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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

http://www.prohealthsys.com/


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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

http://whatis.techtarget.com/definition/element

http://searchcio-midmarket.techtarget.com/definition/atom


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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?


22

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

http://wps.aw.com/bc_marieb_ehap_10/178/45725/11705638.cw/index.html


23

Sesson 3 - The Cellular level of organisation Timing Content Learning experience used Resources


Review Chemistry

30min

Cells Plasma membrane PPTs

30 min

Cell physiology PPTs

15 min BREAK

60 min

Inclusions

PPTs


24

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

http://people.eku.edu/ritchisong/301notes1.htm


25

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


Ribosomes

Made of protein and RNA

Sites of protein synthesis

Found at two locations

Free in the cytoplasm

Attached to rough endoplasmic reticulum


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


Golgi apparatus

Modifies and packages proteins

Produces different types of packages

Secretory vesicles

Cell membrane components

Lysosomes

Golgi Apparatus


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


Mitochondria

“Powerhouses” of the cell

Change shape continuously

Carry out reactions where oxygen is used to break down food


26

Provides ATP for cellular energy


Cytoskeleton

Network of protein structures that extend throughout the cytoplasm

Provides the cell with an internal framework


Cytoskeleton

Three different types

Microfilaments

Intermediate filaments

Microtubules


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


Types of diffusion

Simple diffusion

Unassisted process


27

Solutes are lipid-soluble materials or small enough to pass

through membrane pores


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


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


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


Bulk transport

Endocytosis

Extracellular substances are engulfed by being enclosed in a

membranous vescicle

Types of endocytosis

Phagocytosis – cell eating

Pinocytosis – cell drinking

Endocytosis

http://theydiffer.com/difference-between-hydrostatic-and-osmotic-pressure/

http://theydiffer.com/difference-between-hydrostatic-and-osmotic-pressure/


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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


29

Label this cell


30

Sesson 4 - Pharmacology Timing Content Learning experience used Resources


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

http://www.medterms.com/script/main/art.asp?articlekey=4887

http://www.medterms.com/script/main/art.asp?articlekey=11994


32

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

http://www.biotechnologyonline.gov.au/topitems/glossary.cfm




33

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.


34

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.


35

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.


36

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


37

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


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

http://www.merck.com/mmhe/sec17/ch192/ch192a.html


38

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.


39

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


40

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


41

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.


42

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


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


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

http://en.wikipedia.org/wiki/Pain

http://en.wikipedia.org/wiki/Heel

http://en.wikipedia.org/wiki/Dorsiflexion

http://en.wikipedia.org/wiki/Dorsiflexion

http://en.wikipedia.org/wiki/Achilles_tendon

http://en.wikipedia.org/wiki/Physical_exercise

http://en.wikipedia.org/wiki/Obesity

http://en.wikipedia.org/wiki/Pronation_of_the_foot


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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

http://www.webmd.com/skin-problems-and-treatments/guide/bruises-article


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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

http://en.wikipedia.org/wiki/Nettle

http://en.wikipedia.org/wiki/Urticaria

http://en.wikipedia.org/wiki/Skin_rash

http://en.wikipedia.org/wiki/Urticaria

http://en.wikipedia.org/wiki/Allergy

http://en.wikipedia.org/wiki/Idiopathic

http://en.wikipedia.org/wiki/Autoimmune

http://en.wikipedia.org/wiki/Exanthem

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