Transcript IONTOPHORESIS

IONTOPHORESIS
Dr/ Amal Mohamed Abd El Baky
Mr. Chandrasekar.L
353 RHPT - 1st 1435-1436 / ELECTROTHERAPY 2
Lecture outline
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Definition & Physics of Iontophoresis
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Physiological effects, therapeutic effects of
Iontophoresis
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Indication, Contraindication, Precaution
,Advantages of Iontophoresis
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Technique of application of Iontophoresis
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Iontophoresis
Learning Objective
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Define & outline about the mechanism & basic physics
of Iontophoresis.
Describe, memorize & recall the operation of
apparatus, physiological & therapeutic effects,
indication , contraindication, precaution & dangers of
Iontophoresis.
Demonstrate safely the application of Iontophoresis in
certain conditions or disorders
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Iontophoresis
Definition
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Iontophoresis is simply defined as ion transfer
Ionto = ion ; Phoresis = transfer
It is introduction of ions or substance into the
body for therapeutic purposes using low
voltage direct electrical current (constant GC)
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Important points about iontophoresis
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The primary route of ions transfer:
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a. Skin pores
b. The hair follicles
c. Sweat gland ducts
N.B
Iontophoresis promote transdermal drug transports by
increase the permeability of the stratum corneum.
Ionophoresis has a positive effect on wound healing
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Important points about iontophoresis
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Factors affecting therapeutic results :
- Ion introduced
- The pathology present
- The desired effects.
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Some key points
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An electron
It is small particle that carry negative charge
and it is small in size
Electrical current
It is a net movement of electron through any
material. It’s unit of measurement is ampere
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Some key points
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An electrode:
It is a part of the electrical conductor by which
the current is being applied.
 A cathode:
It is the negative pole or negative electrode of
any device.
 Anode:
it is the positive pole of any electrical device
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Iontophoresis
Some key points
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An electrolyte:
It a substance which contain ions.
 Anion :
An ion that carrying negative charge, it is
attracted to the anode
 Cation:
It is an ion carrying a positive charge and so
attracted to the cathode.
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Iontophoresis
Electrolysis
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It brings about movement of “+” charged ions
towards the negative pole & the “-” charged ions
towards the positive pole.
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Iontophoresis vs Phonophoresis
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Both techniques deliver chemicals to biologic
tissues
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Phonophoresis uses acoustic energy (ultrasound)
to drive molecules into tissues
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Iontophoresis uses electrical current to transport
ions into tissues
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Mechanisms of iontophoresis
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Application of a voltage to the wet pad applied on the
skin electrolysis of chemical produces ions.
The substance to be driven into the tissues needs to be
in nature
The positive charged ions will be drift or repel from the
positive pole and inter the skin and vice versa.
The drug that introduce into the skin move deeper by
the formation of compound in blood stream
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Iontophoresis
Introduction of ions
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Iontophoresis
Introduction of ions
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Iontophoresis
Introduction of ions
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Iontophoresis
Physics of iontophoresis
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Constant GC is used obtained from low voltage
generator.
The amount of substance introduce:
Formula for using iontophoresis:
I x Tx ECE
As I = the intensity of current in amper
T= time in hours
ECE= electrochemical equivalence of the substance
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The number of ion penetrating into the body is
directly proportional to
-Current density “ which is limited via
skin tolerance
-Time of application
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Important points
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Intensity of current: Low intensity of the current
greater penetration of ions through the skin
The negative electrode should be large in size than
the positive . To avoid the irritation effects and
burns under the cathode
Ionic polarity: according to the repel mechanism the
positive or the negative ions are repelled into the
skin by the identical charge on the electrode .
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Advantages of iontophoresis
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Advantages of taking medication via iontophoresis
relative to oral medications
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Concentrated in a specific area
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Does not have to be absorbed within the GI tract
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Safer than administering a drug via injection
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Painless procedure
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Sterile technique
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Noninvasive technique
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Physiological effects of iontophoresis
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Ion penetration
Acid/ alkaline reaction
Hyperemia
Dissociation
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Physiological effects
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1. Ion penetration:
o Penetration is less than 1mm
o
o
o
Some studies said that depth of penetration3mm- 20
mm
Bulk of ions deposition may occur under the active
electrode
Absorption to deeper tissues via capillary circulation
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2. Acid/ alkaline reaction:
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Anode
Cathode
• weak acidic reaction under it • strong alkaline reaction under
it
• It is sclerotic harden tissues • It is sclerolytic soften tissues
under it
under it, releasing hydrogen
under it
• Serving as analgesic due to • Use in management of scars ,
release of oxygen
burns and keloid
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3. Hyperemia
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Both anode and cathode produce hyperemia due to
vasodilatation as heat production according to Joule’s
law
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It disappear within 1h
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Cathode hyperemia is longer lasting than anode
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4. Dissociation:
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The ions dissociated and combined with tissue fluid ,
forming compounds in the tissues that produce
therapeutic effects
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Iontophoresis
Most common drugs
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Drug/Solution
Main Indication
Rationale
Parameters
Acetic acid
Calcific Tendinitis
(Supraspinatus tendinitis),
Myositis ossificans
Acetate believed to
increase solubility of
calcium deposits in
tendons & other soft
tissues
2 – 5% aqueous
solution
NEGATIVE polarity
Dexamethasone
Inflammation
Synthetic - Anti
inflammatory
4mg/ml. aqueous
solution
NEGATIVE polarity
Hydrocortisone
Inflammation
Steroid based Anti
inflammatory
0.5% ointment
POSITIVE polarity
Hydrocortisone,
Prednisone
Inflammation
Steroid based Anti
inflammatory
NEGATIVE polarity
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Most common drugs
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Drug/Solution
Main Indication
Rationale
Parameters
Iodine
Adhesive capsulitis, Other
soft tissue adhesive
presentations, Infection –
Microbial
It acts as a broad spectrum
antibiotic. Its actions in
relation to adhesive
presentations are not fully
understood.
5 – 10% solution
NEGATIVE polarity
Salicylates
Muscle & Joint Pain, Acute &
chronic
Analgesia & anti
inflammatory. Inhibits
synthesis of prostaglandins.
2 – 3% sodium salicylate
solution
NEGATIVE polarity
Lidocaine
Soft tissue pain, Inflammation
Local anesthetic effect(blocks
peripheral nerve activity).
May stimulate healing
4 – 5% solution (Ointment)
POSITIVE polarity
Magnesium Sulphate
Muscle Spasm, Myositis
Relaxing effect is achieved
by ↓ excitability of muscle
membrane & reduced
activity at NMJ
2% aqueous solution
(Ointment)
POSITIVE polarity
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Most common drugs
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Drug/Solution
Main Indication
Rationale
Parameters
Hyaluronidase
Edema (Local) Sub acute &
Chronic stages
↑ Permeability in CT thus
allowing dispersion of
accumulated fluid.
150μg/ml. solution
POSITIVE polarity
Calcium chloride
Muscle spasm
Calcium thought to stabilize
excitable membranes,
appears to ↓ excitability
threshold in peripheral nerves
& skeletal muscles.
2% aqueous solution
POSITIVE polarity
Zinc Oxide
Open wounds – Ulcers. Some
dermatological conditions
Antiseptic effects related to
zinc. May stimulate healing.
20% ointment
POSITIVE polarity
Tap water
Hyperhydrosis
Suppresses sweating in palms,
soles of the feet, axilla
through keratin plug formation
in ducts.
Reverse polarity ½ way
through treatment. (Typically
30min: 15+15)
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Indications therapeutic effects
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Local analgesia
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Neurogenic pain
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Edema relief
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Ischemic ulcer
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Scar mobilization
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Indications therapeutic effects
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Allergic Rhinitis
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Idiopathic hyperhidrosis
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Application of antibiotics
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Application of anti- inflammatory drugs
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Fungal infection
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Indications therapeutic effects
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Local analgesia
As in cases of
trigeminal
neuralgia and
herpes zoster.
Use of
lignocaine or
procaine.
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Neurogenic
pain
Edema relief
As in cases of
post herpetic
neuralgia, pain
due to
carcinoma.
Iontophoresis of
vincaalkaloids
is used
As in cases of
posttraumatic
chronic edema
,use
hyaluronidase .
Scar
mobilization
Iodine and
chlorine
enhance the
extensibility
of scar ts.
Iontophoresis
Ischemic ulcer
As in cases of
pressure ulcer
use zinc
iontophoresis.
Indications therapeutic effects
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Iontophoresis
Contraindication
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As in galvanic type stimulation
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Skin sensitivity reactions
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Sensitivity to aspirin (salicylates)
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Gastritis or active stomach ulcer (hydrocortisone)
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Asthma
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Sensitivity to metals (zinc, copper, magnesium)
Sensitivity to seafood (iodine)
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Dangers
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Electrical Shock
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Burns
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Skin irritation
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Systemic effects
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Iontophoresis
shock
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It is caused by the following:
 Inadequate earthling of the apparatus
 Faulty ammeters
 Wet floor with faulty earthling of the apparatus
 Accidently knocking off the main power supply when
there is a high output of current
 Increasing or decrease the current quickly.
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Burn
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It caused by:
 Contact of the metal to the skin
 Over dosage or current density is high
 Skin lesion lead to low skin resistance.
 Metal in the part.
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Iontophoresis
Skin irritation
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It is caused by
Chemical formed under the electrodes
Irritating nature of the drug
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Iontophoresis
Systemic effects
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Can occur with treating large area.
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Occur with using anticholinergic drugs
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Causes headache, abdominal pain, mild dryness of
mouth
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Current used for iontophoresis
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Low-amperage currents (usually galvanic
current)appear to be more effective as a driving
force than currents with higher intensities.
Higher-intensity currents tend to reduce effective
penetration into the tissues.
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Amplitude of the current used for
Iontophoresis
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The comfortable current density used for iontophoresis
range between 0.1 and 0.2 mA/ cm2.
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When initiating the treatment, the current intensity should
always be increased very slowly until the patient reports
feeling a tingling or prickly sensation.
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If pain or a burning sensation is elicited, the intensity is
too great and should be decreased.
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When terminating the treatment, current intensity should
be slowly decreased to zero before the electrodes are
disconnected.
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Duration of the treatment
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Recommended treatment durations range between 10
and 30 minutes.
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During treatment, the patient should be comfortable
with no reported or visible signs of pain or burning.
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The therapist should check the patient's skin every 3-5
minutes during treatment, looking for signs of skin
irritation. Since skin impedance usually decreases
during the treatment, it may be necessary to decrease
current intensity to avoid pain or burning
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Techniques for application of direct
current
1- Contact method
2- Subaquatic method
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Equipment
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Electrodes Types
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Special Pre gelled disposal electrode
Standard metal electrode
Commercial available electrode
Note
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The negative ( cathode) electrode is made larger
relative to positive one to avoid skin irritation
The negative (cathode) electrode should be 2x
larger than the “+” (anode) electrode.
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Electrodes
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Application
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General Points to note – Lab Activity
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1. Preparation of apparatus
1.a. Assembling of the apparatus
1.b. Testing of the machine
2.Preparation of the patient
3. Application of treatment.
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Iontophoresis
Application
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Application
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