keys Flashcards
mobilization is applied within the ____but not passed the ____
physiologic ROM but not passed the elastic barrier
what do oscillations in a mobilization do
oscillations activate sensory mechanoreceptors to reduce pain and improve proprioception
grade 1-4 mobilization
Grade 1: slow, small amplitude, near beginning of range
Grade 2: mid range (no stiffness or resistance), slow large amplitude
Grade 3: mid range to elastic barrier, slow large amplitude moving into stiffness or muscle spasm
Grade 4: within deep range to elastic barrier, slow small amplitude rhythmic oscillations, stretch into stiffness or muscle spasm
physiologic barrier vs elastic limit
at end of AROM or PROM
pb- end of AROM
el- end of PROM
manipulation creates a
paraphysiological space
manipulation goes to
end of elastic brinier, past physiological ROM (not exceeding anatomical limit)
adequate vs exceeding rxn in manipulation
- Adequate reaction (6-12 hours after): local soreness, bruising, headaches, tired, less than 2 days
- Exceeding reaction: worse signs and symptoms, interferes with work, excessive bruising, more than 2 days
fixation vs sublimation
Fixation= articulation immobilized in a position that it may normally occupy during any phase of physiological movement
Sublaxation= alteration of the normal dynamic, anatomic, or physiologic relationships of contiguous (touching) articular structures.
3 monosacchairde
glucose
fructose
galactose
3 disaccharrides
sucrose
lactose
maltose
how is fructose turned into glucose? what transporter for absorption? problem w excess fructose
converted into glucose in liver and intestine, GLUT5 transporter for absorption, excess not regulated; TG synthesis
storage form of polysaccharides in plants and animals
- Starch is storage carb in plants
- Glycogen is storage carb in animals
what affects zinc absorption
o Rates of absorption depend on body status
o Inhibited by alcohol
interferes with iron and copper absorption
zinc importance
periods of growth
- Protein, DNA and RNA metabolism
manganese importance
- Involved in amino acid, cholesterol, glucose and carb metabolism, ROS, bone formation, reproduction, immune response, blood clot and hemostasis
excess manganese
- Excess accumulates in liver and CNS psychiatric and neuromuscular problems
chromium helps with blood sugar?
- Part of a protein complex that potentiates insulin activity and moves glucose into cells
glutathione peroxidase and deiodinase needs selenium and which vitami
vitamin e
excess fluoride
pitted and discoloured teeth
supplementation in hypothryoid
- Iodine and selenium supplement
o Avoid excess iodine if medicated
3 goitrogens
thiocyanates, glucosinolates, flavonoids
o i.e. cassava, lima beans, sorghum, soy, Millet, cruciferous vegetables
what to do to offset effect of foods that cause goitrogens
- reduced by cooking
- ensure iodine intake sufficient to offset effects
dew walking effects (cold)
- Relieves mild arterial circulatory disorders, venous disturbances in the legs (varicose veins) and morning grumpiness by promoting blood circulation and strengthening the veins, muscles and immune system.
contrast shower effects
- Improve circulation, alertness/energy, reduce severity or frequency of cold and flu
who not to use cold water treading for
- Do not use cold water treading or dew walking if there is rheumatism of toes and/or ankles, sciatica, cystitis, pelvic inflammation, or irritable bowel
cold water treading effects
- Increase circulation and help build up resistance to infections.
- Leg cramping or leg pain that comes from exertion
why does underwater brush massage have stronger effects than dry skin brushing
due to the hydrostatic pressure of the bath water.
knee affusion benefits
- eliminate feelings of tiredness in feet and legs
- varicose veins
what is the derivation effect in knee affusion
decrease head congestion, tension headaches, migraine and cold symptoms presenting in the nose and throat. It is stimulating to the circulation.
epson salt beenfits
- releases toxins and metabolic waste through perspiration
who should avoid epsom salt bath
- very stimulating and therefore people with high blood pressure and severe varicose veins should avoid it
short vs long hot and cold
short hot: < 5 mins
long hot: > 5 mins
short cold: < 1 min
long cold: > 1 min
flavour of burdock/ atrium lappa
sweet
main actions for NAFLD in botanicals
alterative and hepatic
flavour and effect of botanicals in NAFLD
- Bitter and cool formula (put with warming ginger)
peony paeonia lactiflor has an affinity for
female hormones and fertility
botanical actions for T2DM
- Endocrine modulator (insulin), bitter, alterative
what metformin botanical made from
galega officinalis (goats rue)
cinnamomum zeylancicum action in botanical
o Facilitate glucose transport into the cell
o Warming carminative
what 2 botanical shell breast milk productions
galega officinalis (goats rue) and fenugreek (trigonella foenum graceum)
bitter melon (momordica charantria) can cause negative effects
o 2-3 fruits can cause GI pain and diarrhea
o Can cause hypoglycemic events
what does berberine/ barbers vulgaris pair well with in hepatic infections and T2D
Bupleurum sinensis in hepatic infections. Galega officinalis (goats rue) in type II diabetes.
what constitution to avoid using buplerurum sinuses in
Avoided in cold conditions or constitutions
when to use buplerum with peony
stagnant menses with heat presentation
caution when using gentian lutea
dont use if ulceration
gentian is very
bitter
what is blood purifier and laxative
rumex crisupus (yellow dock)
what to use in deficiency or weakened vitality
schisandra
what pairs well with paeonia alba in female hormone patterns that need tonifciation and rooting
schisandra
actions seen in nafld for botanicals
bitter, hectic, anti inflam, alterative, hepatoprotective, adaptogen, laxative, astringent, a
actions seen in T2D for botnaicsl
, antimicrobial, bitter, hepatic, anti-inflammatory, alterative, endocrine modulator (insulin), carminative, hypoglycmeic,
what will goats rue/galega officinalis do if using other treatments
: Will augment effects of other hypoglycemic agents
what botanical for hypoglycemia
goats rue/ galega
herbs for NAFLD
barberry/ berberis vulgaris
bupleurym
burdock/ articum lappa
yellow dock/rumex crispus
peony/ paeonia lactiflora
milk thistle. silybum marianum
gentian
schisandra
sweet wormwood
herbs for diabetes
cinnamomum zeylanicum
galega officinalis/ goats rue
gymnema slyvestre
momordica/ bitter melon
citrus reticualte/ tangerine
curcuma longa/ tumeric,
trigonella foenum graecum/ fenugreek
budock/ articum lappa
barberry/berberis
dandelion
nettle
hibiscus
SMILE and CLEMS
SMILE
Sensations
Modalities (< , >)
Intensity
Location
Etiology
CLEMS
Complaint
Location
Etiology
Modalities
Sesations
2 homeopathic for NAFLD
phosphorus and kalium bicarbonate
2 homeopaths for shoulder pain
arnica and natrum sulphuricum
what makes phoshphorus condition worse
touch, exertion, twilight, thunder, warm food
what makes phosphorus better
cold food, open air, sleep
phosphorus physical picture
tall, slender, nervous, transparrent skin
what does phsohpyorsu crave
thirsty
cold drinks
picture of phosphorus
burning ab
weak
restless
fear
charming
magnetic
sympathetic
sensitive
easily stimulated
diseases that phosphorus is good for
NAFLD
post op vomit
fatty degeneration
pulmonary disease
severe infections
polyps in bowerls
increased liver enzymes
hepatitis
foggy vision w stress
hemorrhage
external impressions (light and sound)
what is kalium bicarbonate better with
heat
heat vs cold in kalium bicarbonate and phoshporus
heat makes KB better and phosphorus worse
cold make P better and KB worse
what makes kalium bicarbonate worse
beer (craves)
morning
cold
wet weather
undressing
what type of pain pattern for kalium bicarbonate
pain in small spots or migrates quickly from place to place
discharge in kalium bicarbonate
green, thick lumpy
inflamed sinuses
f
liver fatty infiltrate
kalium bicarbonate conditions
gastroenteritis
hepatitis
mucosal and cutaneous lesions
what is a mental picture of kalium bicarbonate
indifferent
adverse to exertion
avoids people (fear)
bad memory
homeopath that is afraid of people and avoids them
kalium bicarbonate
what 2 homeopaths are worse with exertion
kalium bicarbonate and phosphorus
what homeopath has green thick lumpy discharge and sinuses and mucus
kalium bicarbonate
charming , magnetic, sympathetic and sensitive and easily stimulated
phosphorus
what is arnica better with
lying down or head low
what is arnica worse with
least touch
motion
rest
wine
damp cold
type of eruptions for arnica
symmetrical
arnica usages
sore, back and limb pain
mental or physical (emotional trauma)
injuries
shock
trauma
surgery
arnica and bed
bed is hard
arnica doesnt like
touch (fears) and wants to be alone
2 homeo worse with cold
kalium carbonate and arnica (damp cold)
natrum sulphuricaum is better with
dry weather
pressure
changing position
natrum sulphuricum is worse with
music
left side lying
damp basement and weather
natrum sulphuric is a shoulder remedy but also good for
mental
liver, hepatitis
brusises
rheumatism (worse w damp)
natrum sulphuricum and music
lively music saddens
natrum sulphuricum and mental picture
mental tousle, melancholy and mania, suicidal
what drug causes the most weight loss
semaglutide
what has longer half life; semaglutide or liraglutide
semaglutide
side effects of semaglutide and liraglutide
N/V, diarrhea, ab pain, fatigue
what action are semaglutide and liraglutide
GLP 1 agonist
Reward systems, delay gastric empty, increase satiety, decrease appetite
what are GLP1 metabolized by
DPP4 enzyme
buproprione mechanism to suppress appetitie
sympathomimetic SNS
when not to use a sympathomimetic drug like buproprione
Since SNS don’t do if hypertensive, seizure, hepatic, ESRF
orlistat inhibits fat absorption; what type of diet to take with
o High fat intake is poorly tolerated
o Less effective on low fat diet
o Take multivitamin
drugs that cause weight gain
antidepressants (TCAs), antipsychotics, corticosteroids, antihyperglycemic drugs (i.e. sulfonylureas), lithium
can you take orlistat in pregngnacy
no because reduces DAKE absorption
% goal of weight loss to see changes in health
5-10%
what drugs can cause dysglycemia
beta blockers, corticosteroids, diuretics, antipsychotics etc
adverse effects of insulin
hypoglycemia, localized fat hypertrophy, allergic rxn
acarbose inhibits what
alpha-glucosidase;; which delays starch and disaccharide digestion (to reduce postprandial glucose levels)
if hypoglyceic when taking acarbose take what
glucose not sucrose (bc inhibits disaccharides)
best drug for T2D
metformin
what does metformin do
o Decrease hepatic glucose production
what can metformin cause deficiency in
b12
stigagliptin is kind of similar to semaglutide and liraglutide because indirectly acts as an incretin mimetic how?
it inhibits DPP4 enzyme which degrade GLP1
what 2 diabetes meds can help with CVD events
semaglytide and liraglutide
and canagliflozin (Na+/glucose con transport inhibitor)
can you use semaglutide and liraglutide in pregnancy
contraindicated
glyburide does what in diabetes
o Insulin secretagogue stimulate basal and meal insulin release
how to use glyburide
add on to metformin
2 weight gain drugs in diaebetes
pioglitazone and glyburide
2 drugs that are insulin secretagogues
glyburide (sulfonylureas) and repalinide (Meglitinides)
pioglitazone works as agonist at what receptor in adipose tissue
PPARG
what does pioglitazone do
PPARG agonist –> up regulate GLUT4 –> increase glucose reabsorption and hydrolyze TGs
which diabetes drugs has most risks and needs consent to prescribe
pioglitazone
o Weight gain, edema, fractures, heart failure
canaglifozin action in diabetes
inhibit Na+/glucose cotransporter so it prevents glucose reabsorption in the kidneys and excretes it more
adverse effects of canagliflozin (think kidneys excreting more glucose and less absorbed, act on Na+/glucose cotransport)
hyperkalemia, genitourinary infections, hypotension, DKA
levothyroxine replacement dose vs conservative dose
replace= 1.6 mcg/kg/ day PO
conservative 25-50 mcg
how long to see if levothyroxine works
6 weeks
what does levothyroxine interact with?
antacids and mineral supplements (i.e. calcium, iron, magnesium) reduce absorption, PPIs, estrogen
i. Take separately, 1st thing in AM
adverse effects of levothyroxine
hyperthyroid is overtreat, glycemic control declines, possible angina exacerbation
desiccated thyroid dosage in comparison to levothyoxine
c. 2/3 dosage (x0.65) of levothyroxine
c. Replacement dosage of levo: 1.6 mcg/kg.day PO
pill option for desiccated thyroid dose
b. 30, 60 and 125 mg tablets
what extra side effects does desiccated thyroid have
d. Similar adverse effects as levothyroxine plus CVD and neurological risks bc of T3
i. Palpitation, tachycardia, nervous, insomnia, sweat, weight loss
2 antithyroid agents to treat hyperthyroid
methimazole and propylthiouracil
methimazole vs propylthiouracil
which does aplasia cutis in 1st trimester?
which is overall better?
which in thyroid storm?
M
M
P
methimazole vs propylthiouracil mechanism of action on thyroid
methimazole: decreases thyroid hormone production
i. Interferes with iodination of tyrosine and coupling
ii. Doesn’t affect stored thyroid hormone or thyroid hormone in circulation
b. Propylthiouracil
i. Same as methimazole PLUS inhibit conversion of T4 to T3 in periphery
ii. Affects production of thyroid hormone and existing thyroid hormone
radioactive iodine to do what
a. Ablate thyroid tissue in Graves w toxic nodules
risks of radioactive iodine
hypothyroid, graves orbitopathy, radiation thyroiditis
use beta blocker propanolol in hyperthryoid but it doesnt effect thyroid hormone production- what does it do
b. Ameliorate symptoms of adrenergic excess caused by excess thyroid hormones (i.e. hypertension, elevated heart rate)
c. Propranolol can decrease conversion of T4 to T3 in periphery
when to avoid propanolol
bradycardia and asthma
it helps with adrenergic excess like elevated heart rate but if take too much can cause : bradycardia, hypotension, fatigue
3 drugs for obesity
orlistat (decrease fat absorption)
semaglutide and liraglutide (GLP1 agonist)
burproprion and naltrexone (appetite suppress; sympathomimetic)
3 drugs for hyperthyroid
radioactive iodine
propanolol (beta block to decrease adrenergic excess)
methimazole and propylthiouracil (decrease thyroid hormone)2
2 drugs for hypothryoid
levothyroxine (t4) and desiccated thyroid (T3/T4)
drugs for diabetes
insulin
acarbose (disaccharide absorb)
metformin (BEST, decrease hepatic glucose production)
sitagliptin (indirect incretin mimetic- DPP4)
semaglutide, liraglutide (GLP1 incerti mimetic)
glyburide (insulin secretagogue)
repaglinide (insulin secretagogue)
pioglizatone (PPARG, GLUT4, most dangerous)
canaflifozlin (Na+/glucose cotransport)
