Pharmacology and Local Anaesthesia for Podiatry Practice - Assignment Example

Pharmacology and Local Anaesthesia for Podiatry Practice Introduction Podiatry, which is also referred to as chiropody, is mainly involved in the study of the conditions associated with the lower extremities specifically the feet. It deals with a variety of ailments that beset the feet, ankle, leg and even hips of the patients. To be able to properly care for the needs of the patient, the health personnel are equipped with a variety of tools that includes the knowledge in the anatomy and the physiology of the feet, the different disorders that are associated with the feet primarily the skin, the joints, the bones and the nerves. Another area is the genetic ailments, the detection and cure to such diseases such as medication, orthopaedic rehabilitation and surgery (Yahoo Encyclopedia, 2006). In dealing with the conditions associated with the feet and the lower extremities, there are areas that are needed to be studied for effective treatment of the patient. This includes the pharmacology and the field of application of the local anaesthesia. Pharmacology is involve in the responsible use of drugs and its effects on the patients well being. An established knowledge on the physiology and reaction to the drugs that is administered to the patients is expected from the health personnel (Tollafield, and Merriman, 1997). In relation to the practice associated with the administration of the appropriate medication for the patient is the immense knowledge on the drugs available in the medical world and the effects, both the positive and the side effects, and the contra-indications in relation to the underlying ailments that can have detrimental effects specifically in the treatment of the conditions associated with the lower extremities (Tollafield, and Merriman, 1997). One of the most significant knowledge that is required and needed to be practiced by a medical practitioner is the handling of local anaesthesia. This is due to the fact that it is a basic knowledge in the field of podiatry. It is important due to the increase in the efficiency in the administration of the medication and treatment specifically if the patient requires surgery. To be able to better determine and study the factors affecting the application of pharmacology and the techniques in relation to the use of local anaesthesia, a particular disease of the lower extremities is taken into consideration. This allows for the distinction and study of a specific case (Tollafield, and Merriman, 1997). Rationale of the Study The study was aimed to present the application of the pharmacology knowledge and principle specifically on the basis data related to foot management in patients with diabetes mellitus. The primary basis if the study conducted is the major roles that a medical practitioner holds in the treatment of patients with diseases related to the feet and lower extremities. A case study on conditions associated with the ingrown in the feet of patient with diabetes mellitus. Application of Pharmacology on Podiatry Practice To be able fully determine the application of pharmacology specifically the administration of local anaesthesia, cases of patients that are diagnosed and/or medicated for diabetes mellitus were studied. This is on the basis of management and care for wounds of the specified patients which usually possess foot ulceration. These cases often include those with primary, secondary or even serious cases of ulcerations, sores and wounds. The management and care is the main consideration in the study conducted. This incorporates the dressing, curettage, the medicines that are applied, the procedures undertaken along with the therapies and the surgery if necessary (O'Meara, Cullum, Majid, and Sheldon, 2000). The cases of consideration on the application of the pharmacological techniques involve factors such as severity of the disease and other underlying ailments that can have detrimental effects on the prescription of medications. Another consideration is the conditions such as pregnancy and other diseases such as diabetes and hyperlipidemia (O'Meara, Cullum, Majid, and Sheldon, 2000). Background of the Study The cases of diabetic foot ailments particularly ulceration is only one of the many ailments that is covered by the practice of podiatry. It is often caused by different factors such as bone structure of the foot, peripheral neuropathy and another is the ailment related to the artery which is known as atherosclerosis. Ulcerations are primarily an effect of sores and exposure to pressures which are commonly magnified by the presence of neuropathy that result to the numbness and loss of sensitivity of the affected areas. Although atherosclerosis occurs also in patients without diabetes, it has the highest occurrence in patients diagnosed with the disease (Stillman, 2005). In the study conducted in the United States, 16 million are diagnosed to have diabetes and 15 percent encounters foot ulcers while almost 1 in every diabetic with foot ulcer leads to amputation. On the other hand, reappearance of the ulceration after healing occurs in 66 out of 100 patients. The greatest risk associated with the disease revolves around scenarios such as lost of the foot or some parts of it, charcot foot or an acute form of neuropathy wherein he deformation of the bones can also occur due the lost of feeling, thus, conditions are oftentimes discovered to late. Mortality can also result to cases of ulceration. This is closely associated to the cases of heart and renal ailments due to the fact that this is commonly exacerbated by the involvement of the arteries and the abnormalities that occur in them (Stillman, 2005). In the study conducted that focused on the risk of the patients with diabetes to acquire foot ulcerations on the basis field study on patients that are largely comprised of type 2 diabetics which generally belongs to 60< age group, there are more that half, specifically 64 % that were studied to have less susceptibility to ulcerations while only 13% have the highest susceptibility to acquiring foot ulcers (Leese, et al., 2006). These studies render 13-15% of the population susceptible to cases of foot ulcerations that are considered as one of the conditions that are given attention by the field of podiatry due to the fact that even simple injuries such as ingrown nails can lead to serious injuries and ulcerations. The Role of the Podiatrist in the Management of Diabetic Foot One of most important consideration in the study is the determination of the role that a podiatrist holds in the care for diabetic patients. This covers the knowledge on specific techniques that are conducted and to be able to do this the processes that are involved with the determined specifically the microbial degenerative causes of the diabetic foot that can lead even to amputation. In this view, it can then be considered that the role of the medical practitioner does not end with the clinical processes but also to the education and the responsibility of informing the community specifically the patient and the relatives (Stillman, 2005; Turns, 2000). The greatest responsibility though is on the process of treatment itself. To be able to fully achieve awareness of the roles of the podiatrist, the processes associated with the disease were viewed on the basis of the medical practitioner himself. In the study conducted by Turns, wherein the major concerns regarding the care for patients with ulcerations that are caused by the diabetes condition, it was determined that information dissemination and impart of knowledge related to the disease is one of the non-clinical responsibility of the medical practitioner (2000). Other specific roles on the other hand shall be discussed in the course of the research. On the basis of the accepted responsibility of the podiatrist the prevention of the spread of the infection and the administration of the proper medicine and even the monitoring is the most essential clinical responsibility that needs in-depth knowledge and dedication (Turns, 2000). The dependability and the responsibility of the medical practitioner fall under the medical professionalism that holds the relationship between the patient and the health practitioner. This incorporates the responsibility on the basis of the care that is given, the medication and treatment intervention that can provide cure to the ailment of the patient and the procedures that achieve and maintain the health of the patient (Diaz, and Stamp, 2004). Objective Analysis of the Treatment Process In the study conducted by different school of thought, the objective determination of the objective observable indications of the effectiveness of the treatment process in an essential process. In cases of study related to the diabetic ulcerations of the foot indications may include the formation of callus due to pressure on the foot. Another is the observance of wounds and ulcerations and the monitoring of the healing process and changes in the severity in relation to the treatment that is being undertaken. For objectivity of the measurement, the time of healing is also monitored along with the record of the sizes of there are observable decrease in the area of the ulcerations. Another measurable factor in relation of occurrence of the ulcerations in the foot is the rate of recurrence of the wounds which is closely associated with the rate of healing (O'Meara, Cullum, Majid, and Sheldon, 2000). Treatment of Diabetic Foot Ulcers The treatment of patients with diabetic foot ulcers includes the primary care given, medication and surgery. In relation to this, the side effects that can result on the administration of such treatments are taken into consideration. In any treatment process, the medication and the primary target is determination of the underlying cause of the disease. In this case the diabetes is taken into account. Other related ailments that can be considered are heart and renal ailments. Primarily, for patients with ulcerations are given the primary care that includes cleaning and the medications that are required (Stillman, 2005). In the determination of the attention that should be given to patients in relation to podiatry care, its was generalized that greater consideration and monitoring is needed by patients that has already been through cases of ulcerations due to the fact that they are susceptible to recurrence even in simple pressure causes. In a study that takes into consideration the practicality of acquiring podiatry care, diabetic patients are not required to take professional care at once but must know their responsibilities. On the other hand, professional care should be sought out by patients specifically those that experiences increase in numbness which is an indication of neuropathy which endangers the condition of the patient due to the fact that it can lead into amputation (McGill, Molyneaux, and Yue, 2005). In patients with diabetes, it is a challenge to encounter cases of injury in the feet. One of the cases that also be considered as of great concern in the field of podiatry is the occurrence of ingrown in the nails of the patients. This can have detrimental effects especially for the patients with diabetes. This is due to the fact that simple injuries can worsen and lead to amputation of the fingers or even feet. On the other hand, ulceration can also lead to removal of the nails if the condition was not given proper attention. Onychocryptosis is the case of ingrown wherein the nails are affected and can trigger injury. The treatment that is provided depends on the severity of the condition. The inflammation associated with the disease, which is also referred to as erythema, can be observed in the early stage of the infection. If not given proper care, this can lead to the enlargement of the infected area. A severe case of infected nail can lead to recurring infection and pain that can lead to surgery (Dovison, and Keenan, 2001). Primary care that are often employed by the patients prior to the consultation and professional medical care are the clearing the nail and applying antiseptic. This is applicable if no infection has occurred yet. One of the medications that can be considered in cases wherein no serious infection occurred is phenolization which is composed of different techniques such as wound dressing with povidone iodine, hydrogel dressing and paraffin gauze. These techniques have no significant differences in relation to the time that the wound will heal. Although this is the case, the study proved that hyrogel dressing has side effects such as hypergranulation (Dovison, and Keenan, 2001). In cases wherein the punctured wound was not given attention, medical attention is needed and can even lead to surgery if infection has already occurred. Surgery is undertaken through local anaesthesia. In the cases wherein surgery is required, there are certain considerations. In cases wherein only cauterization is required, there is less hazards involved. On the other hand, in cases wherein serious infection that involves abscess and ulcers specifically in patients that are diabetics, serious considerations of the situation and even planning along with the permission of the relatives are required. It can be considered that in ages wherein the patients have already reached the age above 60, dangers increased (Lazar, Erez, and Katz, 1999; Schulte, Neumann, and Ruzicka, 1998). In relation to the cases that require surgery, the responsibility of the physician increases specifically due to the fact that there are many methods to consider. The choice mainly depends on the podiatrist and the techniques including the medications that are considered safe and effective. One of the most commonly used local anaesthesia is the xylocaine solution (1%) minus epinepherine administered through 25-27 with 1-1.5 inch syringe. EMLA is used to reduce the pain associated with the injection, thus, it is applied prior to the injection (Lazar, Erez, and Katz, 1999; Schulte, Neumann, and Ruzicka, 1998). Another technique that is applied is the application of phenol to be able to decrease the possibility of recurrence and increases the assurance for complete healing. This procedure is conducted in concurrence with nail avulsion. The side of the nail is elevated as it grows to ensure that no infection will reoccur. In some cases wherein the infection causes hindrance in the drainage and growth the lateral parts of the nails, complete removal of the nail is needed. In cases such as this, the matrix of the nail is exposed and thus requires protection after the operation to be able to ensure growth of the nail and prevent recurrence of infection (Lazar, Erez, and Katz, 1999; Schulte, Neumann, and Ruzicka, 1998). Medication The care given includes the sodium chloride dressing and in some cases isotonic sodium chloride gel. Autolytic treatment of the wound absorbs the dead skin. The different characteristics of the ulcerations require different forms and types of care that is given. Medication constitutes the most important aspect of treatment. In cases wherein an occurrence of ingrown that requires avulsion, attention and precaution is required in the treatment that is prescribed (Stillman, 2005). This case falls under the patients with diabetic foot ulcers and wounds. One of the medications that are considered is hemorheologic drugs. This targets the underlying cases of diabetes and ailments that can be related. Pentoxifylline belongs to this type of medications that increases blood flow due to decrease in the density of the blood which is common for diabetics. Attention is required to contraindications such as hypersensitivity and haemorrhage. Although it is safe for administration for pregnant women, it can cause renal side-effects. Other drugs under the same group that exhibits similar effects is Cilostazol which is also safe for pregnancy but can pose danger to the kidney (Stillman, 2005). Another group of medications in relation to diabetic ulcers are antiplatelet agents that hinder platelet functions. One example of which is the Clopidogrel that acts in patients with atherosclerosis. Contraindications mainly include patients that suffer peptic ulcer disease and hypersensitivity to different medications. This type of medication is not recommended for patients that are susceptible to haemorrhage and bleeding specifically patients that experienced trauma or accidents. It is also not recommended for patients that are pregnant sue to the fact that the effects on this condition was not yet determined, thus, further study is required prior to the application of the medicine in the public (Stillman, 2005). Aspirin is also another drug that belong this group of medication. It has the same action because it prevents the gathering of the platelets. This medication is not recommended during pregnancy which is already an established notion compared to the case of the other medication. Consideration for recommendation of this type of medication is on patients that are susceptible to kidney and liver diseases (Stillman, 2005). Other groups of medications that are given to patients with diabetes and have foot ulcers are antibiotics and medications for hypoglycaemia which also have harmful effects on the healing of the foot ulcers. On the basis of the study conducted on diseases that have effects on diabetes, it has been quoted by Stillman that results of the study conducted by The Diabetes Control and Complications Trial Research Group showed that hyperglycaemia when not given proper attention can increase the danger of ulcerations (Stillman, 2005). Thus, in cases such as this, monitoring the level of glycaemia can prevent the complications that are associated with diabetes. These include neuropathy that poses danger and prevents cases of amputation; nephropathy and retinopathy. Hypertension and hyperlipidemia are also monitored and guarded to prevent magnifying the hazards of ulcerations in cases of diabetes (Stillman, 2005). Classification, Storage and Prescription of Medicines One of the most essential responsibilities performed by medical practitioners revolves around the management of medication that are expected to cure ailments of the patients and lessen the pain that is being suffered in relation to the disease that beset them. Responsibility lies primarily in the classification, storage and prescription of the medicine that will be used by the patients (National Health Service, 2004). Classification is involved in the study of the actions and the effectiveness of the medication that usually falls under the responsibility of the pharmacologist and the research groups. They are involved in performing in-depth application of the action of the drugs. The medications passed through different levelled study prior to the dispersion in the market to ensure safety upon application (National Health Service, 2004). Due to the fact that it can be considered as the primary step in the medication process, it can be considered as the most important. It must be conducted wit great care to be able to ensure that proper drugs are given to corresponding diseases to achieve the cure and the condition expected. Upon passing through the stage of classification and study, the storage of the medications is the next stage that needs great care due to the fact that danger can effect to patients if the medicines are not properly stored. In cases wherein the requirements for storage were not done, chemical reactions can alter the effect of the medicine and worst case scenario of poisoning can occur upon intake (National Health Service, 2004). Different conditions are suitable for different medications. This is on the basis of susceptibility to thermal changes, humidity, moisture and even the presence of light. The most detrimental stage in terms of the medication process is the prescription. This is due to the fact that greatest responsibility is given to the determination of the effects associated with the medicine. In this case, the physician is expected to determine the corresponding medication for varying type of ailments while taking into consideration the interplay of symptoms, actions and contraindications associated with the disease and the medication. Also the side effects are also considered and the patients are informed on the possible conditions that can occur in relation to the intake of the medication (National Health Service, 2004). In terms of the technical aspects and regulation of prescription and distribution of the medications, there are different considerations that are given attention. Prescription drugs are also regulated by the distributors of the drugs. Drugs shall be distributed when the medication must be applied on a serious of prescription. This can ensure that proper distribution occurs. In cases such as these though, monitoring should occur in an organized manner o be able to counter-check the use of the drugs (National Health Service, 2004). On the other hand, monitoring fails, abuse can never be monitored and tracing the cases of wrong prescription can be impossible. Also on the basis of the drugs that fall under the group with possibility of abuse, release and prescription are on special distinctive standards. Distributors and drug manufacturers issues certain contracts that requires the presentation of different document to be able to safeguard the possible utilization of the drugs in illegal purposes. These drugs that are monitored are enlisted in the Misuse of Drugs Act in 1971 as quoted in the National Health Service documents (National Health Service, 2004). In cases wherein medications that belong to the list being monitored are needed in an emergency case, a pharmacologist or a chemist is required to make a request for the dispersion prior to the request being made which is required for the administration of the drugs. Predetermined conditions included must me accomplished. One condition is that cases be specifically implied and proper handling is practiced. The condition of the patient is also denoted and verified. The detailed case is also presented for determination is the case applies for consideration. Even the application of the drugs and the dosage is also determined and this served as the basis for provisions of the requested drug (National Health Service, 2004). Upon study of these prerequisites, it can be viewed that there is enough security applied in the prescription and handling of drugs. In critical consideration though, cases of abuse of controlled drugs still occur. Thus, it is a question on the responsibility that is held by the medical practitioners that can be a target to these cases. The distribution of the medications and apparatus that are used for different ailments is another subject that is considered. This is covered by the Pharmaceutical Regulations that give rules of the use and distribution of such needs. A greater consideration is focused specifically on cases of use under private cases, an example of which is the medication undertaken in own residence of the patient. In cases such as this, it is usually the medical practitioner that provides the request that is required to acquire the needed apparatus and medication. This is due to the fact that monitoring is also undertaken (National Health Service, 2004). Pharmacodynamics and Pharmacokinetics In the administration of any medication and drugs, the effectiveness of the medication can be measured through the changes associated with the intake. The two major aspects in the effectiveness of the drug are the pharmacodynamics and pharmacokinetics. Pharmacodynamics is related to the effective dosage that can create response to the body of the patient. It can be plotted in percent maximal response over the proportion of the drug intake per mass of the body of the patient. An example of the curve is shown in Figure 1 which denoted the efficacy of the medication and the potency through the response observed. This graph shows 3 different medication set-up and their effects (Kracke, 2003; Lorimer, French, ODonnell, and Burrow, 2002) Figure 1. Example that presents pharmacodynamics. Source: (Kracke, 2003) Pharmacokinetics on the other hand is involved in the different processes that occur in the areas wherein the drugs take effect. This process is mainly affected by the chemical make-up of the medication and its reaction to the composition of the body (Kracke, 2003; Lorimer, French, ODonnell, and Burrow, 2002) Absorption is the primary process that is involved in pharmacokinetics. This is the capacity to be incorporated into the circulatory system. This is detrimental due to the fact that medicines operate on the basis of the localization of action. In this case the rate of action can is greatly affected on the time consumed for the medication to be localized or to reach the side of action. Factors that can affect this process are the properties of the surrounding body structures, the permeability and even the concentration of the drugs (Kracke, 2003; Lorimer, French, ODonnell, and Burrow, 2002). Another detrimental factor is the distribution of the active agent of the medication to the sites that need the action. Biotransformation is another important process involved in the pharmacokinetics of drugs. This is the action of the medication itself. It is the changes that can occur in the system as triggered by the agents found in the drugs. After the action of the drug, excretion is the final phase of the process. This is the disposal of the by-products in the process that occurred (Kracke, 2003; Lorimer, French, ODonnell, and Burrow, 2002). The main concern in the two processes that are discussed is the effect on the patient's body processes. In cases wherein the patient has hypersensitivity on the prescribed medication, side effects and danger on the health of the patient can occur, thus, awareness of the contraindications is essential in the process. Summary In the conducted research on the pharmacology related to the podiatry practice, certain fields are taken into consideration. One of the most essential of these is the responsibility that a medical practitioner holds in the medication of the patient. It can be determined that the role of the medical practitioner covers the classification, and the prescription of the medication required in the treatment of the patient. In the field of podiatry, one of the most significant cases is the diabetic foot ulcers that can be exemplified in the case of nail ingrown. 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