Is it safe to treat?

How to decide if it’s safe to treat someone with a medical condition, allergy or
drug history you are not familiar with.

1 Check Authoritive Guidance

for specific mention of the drug interaction, condition or allergen (ingredients) in the
advice leaflet or other authoritive source of the product you would like to use.

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uc ing l
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P afl Tra anu
online Le m

2 Know properties of the drugs in question.

Ingredients, mechanism of action, metabolism, delivery mechanism, half life, mode of onset.

ACTIVE SITE ACTIVE TIME

INGREDIENTS Where does the How long is the drug
Look at the list of drug act? Which active for before it
active and other system, which loses it;s potency or is
ingredients. enzyme/receptor. metabolised or
excreted?

PHYSIOLOGICAL

KEY FACTS
RESULT
What is the potential
Meds in Question results on the system?

MECHANISM
How does the drug EFFECT & Side effects
actually work? Which WHERE IS IT METABO- How can the drug
system, organ or LISED? affect the patient?
pathway is affected?
Which pathway or
organ processes the
drug?

3 Understand the nature of the disease in

question

PATHOGENESIS- WHERE IS THE DISEASE? ACTIVE TIME

What causes the Local, systemic, liver, Is the disease currently
disease? Autoim- kidneys, skin, heart, active, problematic,
mune, genetic, lungs, immune system, getting better or
infective, aquired. nervous system etc. worse.

KEY FACTS
Patient’s Disease
MECHANISM PHYSIOLOGICAL
What is the pathology RESULT
behind the disease What are the signs and
symptoms? symptoms of the
EFFECT disease?
What is the end result
of the disease as a
process?

4. Are there any overlaps? Examples:

1. Myasthenia Gravis and Botox injections 2: Warfarin and Botox injections. 3. Bee Sting Allergy

Myasthenia Gravis Botox® Bee Venom Contents

Physiological result EFFECT Bee Sting Venom- Apitoxin
Decrease in facial movments. Delivery mechansim can cause Melitin (52%) – peptide
bruising. Apamin
Adolapin
Phospholipase A2
Histamine
Dopamine
Noradrenalin
INCREASED INCREASED
Protease inhibitors No common
Hyaluronidases
RISK OF EXTREME RISK OF Constituents, No
FACIAL PARALYSIS increase in risk
BRUISING
of allergy

Reduced facial movents

Warfarin Botox Ingredients
Physiological Result
EFFECT Botulinum A Toxin

Botox® Decrease blood coagulation, increase bruising, Human Albumin

Lactulose

How can identified risks be modified? For every risk there is usually something that can be done to
reduce it. For example those on aspirin could have extra time given to identify veins. They could be
lay down flat to allow blood to redistribute to the face. Once located and marked on to the face, they
could be sat up for injection with a period of cooling to constrict veins just prior to the injection.
Allergy tests could be offered, or treatments could be delayed for a better time. Once any possible
ideas to modify the risks have been discussed, you can then go further into analysing the benefit risk
ratio with your clients.

5. Benefits vs Risks analysis

Do
at Tre not
Tre at

Benefits Risks

The
first rule
is always
‘do no harm’.
Do the benefits of the treat-
ment still outweigh the risks to the
patient? Are they fully informed and in
agreement?

Key Facts- Botox

INGREDIENTS ACTIVE SITE ACTIVE TIME

-Active botulinum Presynaptic Drug activity occurs
toxin A protein membrane of within a period of days
-Human albumin nerves up to 1cm before it loses it’s
-lactulose from injection site. ability to cleave SNARE
proteins.

MECHANISM PHYSIOLOGICAL

KEY FACTS
-Proteolytic cleavage of RESULT
presynaptic receptor Muscle relaxation.
protein, inhibiting
release of Ach until
BOTOX® Tear reduction.
Sweat Reduction.
repair by the body. Saliva Reduction.

MECHANISM-2
The heavy & light
changes dissociate as
they penetrate
neurones- thus once
in, the molecule cannot
be active anywhere
else.
EFFECT
WHERE IS IT METABO- Temporary inhibition
LISED? of nerve transmission
Intraneuronal in acetylecholine
ubiquitination-proteas- releasing synapses
ome pathway. 1cm from delivery
Systemically by the point for ~4months.
liver.

Juvederm Hyaluronic Acid Filler

INGREDIENTS ACTIVE SITE ACTIVE TIME
Cross Linked hyaluronic Only active locally Lidocaine 1-2hours.
Acid mimicking human to the site of HA filler -6 to 36
HA, injection. months.
Lidocaine 0.03%
May have small amounts
of Gram +ve bacterial
protein.

KEY FACTS
PHYSIOLOGICAL RESULT
MECHANISM Filler is not physiological-
Lidocaine blocks ly active like a drug.
sodium channels on
nerve membranes to
Juvederm Filler Lidocaine causes
numbness to the area
temporarily prevent injected.
depolarisation.

MECHANISM-2
Molecules create local
lifting and skin
strengthening through
volume addition and
integration through
intanglement with
local connective tissue
molecules.
WHERE IS IT METABO- Autoimmune diseases
LISED? and bacterial
liver metabolises infections increase the
lidocaine, and dermal likelyhood of immune
filler under goes reactions to dermal
mechanical and local filler.
metabolic degradation
into shorter sugar
molecules.