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E & I 2 > Iontophoresis > Flashcards

Iontophoresis Flashcards

1
Q

what is iontophoresis?

A

the transcutaneous delivery of medications (in the form of ions) via the application of direct electrical current

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2
Q

when is iontophoresis commonly used?

A

in rehabilitation to apply dexamethasone (an anti-inflammatory corticosteroid)

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3
Q

how deep into the skin does iontophoresis penetrate?

A

uncertain

most studies have demonstrated approx 1-2 cm

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4
Q

what are the indications for iontophoresis?

A

analgesia, calcium deposits, fungal infection, hyperhidrosis, inflammation, ischemia, keloids, muscle spasm, myositis ossificans, plantar warts, scar tissue and wounds

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5
Q

what is the current strength of iontophoresis?

A

0.1-4 milliAmperes

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6
Q

what sized ions are more easily transported across the skin barrier?

A

small

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7
Q

what is the transport mechanism of iontophoresis?

A

transport of ions through the skin is enhance by imposed electrical fields

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8
Q

what charge ion will an anode drive?

A

positive

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9
Q

what charge ion will a cathode drive?

A

negative

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10
Q

what are the components of iontophoresis?

A 
polarity - black wire is negative and red wire is positive
treatment electrode (active/ delivery- medication is injected into the pad) and dispersive electrode (inactive- contains gel or saline)
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11
Q

When are ions driven through the skin?

A

only if a polarity match exists between the charged ions and the electrode under which they are placed (like poles repel)

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12
Q

what are the physiological mechanisms?

A

electromigration
electroporation
electroosmosis

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13
Q

what is electromigration?

A

electrical repulsion of ions

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14
Q

what is electroporation?

A

ES increase porosity of superficial skin (especially in the striatum corneum)

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15
Q

what is electroosmosis?

A

human skin has a net negative charge
direction of ionic flow is from anode to cathode
anodic delivery is assisted by electroosmosis (+) current flows easier
cathodic delivery is impeded

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16
Q

what are the 3 mechanisms?

A
  1. electrical repulsion of like charges
  2. electroporation, increasing openings in skin surface for ions
  3. electroosmosis or movements of water and sodium toward the cathode, creating a stream by which ions are moved
17
Q

what increases with current density?

A

permeability of skin
response may be more pronounced under the cathode due to alkaline reaction from formation of NaOH (increased skin pH)
cathode usually has greater skin response
anode usually more uncomfortable (smaller electrodes)

18
Q

what are the three routes of penetration through the skin?

A

sweat glands
oil glands
hair follicles

19
Q

what are the advantages of iontophoresis?

A

better than oral meds if the patient is vomiting
better than nasal delivery
better than injections (which may cause pain, bleeding, infection, traumatic injury)

20
Q

what are the disadvantages of iontophoresis?

A

acidic and alkaline reactions can cause significant discomfort, tingling, skin irritation, itching, chemical burns, redness
acidic reaction- thickening of skin under the anode
alkaline reaction- softening of skin under the cathode

21
Q

how can you minimize burns?

A

increasing the size of the cathode relative to the anode
decrease the current density (using larger electrodes)
increasing the space between the electrodes

22
Q

what are the anode reactions?

A

attracts C-
forms HCl
Process- sclerotic
effects- skin hardens

23
Q

what are the cathode reactions?

A

attracts Na+
forms NaOH
process- sclerolytic
effects- skin softens (increase risk of electrical burn)

24
Q

what is the current dosage?

A

higher the amplitude, shorter the treatment time
lower is usually more comfortable
current amplitude is determined by patient comfort, time is then calculated by the machine
electrodes determine dosage most often 40mA-80mA
can go as high has 120mA-min

25
Q

what are electrode considerations?

A

if electrodes are manufactured, they will be buffered for optimal medication intake (the size of the electrode is fixed and the pole is determined by the ion used)
home-made/ sponge electrodes will nit be buffered (anode will be smaller and pH will not be proper throughout the treatment)

26
Q

what are the general considerations of iontophoresis?

A

electrode placement and size-type dependent
active electrode over area of inflammation-palpate
electrode size should be large enough so current density does not exceed (cathode: 0.5 mA/cm2 and anode 1.0 mA/cm2)
drug delivery electrode polarity: same as active ion of the drug
current amplitude: varies
treatment time: determined by machine

27
Q

what are the recommended parameter settings for iontophoresis?

A

current type/ waveform: direct current
pulse frequency: N/A
pulse duration: N/A
Amplitude: to patient tolerance not greater than 4mA
Dosage: 40-120 mA-min
treatment time: calculated by device
electrode configuration: active target area; dispersive- remote area
polarity (active electrode)- same as drug ion

28
Q

what is dexamethasone and why should it be used?

A

a corticosteroid with inflammatory effects
recommended for tendonitis and bursitis
works well for lateral epicondylitis and plantar fasciitis
applications: ions negative polarity- medication placed under cathode

29
Q

what is lidocaine and why should it be used?

A

topical anesthetic drug
recommended for children as localized anesthesia
effect in relieving pain, well tolerated and cost effective
application: ions have positive polarity- medication placed under anode

30
Q

what is naproxen?

A

non-steroidal

effective in reducing pain in lateral epicondylitis

31
Q

what is fentanyl?

A 
obtained with MD orders in hospital
synthetic opiate analgesic
control of post operative pain
more effective than placebo
comparable effects of IV morphine
32
Q

what is the procedure for the use of iontophoresis machine?

A

need MD prescription
patient should have own medication
explanation of procedure including side effects and sensations
inspect skin integrity and color
palpate
skin prep (remove hair/ alcohol swab/ soap and water)
electrode prep and placement
determine polarity and dosage (to patient comfort)
start treatment
monitor every 3-5 minutes for burns/ skin irritation

33
Q

what are post- treatment considerations?

A

check skin irritation
re-evaluate treatment area from previous treatment
frequency of treatment dependent on ion selected and underlying condition
effectiveness of treatment determined within 3-5 treatment sessions

34
Q

what are the contraindications for iontophoresis?

A 
drug allergies
skin sensitivity reaction to specific ions
metal in or near treatment area
cuts or broken skin
be wary of tattoos
35
Q

what are ES precautions?

A

cardiac disease
impaired mentation or sensation
malignant tumors
skin irritation or open wounds

36
Q

what are ES contraindications?

A

demand pacemakers or unstable arrhythmias
over the carotid sinus/ trans cervical area
venous/arterial thrombosis or thrombophlebitis
over the pelvis, abdomen, trunk and low back during pregnancy

37
Q

how can you apply iontophoresis in conjunction with other agents?

A

should not be applied after a physical agent that can alter skin permeability (heat, ice, US)
use of heat will: cause vasodilation, increased blood flow, accelerate drug to disperse away from targeted tissue

38
Q

how do you document use of iontophoresis?

A 
the area of the body treated
patient positioning
specific stimulation parameters
electrode placement
treatment duration
patient response
condition of skin and surrounding area
39
Q

what is the difference between phonophoresis and iontophoresis?

A

PHONO- ultrasound, molecular transport, creme based, local/systemic effects, via process of cavitation
IONTO- DC current, ion transport, liquid solution, local/systemic effects, repelling electrical charge

E & I 2 (5 decks)

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