecules that store that energy for later use in other reactions
• Activation Energy • Atoms, ions & molecules are continuously moving & colliding • Activation energy is the collision energy needed to break bonds & begin a reaction • Increases in concentration & temperature, increase the probability of 2 particles colliding
– more particles in a given space as concentration is raised – particles move more rapidly when temperature is raised
• Catalysts or Enzymes • Normal body temperatures and concentrations are too low to cause chemical reactions to
occur • Catalysts speed up chemical reactions by lowering the activation energy needed to get it
started • Catalysts orient the colliding particles properly so that they touch at the spots that make
the reaction happen • Catalyst molecules are unchanged and can be used repeatedly to speed up similar
reactions. • Effectiveness of Catalysts • Catalysts speed up chemical reactions by lowering the activation energy. • Synthesis Reactions--Anabolism • Two or more atoms, ions or molecules combine to form new & larger molecules • All the synthesis reactions in the body together are called anabolism
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• Usually are endergonic because they absorb more energy than they release • Example
– combining amino acids to form a protein molecule – Decomposition Reactions--Catabolism
• Large molecules are split into smaller atoms, ions or molecules • All decomposition reactions occurring together in the body are known as catabolism • Usually are exergonic since they release more energy than they absorb • Exchange Reactions • Substances exchange atoms
– consist of both synthesis and decomposition reactions • Example
– HCl + NaHCO3 gives rise to H2CO3 + NaCl – ions have been exchanged between substances
• Reversible Reactions • Chemical reactions can be reversible.
– Reactants can become products or products can revert to the original reactants • Indicated by the 2 arrows pointing in opposite directions between the reactants and the
products • AB A + B • Oxidation-Reduction Reactions • Oxidation is the loss of electrons from a molecule (decreases its potential energy)
– acceptor of the electron is often oxygen – commonly oxidation reactions involve removing a hydrogen ion (H+) and a hydride
ion (H-) from a molecule – equivalent to removing 2 hydrogen atoms = 2H
• Reduction is the gain of electrons by a molecule – increases its potential energy
• In the body, oxidation-reduction reactions are coupled & occur simultaneously • Inorganic Compounds & Solvents • Most of the chemicals in the body are compounds • Inorganic compounds
– usually lack carbon & are structurally simple – water, salts, acids and bases
• Organic compounds – contain carbon & usually hydrogen – always have covalent bonds
• Inorganic Acids, Bases & Salts • Acids, bases and salts always dissociate into ions if they are dissolved in water
– acids dissociate into H+ and one or more anions – bases dissociate into OH- and one or more cations – salts dissociate into anions and cations, none of which are either H+ or OH-
• Acid & bases react in the body to form salts • Electrolytes are important salts in the body that carry electric current (in nerve or muscle) • Mixtures, Solutions, Colloids, & Suspensions • Mixture is a combination of elements or compounds that are physically blended by not
joined by bonds ---- air • Common liquid mixtures
– solutions are solutes mixed in a solute • usually looks clear (sweat is water and dissolved salts)
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– colloid are solutes mixed in a solute • particles are larger so does not look clear (milk) • particles do not settle out of solution
– suspension are solutes mixed in a solute • particles settle out of solution because of size (blood)
• Concentration • Concentration of a solution can be expressed as percentage or moles per liter • Percentage
– relative mass of a solute in a given volume of solution • Moles per liter
– measures total number of molecules in a given volume of solution – a mole is Avogadro’s number or the atomic mass in grams of all of its atoms
• Water • Most important inorganic compound in living systems • Medium of nearly all chemical reactions • Polarity
– uneven sharing of valence electrons – partial negative charge near oxygen atom and partial positive charge near
hydrogen atoms • makes it an excellent solvent for ionic or polar substances • gives water molecules cohesion • allows water to moderate temperature changes
– Water as a Solvent • Most versatile solvent known
– polar covalent bonds (hydrophilic versus hydrophobic) – its shape allows each water molecule to interact with 4 or
more neighboring ions/molecules • oxygen attracts sodium • hydrogen attracts chloride • sodium & chloride separate as ionic bonds are broken • hydration spheres surround each ion and decrease possibility of bonds
being reformed • Water dissolves or suspends many substances • Water in Chemical Reactions • Participates as a product or reactant in certain reactions in the body
– hydrolysis reactions • water is added to a large molecule to separate it into two smaller molecules • digestion of food
– dehydration synthesis reaction • two small molecules are joined to form a larger molecule releasing a water
molecule • Heat Capacity of Water • Heat capacity is high
– can absorb a large amount of heat with only a small increase in its own temperature
• large number of hydrogen bonds in water – bonds are broken as heat is absorbed instead of increasing
temperature of water
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– large amount of water in body helps lessen the impact of environmental changes in temperature
• Heat of vaporization is also high – amount of heat needed to change from liquid to gas – evaporation of water from the skin removes large amount of heat
• Cohesion of Water Molecules • Hydrogen bonds link neighboring water molecules giving water cohesion • Creates high surface tension
– difficult to break the surface of liquid if molecules are more attracted to each other than to surrounding air molecules
– respiratory problem causes by water’s cohesive property • air sacs of lungs are more difficult to inflate
• Water as a Lubricant • Major component of lubricating fluids within the body
– mucus in respiratory and digestive systems – synovial fluid in joints – serous fluids in chest and abdominal cavities
• organs slide past one another • Concept of pH • pH scale runs from 0 to 14 (concentration of H+ in moles/liter) • pH of 7 is neutral (distilled water -- concentration of OH- and H+ are equal) • pH below 7 is acidic and above 7 is alkaline • pH of 1 (10 times more H+ than pH of 2) • Buffer Systems of the Body • Body fluids vary in pH but the range of each is limited and is maintained by a variety of
buffering systems. – gastric juice 1.2 to 3.0; saliva 6.35 to 6.85; bile 7.6 to 8.6 and blood 7.35 to 7.45
• Buffers convert strong acids to weak ones which contribute fewer H+ ions & have less effect on pH
– carbonic acid - bicarbonate buffer system – together they contribute H+ or OH- ions as needed to keep the pH of the blood
stable • Organic Compounds • Always contain carbon and hydrogen • Usually contain covalent bonds • Usually large, unique molecules with complex functions • Make up 40% of body mass • Carbon & Its Functional Groups • Properties of carbon atoms
– forms bonds with other carbon atoms produce large molecules • with many different shapes (rings, straight or branched chains) • do not dissolve in water
• Many functional groups can attach to carbon skeleton – esters, amino, carboxyl, phosphate groups (Table 2.5)
• Very large molecules called macromolecules (polymers if all monomer subunits are similar) • Isomers have same molecular formulas but different structures (glucose & fructose are
both C6H12O6 • STRUCTURAL FORMULA OF GLUCOSE • Carbohydrates
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• Diverse group of substances formed from C, H, and O – ratio of one carbon atom for each water molecule (carbohydrates means “watered
carbon”) – glucose is 6 carbon atoms and 6 water molecules (H20)
• Main function is source of energy for ATP formation • Forms only 2-3 % of total body weight
– glycogen is storage in liver and muscle tissue – sugar building blocks of DNA & RNA (deoxyribose & ribose sugars)
• Only plants produce starches or cellulose for energy storage
• Diversity of Carbohydrates • 3 sizes of carbohydrate molecules
– monosaccharides – disaccharides – polysaccharides
• Monosaccharides • Called simple sugars • Contain 3 to 7 carbon atoms • We can absorb only 3 simple sugars without further digestion in our small intestine
– glucose found syrup or honey – fructose found in fruit – galactose found in dairy products
• Disaccharides • Formed by combining 2 monosaccharides by dehydration synthesis (releases a water
molecule) – sucrose = glucose & fructose – maltose = glucose & glucose – lactose = glucose & galactose (lactose intolerance)
• Polysaccharides • Contain 10 or 100’s of monosaccharides joined by dehydration synthesis • In animals
– glycogen is a chain of hundreds of glucose molecules – found in liver & skeletal muscle – when blood sugar level drops, liver hydrolyzes glycogen to create and release
glucose into the blood • In plants
– starch and cellulose are large carbohydrate molecules used for energy storage (rice, potatoes, grains)
• Lipids = fats • Formed from C, H and O
– includes fats, phospholipids, steroids, eicosanoids, lipoproteins and some vitamins • 18-25% of body weight • Hydrophobic
– fewer polar bonds because of fewer oxygen atoms – insoluble in polar solvents like water
• Combines with proteins for transport in blood – lipoproteins
• Triglycerides • Neutral fats composed of a single glycerol molecule and 3 fatty acid molecules
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– three-carbon glycerol molecule is the backbone • Very concentrated form of energy
– 9 calories/gram compared to 4 for proteins & carbohydrates – our bodies store triglycerides in fat cells if we eat extra food
• Triglycerides • 3 fatty acids & one glycerol molecule • Fatty acids attached by dehydration systhesis • Saturation of Triglycerides • Determined by the number of single or double covalent bonds • Saturated fats contain single covalent bonds and are covered with hydrogen atoms----lard • Monounsaturated are not completely covered with hydrogen----safflower oil, corn oil • Polyunsaturated fats contain even less hydrogen atoms----olive and peanut oil • Chemical Nature of Phospholipids • Phospholipids • Composition of phospholipid molecule
– a polar head • a phosphate group (PO4-3) & glycerol molecule • can form hydrogen bonds with water
– 2 nonpolar fatty acid tails • interact only with lipids
– amphipathic(molecules with polar & nonpolar parts) • Composition of cell membrane
– double layer of phospholipids with tails in center – Steroids
• Formed from 4 rings of carbon atoms joined together • Common steroids
– sex hormones, bile salts, vitamins & cholesterol – classified as sterols because have alcohol group attached to one or more of the
rings • Cholesterol found in animal cell membranes
– starting material for synthesis of other steroids • Four Ring Structure of Steroids • Eicosanoids • Lipid type derived from a fatty acid called arachidonic acid
– prostaglandins = wide variety of functions • modify responses to hormones • contribute to inflammatory response • prevent stomach ulcers • dilate airways • regulate body temperature • influence formation of blood clots
– leukotrienes = allergy & inflammatory responses • Proteins
• 12-18% of body weight • Contain carbon, hydrogen, oxygen, and nitrogen • Constructed from combinations of 20 amino acids.
– dipeptides formed from 2 amino acids joined by a covalent bond called a peptide bond
– polypeptides chains formed from 10 to 2000 amino acids.
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• Levels of structural organization – primary, secondary and tertiary – shape of the protein influences its ability to form bonds
• Amino Acid Structure • Central carbon atom • Amino group (NH2)
• Enzymes are protein molecules that act as catalysts • Enzyme = apoenzyme + cofactor
– Apoenzymes are the protein portion – Cofactors are nonprotein portion
• may be metal ion (iron, zinc, magnesium or calcium) • may be organic molecule derived from a vitamin
• Enzymes usually end in suffix -ase and are named for the types of chemical reactions they catalyze
– Enzyme Functions • Bonds made or broken when atoms, ions or molecules collide • Enzymes speed up reactions by properly orienting colliding molecules • 1000 known enzymes speed up metabolic reactions to 10 billion times that in beaker • Composed of protein portion (apoenzyme) & nonprotein portion (cofactor)
– cofactors can be metal ions or vitamins • Enzyme Functionality • Highly specific
– acts on only one substrate • active site versus induced fit
– speed up only one reaction • Very efficient
– speed up reaction up to 10 billion times faster • Under nuclear control
– rate of synthesis of enzyme – inhibitory substances – inactive forms of enzyme
• Galactosemia • Inherited disorder in which baby lacks a digestive enzyme • Galactose accumulates in the blood causing anorexia • Treatment is elimination of milk from the diet • DNA Structure • Huge molecules containing C, H, O, N and phosphorus • Each gene of our genetic material is a piece of DNA that controls the synthesis of a specific
protein • A molecule of DNA is a chain of nucleotides • Nucleotide = nitrogenous base (A-G-T-C) + pentose sugar + phosphate group • DNA Fingerprinting • Used to identify criminal, victim or a child’s parents
– need only strand of hair, drop of semen or spot of blood • Certain DNA segments are repeated several times
– unique from person to person • RNA Structure • Differs from DNA
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– single stranded – ribose sugar not deoxyribose sugar – uracil nitrogenous base replaces thymine
• Types of RNA within the cell, each with a specific function – messenger RNA – ribosomal RNA – transfer RNA – Adenosine Triphosphate (ATP)
• Temporary molecular storage of energy as it is being transferred from exergonic catabolic reactions to cellular activities
– muscle contraction, transport of substances across cell membranes, movement of structures within cells and movement of organelles
• Consists of 3 phosphate groups attached to adenine & 5-carbon sugar (ribose)
• Formation & Usage of ATP • Hydrolysis of ATP (removal of terminal phosphate group by enzyme -- ATPase)
– releases energy – leaves ADP (adenosine diphosphate)
• Synthesis of ATP – enzyme ATP synthase catalyzes the addition of the terminal phosphate group to
ADP – energy from 1 glucose molecule is used during both anaerobic and aerobic
respiration to create 36 to 38 molecules of ATP
Clinical Application The chemical activity of various tissues can be recorded and studied through radio-isotopic scanning. Sophisticated computer imaging techniques (similar to those used in CT scanning) produce Positron Emission Tomography (PET). Short lived radio-isotopes such as
11C,
13N or
15O are produced and included into a
solution to be injected into the body. As the radio-isotope circulates through the body it gives off positively charged electrons called positrons. These collide with negatively charged electrons in body tissues, releasing gamma rays. The gamma rays are detected by PET receptors and a computer constructs a coloured PET scan showing where the radio-isotopes are bind used in the body. PET can be used - to study the effects of various drugs on tissues/ organs of the body. - to measure blood flow through various organs. - to detect cancers. - to measure the effects of treatment. - to determine chemical changes, for example in epilepsy.
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Homeostasis is the tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes. A simple
example of homeostasis is the body's ability to maintain an internal temperature around 98.6 degrees Fahrenheit, whatever the temperature outside.
Aging is a form of homeostatic imbalance which can contribute to the development of diseases whereby the body’s negative feedback loops become less efficient. Examples of age related diseases include
type 2 diabetes
gout
hypoglaecemia/hyperglycaemia
dehydration
The role of carbohydrates and protein in the process of metabolism. Carbohydrates: Foods supply carbohydrates in three forms: starch, sugar, and cellulose (fibre).
Examples of carbohydrates include rice, wheat, bread or pasta. Both starch and sugars form the major and essential sources of energy. Carbohydrates and sugars from foods we consume yield glucose by digestion or metabolism, and glucose is required for body tissues to perform all activities.
Proteins: Proteins are the main tissue builders in the body required for nutrition as they contain amino acids, which form part of every cell in the body. Proteins assist in a variety of processes such as cell structure and functioning, haemoglobin formation to carry oxygen, enzymes to carry out vital reactions and a myriad of other functions in the body.
Organs involved in the process of acid-base balance and their role in this process?
Blood: calcium and other minerals and electrolytes are leached from bone and other tissues such as hair and nails if too acidic.
Kidneys: the primary organ responsible for excreting acid and regulating electrolyte balance.
Lungs: regulate acidity by increasing the rate of respiration which results in excreting higher levels of CO2.
Potential causes of Acid Base imbalances
Dehydration
Ingestion of acidic foods
High protein diet
Alcohol, caffeine, pop and other acidic beverages
Smoking and recreational drugs
Prescription medications (such as diuretics)
Environmental factors and toxins (such as air and water pollution)
Household chemicals
Emotional stress
Lack of sleep
Extreme exercise.
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Potential physiological changes occur as a result of acid-base imbalance
Weakness
Headache
Increases in body temperature
Changes in levels of potassium and other electrolytes
Calcifications in the joints and tissues
Infections
Increased aging
Destruction of protective barriers or tissues
Higher than normal acid levels in body fluids and tissues
Cells do not utilize oxygen efficiently
Coma and even death.
The role of acid-base imbalance in renal acidosis
Renal tubular acidosis (RTA) occurs when there is an accumulation of acid in the body when the kidneys fail to excrete acids into the urine. This can cause a person's blood to remain too acidic. The body's cells use chemical reactions to carry out tasks such as turning food into energy and repairing tissue. These chemical reactions generate acids.
The opposite of acidosis is Alkalosis which occurs when fluids have excess base (alkali).
Cellular Respiration.
Cellular respiration refers to the biochemical pathway by which cells release energy from the chemical bonds of food molecules and provide that energy for the essential processes of life. There are 2 types of cellular respiration – aerobic (with oxygen) or anaerobic (without oxygen).
Cellular adaptation
Cellular adaptation refers to changes made by a cell in response to adverse environmental changes. These changes can be caused by either physiological, normal, pathological or abnormal changes. There are 5 main types of cellular adaptation – atrophy, hypertrophy, hyperplasia, dysplasia and metaplasia.
Cellular adaption can contribute to abnormal changes
Atrophy – occurs when cells decrease in size, and can result in a decrease in size of the overall organ
Hypertrophy – the opposite of atrophy, when cells increase in size due to the increase in proteins or cytosol. This can result in enlarged organs
Hyperplasia – when the number of cells increases due to an increase in cell division
Dysplasia – abnormal changes in cell size or shape
Metaplasia – when a cell is replaced by a different cell.
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The image depicts the process of cell differentiation which occurs through gene expression. In this process organisms are provided with many types of specialised cells needed to perform specific functions. Organisms start from a single cell that contains all the required genetic information, or instructions, which reproduces into many stem cells with the potential to become any type of specialised cell.
The changes which occur within a cell and in connective tissue due the process of ageing.
As humans age the cells become larger and are less able to divide and multiply. There is also an increase in pigments, waste products and fatty substances (lipids) inside the cell which causes the cell to lose ability to function, lose mass, or function abnormally. Connective tissue changes and becomes stiff. This makes the organs, blood vessels, and airways more rigid. Cell membranes change, so many tissues have more trouble getting oxygen and nutrients, and removing carbon dioxide and wastes. The changes occurring in cells as we age occur to the overall organ which means organs begin to lose their functioning over time.
Muscles age related changes
Reduction in size
Loss of strength
Reduced toleration to exercise
Muscle fibres reduce in number and shrink in size
Muscle tissue is replaced more slowly and lost muscle tissue is replaced with a tough, fibrous tissue.
Oxygen O
Oxidation of glucose, fat, protein to provide energy- Cellular respiration. Part of all the major organic compounds. E.g carbohydrates, lipids,
proteins, nucleic acids + H2O
Carbon C Major constituent of all organic molecules and
compounds.
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Hydrogen H Constituent of water, all foods, most organic
compounds, contributes to acidity H+
Nitrogen N Associated with all proteins and nucleic acids
Calcium Ca Strength and integrity skeletal system, blood
clotting and muscular contractions, cell division- preparation of chromosomes, release of hormones
Potassium K Nerve impulse conduction, muscle contraction,
most abundant cation inside the cell K+
Sulfur S Component of proteins esp muscle, also some
vitamins
Sodium Na Aids fluid balance, muscle contraction, conducts
nerve impulses, most abundant extra-cellular cation
Chlorine Cl Maintains water balance, most abundant extra
cellular anion
Magnesium Mg Component of bone, an enzyme co-factor, aids
muscle relaxation
Iodine I Basis of thyroid hormones
Iron Fe Fe2+ and Fe3+ are important parts of
haemoglobin
Phosphorus P
Important component of ATP, and bones and teeth. Part of many nucleic acids and proteins, conducts nerve impulses and an intracellular
mediator
REVIEW QUESTIONS:-
1. Name four life processes of humans, and briefly define what they are. 2. What is homeostasis? 3. Which systems of the body play a major role in homeostasis, and how do they contribute? 4. What is the difference between a negative feedback loop and a positive feedback loop? 5. How does the respiratory mechanism affect pH? 6. What is the simplest level of matter?
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7. What are the most common elements found in the body? 8. What are the main components of an atom? 9. Why do atoms try to fill their outer shell, and how do they do this? 10. How many types of bonds can be formed between atoms? Name them. 11. What type of bonds share their electrons? 12. What type of compounds provide a good source of energy? Give an example of such a compound. 13. How do inorganic compounds differ from organic compounds? 14. What is pH and what is the pH scale? 15. What is interstitial fluid? 16. What is the relevance of studying the chemical level of organisation in relation to the human organism?
SELF-DIRECTED STUDY:-
Complete the multiple choice reading quiz from the support website for Essentials
of Human Anatomy and Physiology, by Elaine Marieb
http://wps.aw.com/bc_marieb_ehap_10/178/45725/11705638.cw/index.html
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Sesson 3 - The Cellular level of organisation Timing Content Learning experience used Resources
15min Review last week’s class
Review Chemistry
30min
Cells Plasma membrane PPTs
30 min
Cell physiology PPTs
15 min BREAK
60 min
Inclusions
PPTs
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Marieb PPTs
Extra learning website
http://people.eku.edu/ritchisong/301notes1.htm
Cells and Tissues
Carry out all chemical activities needed to sustain life
Cells are the building blocks of all living things
Tissues are groups of cells that are similar in structure and function
Anatomy of the Cell
Cells are not all the same
All cells share general structures
Cells are organized into three main regions
Nucleus
Cytoplasm
Plasma membrane
The Nucleus
Control center of the cell
Contains genetic material (DNA)
Three regions
Nuclear membrane
Nucleolus
Chromatin
Nuclear Membrane
Barrier of nucleus
Consists of a double phospholipid membrane
Contain nuclear pores that allow for exchange of material with the rest of the
cell
Nucleoli
Nucleus contains one or more nucleoli
Sites of ribosome production
Ribosomes then migrate to the cytoplasm through nuclear pores
Chromatin
Composed of DNA and protein
Scattered throughout the nucleus
Chromatin condenses to form chromosomes when the cell divides
Plasma Membrane
Barrier for cell contents
Double phospholipid layer
Hydrophilic heads
Hydrophobic tails
Also contains protein, cholesterol, and glycoproteins
Plasma Membrane
Plasma Membrane Specializations
Microvilli
Finger-like projections that increase surface area for absorption
Plasma Membrane Specializations
Membrane junctions
Tight junctions
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Desmosomes
Gap junctions
Cytoplasm
Material outside the nucleus and inside the plasma membrane
Cytosol
Fluid that suspends other elements
Organelles
Metabolic machinery of the cell
Inclusions
Non-functioning units
Cytoplasmic Organelles
Cytoplasmic Organelles
Ribosomes
Made of protein and RNA
Sites of protein synthesis
Found at two locations
Free in the cytoplasm
Attached to rough endoplasmic reticulum
Cytoplasmic Organelles
Endoplasmic reticulum (ER)
Fluid-filled tubules for carrying substances
Two types of ER
Rough Endoplasmic Reticulum
Studded with ribosomes
Site where building materials of cellular membrane are
formed
Smooth Endoplasmic Reticulum
Functions in cholesterol synthesis and breakdown, fat
metabolism, and detoxification of drugs
Cytoplasmic Organelles
Golgi apparatus
Modifies and packages proteins
Produces different types of packages
Secretory vesicles
Cell membrane components
Lysosomes
Golgi Apparatus
Cytoplasmic Organelles
Lysosomes
Contain enzymes that digest nonusable materials within the cell
Peroxisomes
Membranous sacs of oxidase enzymes
Detoxify harmful substances
Break down free radicals
(highly reactive chemicals)
Replicate by pinching in half
Cytoplasmic Organelles
Mitochondria
“Powerhouses” of the cell
Change shape continuously
Carry out reactions where oxygen is used to break down food
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Provides ATP for cellular energy
Cytoplasmic Organelles
Cytoskeleton
Network of protein structures that extend throughout the cytoplasm
Provides the cell with an internal framework
Cytoplasmic Organelles
Cytoskeleton
Three different types
Microfilaments
Intermediate filaments
Microtubules
Cytoplasmic Organelles
Centrioles
Rod-shaped bodies made of microtubules
Direct formation of mitotic spindle during cell division
Cellular Projections
Not found in all cells
Used for movement
Cilia moves materials across the cell surface
Flagellum propels the cell
Cellular Physiology: Membrane Transport
Membrane Transport – movement of substance into and out of the cell
Transport is by two basic methods
Passive transport
No energy is required
Active transport
The cell must provide metabolic energy
Solutions and Transport
Solution – homogeneous mixture of two or more components
Solvent – dissolving medium
Solutes – components in smaller quantities within a solution
Intracellular fluid – nucleoplasm and cytosol
Interstitial fluid – fluid on the exterior of the cell
Selective Permeability
The plasma membrane allows some materials to pass while excluding others
This permeability includes movement into and out of the cell
Passive Transport Processes
Diffusion
Particles tend to distribute themselves evenly within a solution
Movement is from high
concentration
to low
concentration,
or down a
concentration
gradient
Passive Transport Processes
Types of diffusion
Simple diffusion
Unassisted process
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Solutes are lipid-soluble materials or small enough to pass
through membrane pores
Passive Transport Processes
Types of diffusion
Osmosis – simple diffusion of water
Highly polar water easily crosses the plasma membrane
Facilitated diffusion
Substances require a protein carrier for passive transport
Diffusion through the Plasma Membrane
Passive Transport Processes
Filtration
Water and solutes are forced through a membrane by fluid, or
hydrostatic pressure
A pressure gradient must exist
Solute-containing fluid is pushed from a high pressure area to a
lower pressure area Osmotic pressure is the pressure that is needed to stop the transfer of a fluid in
a semi permeable membrane, while hydrostatic pressure is pressure applied on
a point in a fluid.Source: http://theydiffer.com/difference-between-
hydrostatic-and-osmotic-pressure/ Active Transport Processes
Transport substances that are unable to pass by diffusion
They may be too large
They may not be able to dissolve in the fat core of the membrane
They may have to move against a concentration gradient
Two common forms of active transport
Solute pumping
Bulk transport
Active Transport Processes
Solute pumping
Amino acids, some sugars and ions are transported by solute pumps
ATP energizes protein carriers, and in most cases, moves substances
against concentration gradients
Active Transport Processes
Bulk transport
Exocytosis
Moves materials out of the cell
Material is carried in a membranous vesicle
Vesicle migrates to plasma membrane
Vesicle combines with plasma membrane
Material is emptied to the outside
Exocytosis
Active Transport Processes
Bulk transport
Endocytosis
Extracellular substances are engulfed by being enclosed in a
membranous vescicle
Types of endocytosis
Phagocytosis – cell eating
Pinocytosis – cell drinking
Endocytosis
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Cell Life Cycle
Cells have two major periods
Interphase
Cell grows
Cell carries on metabolic processes
Cell division
Cell replicates itself
Function is to produce more cells for growth and repair
processes
DNA Replication
Genetic material duplicated and readies a cell for division into two cells
Occurs toward the end of interphase
DNA uncoils and each side serves
as a template
Events of Cell Division
Mitosis
Division of the nucleus
Results in the formation of two daughter nuclei
Cytokinesis
Division of the cytoplasm
Begins when mitosis is near completion
Results in the formation of two daughter cells
Stages of Mitosis
Interphase
No cell division occurs
The cell carries out normal metabolic activity and growth
Prophase
First part of cell division
Centromeres migrate to the poles
Stages of Mitosis
Metaphase
Spindle from centromeres are attached to chromosomes that are
aligned in the center of the cell
Stages of Mitosis
Anaphase
Daughter chromosomes are pulled toward the poles
The cell begins to elongate
Telophase
Daughter nuclei begin forming
A cleavage furrow (for cell division) begins to form
Stages of Mitosis
Stages of Mitosis
Protein Synthesis
Gene – DNA segment that carries a blueprint for building one protein
Proteins have many functions
Building materials for cells
Act as enzymes (biological catalysts)
RNA is essential for protein synthesis
Class Powerpoint Outline
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Label this cell
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Sesson 4 - Pharmacology Timing Content Learning experience used Resources
15min Review last week’s class
Review cell
30min
Pharmacology Introduction and timeline of drug usage in history
PPTs
30 min
Pharmakokinetics
How drugs are absorbed, distributed metabolised and eliminated
PPTs
15 min BREAK
60 min
New drugs
Drug approval and evaluation PPTs
Powerpoint outline for pharmacology introduction
Definitions Of Pharmacological terms Pharmacology: The study of the way drugs work in the body. Drug: A substance, which affects normal bodily functions at the cellular level. Pharmacodynamics: The study of what a drug does to the body- the biochemical and physiological effects of drugs and their mechanisms of actions. Pharmacokinetics: The study of what the body does to drugs – how the person handles the drug. How it absorbs, distributes, biotransforms and excretes drugs. Drug absorption: The process of drug movement from the site of administration toward the systemic circulation. Drug half-life: The time required for one half of the amount of drug in the body to be inactivated and eliminated. Therapeutic Index: A ratio of lethal dose of a drug to the therapeutic drug. Bioavailability: The rate and extent to which the active (drug or metabolite) enters the general circulation, thereby gaining access to the site of action and exerting a therapeutic effect. Drug interactions: Alterations of the effects of one drug by the prior of concurrent administration of another (drug-drug interaction); alteration of the effects of a drug by food (drug-food interactions). Adverse drug reaction: An undesirable drug action that can occur in the body and which is often harmful. Contraindication: A reason for not administering a drug. Side effect: A known response to a drug administration within normal dose ranges. Chemical name: The name given to a drug which accurately describes its chemical structure. Generic name: A simplified chemical name or artificial name given to a drug by its original manufacturer.
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Brand name: Trade or proprietory name given to a drug by its manufacturer. In utero: A term meaning in the uterus. In vitro: Experiments that are carried out in the laboratory that does not involve the use of living organisms, but could involve the use of living cells in culture. In vivo: Experiments that are carried out on a living organism. Polypharmacy: When a client is receiving therapy with a number of drugs concurrently. Placebo: A physiologically inactive substance. MIMS: Monthly Index of Medical Specialities. A reference text that health professionals uses to locate specific drugs. Iatrogenic: Due to the action of a physician or a therapy the doctor prescibed. An iatrogenic disease may be inadvertently caused by a physician or surgeon or by a medical or surgical treatment or a diagnostic procedure Timeline of Pharmacology Prior to 1
st Century
Alcohol is probably the first known natural substance used because of its profound effects on the human body Extracts of ephedrine, marijuana and opium used Camphor and cod liver oil used ALCOHOL 1st Century Drug syrups first used 6
th Century
Colchicine used 14
th Century
Tinctures 1st used.
16th
Century Tobacco, coffee, cocoa and tea introduced into Europe 17
th Century
Extracts of ipecacuanha, strychnine and quinine first used in Europe. Nitrous oxide discovered 18
th Century
Extracts of digitalis and atropine first used in the western world 19
th Century
The beginning of synthetic substance use, such as aspirin. The active constituents of plants are isolated (morphine, strychnine, quinine, codeine and cocaine) Early 20
th Century
Synthetic narcotics, insulin, antibiotics, anticonvulsants, psychotropic drugs, anticancer drugs developed Late 20
th Century
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The age of biotechnology Using living things to create products or to do tasks for human beings is a general description of biotechnology. 'Biotechnology' is the practice of using plants, animals and micro-organisms such as bacteria, as well as biological processes - such as the ripening of fruit or the bacteria that break down compost - to some benefit. For example, in industry, medicine and agriculture, biotechnology is used to produce foods, medicines, test for diseases and remove waste. It can also be used to solve problems and conduct research. Over time biotechnology has formed the basis of learning about people and diseases. Biotechnology has also underpinned the development of treatments.
Pharmacokinetics
1 Absorption
2 Distribution
3 Metabolism
4 Elimination
Absorption Movement of drug from site of administration into the bloodstream The rate of absorption and amount of drug absorbed will be dependant upon a number of factors including the drug product and route of administration IVI intravenous injection SL sub lingual IMI intramuscular injection Topical Skin application PO per oral SC subcutaneous PV per vaginal PR per rectum The most common site of absorption is via the GIT. Physiology of absorption
Oral Cavity Epithelium- large surface area sub lingual drugs Salivary acids enhance absorption into capillaries. Short contact time
Stomach Large surface Acid pH -2 Protease activity Pepsin ( inhibits or destroys warfarin and heparin) Contact time will vary diet, timing of eating, activity, posture Fe absorbed
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Small Intestine Major area of drug absorption- very large surface area Long contact Absorption of fat soluble drugs Proximally pH 4-5 enhances acidic drugs Distally pH 7-8 enhances basic drug absorption
Large intestine Less surface and less absorption More absorption of water soluble drugs Digestive enzymes inactivated
Powerpoint outline for Pharmacology absorption and distribution Absorption through the skin Also known as transdermal or topical administration Absorption through the skin is slow Absorption is by passive diffusion Examples are nicotine patches, glycerol trinitrate (prophylaxis of angina), Estraderm
Respiratory absorption Inhalation Most effective route for rapid absorption of drugs delivered as gases or aerosols The blood leave the lungs directly to the brain taking up to 5-8 seconds. Intravenous injection can take 15 seconds Examples are ventolin and becotide
Drug distribution Distribution takes place after the drug had absorbed into the bloodstream and involves the phase whereby the drug moves to its place of action
How drugs are distributed Protein binding This allows the drugs to be transported around the body bound to blood proteins. Protein binding is only temporary, if the drug is to act upon the body; entry into the tissues is required Protein binding also results in a longer duration of action of the drug, as the drug is held in the blood and only released in proportion to that which is leaving the blood and metabolised in the liver. Sometimes if 2 drugs are taken together, both which bind proteins then this may cause a drug-drug interaction eg Warfarin and aspirin, and alcohol and alprozalam
Liver After a drug is absorbed it is taken up by the hepatic portal system. Some exceptions to this are lipids, which normally enter into the lymphatic system and are eventually deposited into the blood via the thoracic duct into the …………..? The hepatic portal system is designed to take digested foodstuffs to the liver where they can be processed. When this happens to drugs they may be metabolised before they reach their target tissues. This is called a high hepatic first pass.
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An example of a high hepatic first pass drug is Pethidine. An IVI dose of 25 mg is equivalent to an oral dose of 100mg
Blood – Brain Barrier The blood brain barrier prevents harmful substances that may be present in the blood from entering the brain. Lipid soluble drugs diffuse readily across the blood brain barrier. Ions and water soluble drugs do not diffuse readily and require facilitated or active transport mechanisms. If specific carriers are not present, the blood brain barrier remains impermeable to the substances. Spaces between the endothelial cells of brain capillaries are sealed by tight junctions. That means that the only way a molecule can cross this barrier is through the cell, by diffusion through cell membrane and cytoplasm or via a carrier or membrane transport system. Lipid soluble drugs readily diffuse.
Drug Distribution from Mother to Fetus The fetus is not protected from the effects of drugs administered to the mother. Few drugs are considered safe in pregnancy. Which categories are considered safe in MIMS?
Metabolism Not all drugs undergo the metabolism before they are excreted, however it is often desirable for drugs to undergo some chemical alteration or metabolism in the body. The aim of drug metabolism is to point 1. to destroy pharmacological activity
2. to detoxify a drug 3. to render the drug water soluble for elimination.
Some drugs require metabolism in the body before they are able to act so a fourth aim is 4 to convert a prodrug (inactive precursor of a drug to its active form so that it has biological activity). Example of drugs that massage therapists might see are aspirin ( a drug that has an analgesic, antipyretic, anti-platelet and anti-inflammatory action) is converted to salicylic acid.
Drug metabolism in the liver Most drug metabolism occurs in the liver, and involves a two step enzymatic process. These two stage processes are phase 1 and phase 2 reactions. Phase 1 reactions involve the chemical modification or inactivation of a substance by adding oxygen to a lipid soluble drug structure. Phase 2 involves a process called conjugation combining of the substance to gluconuric acid. The metabolite is highly water soluble, assisting in elimination via kidneys. Phase 1 and phase 2 take place in the liver cells. These reactions are facilitated by cytochrome P450 which is a pigment found on the membranes of the mitochondria and endoplastmic reticulum. Cytochrome P450 is a mixed function of oxidative enzymes.
Elimination The elimination of drugs can take place in a number of sites depending on the chemical and the physical properties of the drug or metabolite to be excreted. These include
1: gases, lungs. 2: water soluble agents, sweat, saliva, tears and breast milk. 3: non absorbed drugs taken orally: GIT and bile.
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4: Water soluble drugs: kidneys, liver.
New drug evaluation and approval (notes for powerpoint)
The process for new drug testing involves the determination of the effectiveness of a new drug and an assessment of its toxicity. There are few differences between toxicology and pharmacology, as the Greek word pharmacon means both “remedy” and “poison”. A modern toxicologist is concerned with the undesirable effects of all chemicals, whereas the pharmacologist is concerned with one class of these drugs.
Drug manufacturers invest a large amount of time and resources to the development of new therapeutic agents.
Prior to human testing the potential drugs are tested on cells in tissue culture and on a variety of animal species in order to establish a chemical and pharmacological profile.
The agent that is to be tested is described in terms of its chemistry, probable physiological action, therapeutic use, potency, efficacy and toxicity.
Approval for the clinical trials is granted by the Australian Drug Evaluation Committee (ADEC) a department of the Therapeutic Goods Administration (TGA).
When undergoing a clinical trial the investigators must obtain written informed consent from all participants in the study before it can proceed. The trial then proceeds in phases.
Phase 1- The effect of the drug in healthy humans is evaluated.
Phase 2- Begins after satisfactory preliminary evidence regarding safety has been obtained. It involves the supervised administration of the drug to patients for treatment of, or prophylaxis against the disease or symptoms in which the drug is intended.
Phase 3- Begins after the initial phases have provided reasonable evidence of efficacy and consists of more wide spread clinical trials.
Phase 4- Is the study of the drug in medical practice although not often recognised as a phase of clinical investigation; it is the most important one from a clinical stand point.
When the clinical trial is completed after (phase 3) a final report is submitted to the government authority for approval to market the drug. In Australia it is the minister of health that is responsible for this. In order for the drug to be approved the pharmaceutical company must prove this new agent is better in terms of safety, potency or efficacy than the drugs that are available presently. ADEC are also responsible for the ongoing monitoring of safety and usage of all drugs available on the market and must approve any changes to existing products.
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Some misadventures associated with therapeutic drugs
The first major incident was in 1937, in the US from the use of sulphanylamide elixir used to treat systemic infections. When administered this drug 100 people died of nephrotoxicity induced by the solvent.
The second example of misadventure is by the antibiotic chloramphenicol used to treat bacterial infections. Before the full extent of its toxicity was investigated it caused the grey baby syndrome, vasomotor collapse cyanosis, abdominal distention, rapid and irregular respiration resulting in a grey appearance.
The third example is the thalidomide tragedy. Thalidomide was used as safe and effective hypnotic drug. However, it was found that in the 1960’s there was an increase in the number of infants born with phocomelia, seal like limbs and deformed organs by mothers who were taking the drug while pregnant
Ask about the Thalidomide class action formed in Melbourne last year?
Antimicrobials drugs This is a large area of drugs that treat those conditions of an effective nature. 1 Anti biotics 2 Anti viral 3 Anti fungals How do antimicrobial drugs lyse or prevent the growth of micro organisms? 1. 2. 3. 4. 5.
Antibiotics Bacteriostatic means prevent bacteria from proliferating Bactericidal means to kill the offending organism
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Antibiotics are classified as one of these. Give three examples of each. Bacteria are also classified according to the microscopic appearance and staining properties of the cell e.g. bacterium are gram positive if they are stained purple and gram negative if stained red. Antibiotics are classified according to their activity against these two types of bacteria. Side effects of specific antibiotics http://www.merck.com/mmhe/sec17/ch192/ch192a.html
Antiviral drugs These are a group of drugs that are active against viral organisms and can be used to treat infections like herpes simplex, HIV and hepatitis B and C. Antiviral drugs that are used in common diseases by massage therapists herpes, acyclovir, Zovirax, hepatitis, interferon alpha, respiratory viruses, amantadine outwith, and ribeoviron.
Antifungal drugs
Drugs that are used to treat fungal infections are called antimycotics. Antifungal drugs may be systemic or topical depending on the type of infection. Lists of common antifungal agents that a massage therapist may have clients using.
Sesson 5 - Pharmacology Timing Content Learning experience used Resources
15min Review last week’s class
How was your week?
45min
Pharmacology Pain relievers, how does this class of drugs work?
PPT
15 min BREAK
60 min
Neuropharmacy
Drugs and the nervous/respiratory system (complex drug interactions)
PPTs
60 min
Finish Pharmacology
Check all materials in chemistry and cells has been covered review assessment quizzes
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Drugs used to relieve pain
Pain is a common presenting complaint for many clients. There are 2 main types of pain 1 productive pain which occurs immediately upon tissue damage 2 non-productive pain; caused by tissue injury, but there is little control over it e.g stomach ulcer perforation. What is the mechanism of pain?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Pain relievers Narcotic analgesics Used in the treatment of severe pain and act on the CNS. Narcotic analgesics act on the CNS in two ways, they reduce the ability of the person to perceive sensation and alter the emotional reaction to it so that it is no longer perceived as an unpleasant sensation. Narcotic analgesics also have peripheral effects such as constipation, vomiting, bronchospasm, and flushing and arteriolar dilation due to the location of opioid receptors at these sites. When narcotics are used recreationally the addiction rate is high.
Opiates
An opiate is a narcotic analgesic that is derived directly from morphine. All analgesics are compared to the action of morphine, even though more potent analgesics are on the market. How depressants and stimulants are processed in the body
Depressants slow down or reduce the activity of the central nervous system (the brain and spinal cord). This causes a reduction in alertness, and a slowing of physical functions such as breathing and heart rate. Examples include alcohol, heroin, cannabis, or certain prescription drugs (such as benzodiazepines)
Stimulants increase the activity of the central nervous system, making the person more alert feeling energetic and aroused. Examples of stimulants include nicotine, caffeine, cocaine, ecstasy and the methamphetamines, speed and ice.
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Non-steroidal anti-inflammatory (NSAID)/ anti-pyretic and analgesic
drugs, an example is ibuprofen (Nurofen)
The anti-inflammatory, analgesic and anti-pyretic drugs are effective against low to moderate pain.
NSAID will be the most common groups of drugs seen by massage therapists as they are used primarily in the treatment of musculoskeletal disorders.
These groups of drugs exert their action peripherally, on pain, by influencing the production of the pain producing substance at the site of injury.
As anti-inflammatory agents, they are used in treating musculoskeletal disorders providing symptomatic relief from pain and inflammation but not changing the progression of the disease.
Most of the drugs that are used both as analgesics and anti-inflammatory are prostaglandin inhibitors.
Prostaglandins are found throughout the body in all bodily tissues.
Prostaglandins in inflammation enhance the action of histamines and other naturally occurring compounds in causing vasodilation, increasing vascular permeability to fluids, and by directly acting on pain receptors.
Prostaglandins are also found in the hypothalamus and are involved in increasing the body temperature in some infections. NSAIDS can be anti-pyretic.
Adverse effects of prostaglandin inhibitors like ibuprofen include effects on the stomach and kidneys. Most prostaglandin inhibiting drugs are acidic and indirectly increase HCL and pepsin in the stomach often leading to ulcer formation. In the kidneys, prostaglandin inhibitors can reduce glomerular filtration, increasing fluid and sodium retention leading to high blood pressure.
5 types of contraindications when taking Ibuprofen
Smoking
Post-surgery
High blood pressure
Heart failure/heart attack
Kidney disease
Pregnancy
Stomach ruptures
Blood clots
Heavy alcoholic drinking habits.
Salicylates
Aspirin is the most common salicylate used for its analgesic, anti-inflammatory, anti-pyretic and anti-platelet properties.
It is preferable that aspirin be taken on a full stomach, due to the possibility of gastric irritation.
Aspirin must never be given to children and young teenagers as it may cause Reyes syndrome.
What is Reyes syndrome?
Other side effects of NSAIDS and salicylates
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Neuropharmacy and Respiratory Drugs
Drugs can be classified according to how they affect the CNS Autonomic Nervous System The automonic nervous system is the efferent pathway controlling the action of involuntary organs or tissues. The 2 main neurotransmitters involved in the ANS are ______________________ and _____________________ A nerve which releases acetylcholine as its chemical messenger is a ____________________ receptor.
A nerve which releases noradrenalin as its chemical transmitter is a ______________ receptor. In many instances autonomic tissues bear surface receptors for both these transmitters. Other chemical messengers are collectively called catecholamines. Dopamine and the blood borne hormone adrenalin (epinephrine) stimulate peripheral adrenergic receptors. An agent (drug) that acts on a receptor ina similar fashion to the transmitter is termed and agonist. An example is Minipress (Prazosin), and medication used to control mild to moderate hypertension. Minipress competes with norepinephrine causing the muscle cells in the blood vessel walls to relax, therefore assisting to reduce blood pressure.
Action of sympathetic and parasympathetic nerve stimulation Organ
Innervation
Adrenergic receptor Adrenergic
responses
Cholinergic
responses
Heart Beta Sinus tachycardia Increase force of contraction of atria and ventricles
Sinus bradycardia decreased AV conduction and atrial contractility
Blood vessels Skin Skeletal muscle
Alpha Alpha Beta
Vasoconstriction Vasoconstriction Vasodilation
Dilation Dilation
Lungs Beta Smooth muscle relaxation
Smooth muscle contraction
Intestine Motility and tone Sphincters Secretion
Alpha and beta Alpha
Decreased contraction
Increased Relaxation Stimulation
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Bladder Detrusor muscle Trigone and sphincter
Beta Alpha
Relaxation contraction
Contraction Relaxation
Salivary glands alpha Sparse thick secretion
Profuse watery secretion
Cholinergic receptors Cholinergic receptors are activated by acetylcholine or to drugs (cholinergic or cholinomimetics) which mimic the effect of acetylcholine. Cholinergic drugs are able to affect both divisions of the ANS and the somatic division, as cholinergic receptors are found at these sites. There are 2 sub-types of cholinergic receptors; nicotinic and muscarinic receptors.
Adrenergic receptors There are 2 types of adrenergic receptors; alpha and beta receptors. These are further subdivided into alpha 1 & 2, and beta 1 & 2. Adrenergic pharmacology is only contained in the sympathetic nervous system function. Adrenergic receptors respond to noradrenaline (fight or flight) and the hormone epinephrine which is released into the bloodstream via which gland?
ALPHA 1 receptors are located on blood vessels and influence both blood pressure and tissue perfusion. They are also found on the radial muscle of the iris, the sphincters and smooth muscles of the reproductive tract, and the sphincters and smooth muscles of the urinary bladder. Clinical applications of alpha 1 stimulation are control of hypotension, nasal congestion, red eyes and circulatory shock.
BETA 1 receptors located on the myocardium, adipocytes, sphincters and smooth muscles of the GIT and renal arterioles.
BETA 2 receptors are distributed on the smooth muscles of the bronchioles, skeletal muscle, blood vessels supplying the brain, heart, kidneys and skeletal muscle, mast cells, the uterus and liver cells. Clinical applications include COAD, circulatory shock, premature labour and peripheral vascular disease.
ALPHA 2 receptors provide at a local level. When adrenergic nerve stimulation is excessive, the activation of the alpha 2 receptor sites results in inhibition of transmitter release.
Drug interference with the ANS
Both the sympathetic and parasympathetic nervous system contains several mechanisms by which drugs interfere with normal ANS functions. These include-
Drugs which mimic the effect of either sympathetic or parasymp stimulation
Drugs which interfere with the enzymatic destruction of transmitters.
Drugs which block the receptor to the transmitter.
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Drug interference with the parasympathetic system
1 parasympathomimetics (cholinergic)
Drugs that act like acetylcholine and stimulate or mimic the effects of parasympathetic nerve stimulation.
2 Anti-cholinesterase
Drugs that interfere with cholinesterase, the enzyme responsible for the destruction of acetylcholine.
3 Parasympatholytics (Anti-cholinergics) These drugs effectively block the effect of parasympathetic nerve activity eg atropine. These drugs act distally to the nerve endings to prevent the muscarinic effects of acetylcholine on the smooth muscles, glands and heart.
Drug interference on the sympathetic system
1 sympathomimetics (adrenergics) Drugs that partially or completely mimic the effects of sympathetic nerve stimulation. Sympathomimetics vary in their ability to stimulate alpha, beta 1 & 2 receptors. There are only a small group of Sympathomimetics available, which can be used for a wide range of specificities. Adrenalin, isoprenaline and salbutamol can all be used in the treatment of asthma. Adrenaline stimulates alpha, beta 1 & 2 sympathetic receptors, therefore having the least effect on asthma. Isoprenalin is regarded as being more specific in the treatment of asthma, as it stimulates only beta 1 & 2 sympathetic receptors. While salbutamol has the most specific of all effects as it stimulates beta 2 sympathetics.
2 Sympathoplegics Covers those drugs that block the action of sympathomimetics or limit sympathetic outflow. This group includes- Alpha-adrenergic blocking agents phentolamine/phenoxybenzamine. Beta-adrenergic blocking agents: propanol/oxprenolol MAO inhibitors
Drug treatment in respiratory conditions Bronchodilators There are 3 groups of drugs that have a direct bronchodilation action.
1 beta-adrenergic agonists; stimulate beta-adrenergic receptors on bronchial smooth muscle
2 anti-muscarinic (anti-cholinergic) agents. Block muscarinic cholinergic receptors on smooth muscle.
3 Methylxanthines; elevate the levels of intracellular messenger molecule cAMP which modulates cellular activity. Each of these groups triggers the same response, therefore, these drugs can be used in combination to produce greater effects than used alone. This is an example of a positive drug action.
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Beta-adrenergic agonists The muscle fibres surrounding bronchioles are under the control of the sympathetic nervous system. The beta 2 receptor sites respond to adrenergic stimulation by relaxing the muscles, thereby leading to increased circulation. Beta 2 agonists also prevent the rupture of mast cells, however this is often short lived and a more prolonged effect is attained when using corticosteroids or sodium cromoglygate. Examples of beta 2 agonists are salbutamol, eformoterol, formoterol, terbutaline, orciprenaline, hexoprenaline, salmeterol and fenoterol.
Anti-muscarinic agents
The role of sympathetic vagal pathways is to maintain a small amount of bronchial smooth muscle tone within the airways. Bronchoconstriction may be superimposed by a reflex action in response to stimulation of the irritant receptors in the mucosal lining. This pathway is mediated by the chemical transmitter acetylcholine. The synthetic atropine like drug ipratropium (atrovent), blocks the muscarinic receptors associated with the parasympathetic stimulation of the bronchial air passages. This will diminish bronchoconstriction and viscous mucous production.
Xanthine bronchodilators
The xanthine bronchodilators include theophylline (Neulin). These substances have a wide range of pharmaceutical activity as central nervous and cardiac stimulants and in the relaxation of smooth muscle. These drugs act on secondary messenger systems within the smooth muscle cells of the bronchioles. The methylxanthines prevent the degradation of cAMP. Increased levels of cAMP in bronchial smooth muscle mediate bronchodilation.
Anti-inflammatory agents
Corticosteroid therapy Corticosteroids are potent anti-inflammatory agents. They are not bronchodilators but do enhance the bronchodilator effect of beta 2 agonists. Corticosteroids prevent the rupture of mast cells, diminish the synthesis of inflammatory mediators, halt new ant body formation and suppress activity of immune cells (especially lymphocytes and macrophages).
The clinical effects of corticosteroids do not take effect immediately and may take hours. Some corticosteroids are available as inhalers including beclomethasone, budesonide and fluticasone. A common adverse reaction to inhaled corticosteroids is thrush in the pharynx and the development of a sore throat. Systemic corticosteroid therapy is also used, eg dexamethosone and hydrocortisone. Common side effects are suppression of the hypothalamic-pituitary axis (decreased cortisol production), fluid retention, risk of infection and low potassium levels.
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Discuss Cushings syndrome
Sesson 6 - Upper Limb Timing Content Learning experience used Resources
15min Review pharmacology
Discuss 3 quiz assessment 2
60min
Review structures in upper limb
Shoulder/elbow/wrist Handout
30 min ROM Assess functional characteristics in pairs
15 min BREAK
30 min Pathologies of the upper limb
30 min Workbook Discuss workbook to be
completed for upper limb
Sesson 7 - Lower Limb Timing Content Learning experience used Resources
15 min Review previous class
Lower limb
60min
Lower Limb Hip/knee/ankle Handout
30 min ROM Assess functional characteristics of lower limb in pairs
15 min BREAK
30 min Pathology Pathologies of the lower limb
30 min workbook Discuss workbook to be
completed for lower limb
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Sesson 8 - Cervical and Thoracic Spine Timing Content Learning experience used Resources
15 min Review last weeks class
Lower limb
60min
Cervical Vertebral column handout
30 min Thoracic Vertebral column handout
15 min BREAK
60 min Dysfunction of Spine
Sesson 9 - Lumbar spine and Sacroiliac joint Timing Content Learning experience used Resources
15 min Review last weeks class
60min
Lumbar Spine Vertebral column handout
SIJ
15 min BREAK
60 min 60 min
30 min Gap fill 30 min
Finalise Class
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Sesson 10 - Student Clinic Timing Content Learning experience used Resources
60min
Student clinic Students can either bring friends or treat clients from student clinic in clinic rooms or in the classroom if extra room is needed
15 min BREAK
60 min
30 min
Session 11 - Pathophysiology of chronic diseases Timing Content Learning experience used Resources
15 min Review last weeks class
60min
Immunity Immune system PPTs Part A
15 min BREAK
60 min Immunity Immune system PPts Part B
60 min
30 min Gap fill Present any missing A&P information relevant to changeover of teaching staff for A&P
30 min
Finalise Class
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Powerpoint Notes
Pathology introduction and musculoskeletal system health disorders
Definitions Pathology: from the greek pathos meaning disease, and logos, science is the study
of the nature and causes of disease as related to structure and function of the body.
Pathophysiology: involves the study of functional or physiologic changes in the body that result from various disease processes. It explains the processes within the body that create the signs and symptoms of the disorder and examines how normal functions are altered by disease.
Massage and pathology
Massage therapy is intimately involved with anatomic and histological
changes associated with disease and injury more importantly, we work with
how these diseases or conditions change the way our clients function.
Therefore massage therapists need to be familiar with the principles of
pathophysiology to be able to judge whether our work is appropriate for each
client.
Musculoskeletal conditions We will examine disorders effecting bones, muscles and joints including ligaments,
tendons, cartilage, joint capsules, tendon sheaths and bursae. With each disorder the therapist needs to be able to tell: What the disorder is how to recognize it when it is contraindicated or indicated Some Musculoskeletal pathologies
Spinal stenosis Massage will not cure, only alleviate Spondyloarthritis Massage can help manage this Rheumatoid arthritis Contraindicated in acute stage Osteoarthritis Massage can help manage Metabolic bone disease Local contraindication Chondrocalcinosis Calcium crystal build up in joints Gout Contraindicated Spondylolisthesis Well developed massage strategy Ankylosing spondylitis Scheuermann’s disease Spondylolysis Viscero-somatic lesions Vascular lesions Subluxations Reiter’s disease Osteoporosis Paget’s disease Osteomalacia Disc degeneration Osteomyelitis Fibromyalgia
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McArdle disease Myositis Reflex Sympathetic Dystrophy
Ankylosing Spondylitis (Bamboo Spine) AI- auto immune where the body attacks spinal joints and SIJ
Clinical presentation Low back pain, persistent or intermittent, worse for rest esp. lying in bed Can mimic sciatica ↓ ROM Lateral flexion, extension and rotation of lumbar spine Creates inflammation gradually fuses the spine from the Lx upwards Commonly called Bamboo spine
Diagnosis HLAB27 positive blood test and x-ray Strong steroidal meds/ narcotic analgesics/ NSAIDs, immunosuppressant’s Only treat during remission Massage – Swedish, deep tissue and stretching target Lx/pelvic stabilisers Rem techs- TP, MFR, MET, MDN
Bone Disorders
Fractures Osteoporosis Paget's disease Postural deviations responds well to massage Spina Bifida Pars defects Muscular disorders Contractures Fibromyalgia Myositis ossificans Contraindication Shin splints and MTSS Indicated Spasms, cramps Recommend magnesium Strains very indicated post acute with TF Joint disorders Ankylosing spondylitis Chondromalacia, Patellofemoral Syndrome Dislocations Gout Osteoarthritis Rheumatoid arthritis Joints cont’ Spondylosis try to manage pain Sprains TMJ disorders comprehensive massage plan Bursitis Dupuytren’s contracture Plantar fasciitis Tendonitis Tenosynovitis
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Plantar Fasciitis disorder that results in pain in the heel and bottom of the foot The pain is usually most severe with the first steps of the day or following a period
of rest. Pain is also frequently brought on by bending the foot and toes up towards the
shin and may be worsened by a tight Achilles tendon The condition typically comes on slowly Risk factors include overuse such as from long periods of standing, an increase
in exercise, and obesity It is also associated with inward rolling of the foot and a lifestyle that involves little
exercise
Prevention Training progression 10%rule Careful of terrain when running Correct footwear, shoes to suit foot type Flexibility/stretching exercises Dynamic stretches- work on exercising the muscle while contracted- in outer ROM This increases the ROM by lowering the muscle tension, and increases collagen
formation in end range connective tissue and strength in end range
Management Acute phase ?????? Chronic phase Decrease training by 25-75% Minimize sprinting and avoid uphill running, vary training- add aerobics, swimming
etc… Ice up to 5 times PD 5-10 mins Taping esp FFT or kinesio Pain free strength and flexibility training
Massage treatment Mobilise foot/ankle joints DT- calcaneus, fascial attachments, TF, cross-fibre, longitudinal frictions Digital friction intrinsic foot muscles
Neuromuscular disorders Generally very difficult to treat and a long term approach can prove beneficial with
massage Carpal Tunnel Syndrome Herniated disc Sciatica Thoracic Outlet Syndrome
Temporomandibular joint syndrome also known as TMD SYMPTOMS Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or
around the ear when you chew, speak, or open your mouth wide Problems when you try to open your mouth wide Jaws that get "stuck" or "lock" in the open- or closed- mouth position
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Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
A tired feeling in your face Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth
are not fitting together properly Swelling on the side of your face
CARPAL TUNNEL Compression of median nerve under carpal lig anterior wrist S&S pain and paresthesia in thumb and 1
st 2 fingers, usually worse at night
Work related often with overuse of hands Rule out other conditions with similar symptoms- Cx problems Disc, TOS, Scalene
upper traps hypertension Tinels sign, Phalens test to attempt to confirm CTS Conservative treatment is often successful Active and passive MFR on Carpal lig, release deep forearm flexors Compliance with self MFR treatment is essential for a successful outcome.
Herniated Lumbar Disc S&S- Acute Lx pain usually unilateral Increased pain on sneezing/coughing Positive Valsalva Test (refer) Positive Slump test (nerve root impingement) ROM usually reduced Lx flexion and extension, and lat flex to affected side Herniation Treatment Lx MFR for thoracolumbar fascia DF – full back focus ES and QLs (maybe side lying) Depending on severity proceed to mobilising technique DO NOT LIE CLIENT PRONE FOR MORE THAN 30 MINS Psoas and piriformis releases Treatments 2/3 per week- 3 to 4 weeks Client to embark on manageable gluteal, lumbar stretching and Lumbar
hyperextension exercise as pain permits
Pathology of Integumentary System
Contagious skin disorders Boils Erysipelas Fungal infection Herpes simplex Impetigo Lice and mites Warts Are these a local or systemic/contraindication
Non-contagious inflammatory disorders Acne
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Dermatitis/excema Hives Psoriasis Skin cancer
Boils are a staphylococcus bacterial infection of the sebaceous gland. A boil is a common, painful infection of a hair follicle and the surrounding skin. It
begins as a red lump, then fills with pus as white blood cells rush in to fight the infection. Good home care can often clear up a single boil, also known as a skin abscess. A doctor's care is needed when a boil resists treatment or develops in certain vulnerable areas of the body.
Erysipelas a superficial form of Cellulitis The affected skin may be warm to the touch. At one time, erysipelas was thought to
affect mostly the face, but recent studies suggest that the distribution of the inflammation is changing since at the present time the legs are involved in almost 80% of cases. The rash may also appear on the arms or trunk. Erysipelas begins with minor trauma, such as a bruise, burn, wound, or incision. When the rash appears on the trunk, arms, or legs, it is usually at the site of a surgical incision or a wound.
Fungal infections
Tinea- versicolor - corporis - pedis
Common names Jock itch Tinea Ringworms Athletes foot
Highly contagious also known as Mycoses, they live on perspiration and dead skin cells especially in warm, moist places
Impetigo Another bacterial staph/strep infection usually in children, although can infect adults also. Often involves crusty lesions around the mouth and nose EXTREMELY contagious
Scabies mite Microscopic mites, the female burrows under the skin in warm moist spots to drink
blood, defecate, urinate, and lay eggs
Acne vulgaris Definition: Inflammation of the sebaceous gland ducts in the skin; bacterial
infection.
Causes: overactive sebaceous glands secreting too much oil leads to clogging of pores; may be genetic, hormonal related, over consumption of fatty foods, junk foods, and meat, nutritional deficiencies, using cosmetics, allergies, stress, liver toxicity, toxins
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Signs/Symptoms: black heads, white heads, small inflamed pustules Indications: Massage to surrounding area, may want to avoid direct contact as it may be painful; may assist in detoxification Contraindications: Detoxification process may lead to more acne; some oils or lotions may clog pores of client and cause acne. Use water based lotion or no lotion or oil at all. Remove oil with alcohol or shower directly after treatment. May be on antibiotics (may cause intestinal imbalance) or retinoids (may cause joint pain and hair loss) Refer to appropriate health care provider for nutritional support and detoxification.
Dermatitis/Eczema Definition: type of dermatitis; sometimes called dermatitis; inflammation of the skin
Causes: allergies, stress, exposure to poisonous plants, depleted cortisol levels due to continued high stress. Signs/Symptoms: fluid filled blisters that weep, ooze and crust over, itching, redness, scaling, dry flaky skin Indications: Massage to reduce stress, eliminate toxins; Use Vitamin E oil Contraindications: Refer to appropriate health care practitioner: Avoid inflamed areas.
Hives/Urticaria
Urticaria (from the Latin urtica), nettle ,[1]
commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives might also cause a burning or stinging sensation.
[2] Hives are frequently caused by allergic reactions;
however, there are many nonallergic causes. Most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) is rarely due to an allergy.
The majority of chronic hives cases have an unknown (idiopathic) cause. In perhaps as many as 30 to 40% of patients with chronic idiopathic urticaria, it is caused by an autoimmune reaction. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight.
Psoriasis Definition: skin disease
Causes: heredity, trauma, infections, seasonal, stress, illness, viral or bacterial infection, overuse of drugs or alcohol, reaction to medications, faulty utilization of fat, weakened immune system, build up of toxins in colon Signs/Symptoms: silvery scales or red area on skin, ridges on nails, itching Indications: Massage for detoxification and stress reduction Contraindications: Avoid infected area; Refer to Naturopath and Acupuncturist for detoxification, diet modification and treatment
Skin cancer BCC SCC MM What do these abbreviations stand
for? Which is which?
What are the ABCDE’s of MMs A- Asymmetry B- Border C- Colour D- Diameter 5mm E- Elevated