1Topic 3.18 Pharmacology AVMO 0019

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  1. Learning Outcomes?
    • • Explain the basic policies and principles of safe prescribing for aircrew.
    • • Explain the use of a "Ground Trial" for therapeutic agents.
    • • Describe aeromedical issues pertaining to the safe use of commonly used prescription and over-the-counter medications.
    • • Describe the hazards of, and ADF policies relevant to, recreational drug use by aircrew.
    • • List the ADF policy and reference documents regarding medications and aircrew.
    • • Differentiate between acceptable and unacceptable therapeutic and recreational substances that aircrew might use, and apply appropriate procedures when prescribing.
  2. Alcohol Elimination/ Excretion?
    • • 90+% metabolised in liver
    • • 2-10% via lungs, urine, faeces and sweat
    • • Racial differences in metabolism
    • • Reduced mitochondrial aldehyde dehydrogenase in Asian races increases symptoms of intoxication
    • • Thiamine essential co-factor.
    • MEOS: microsomal ethanol oxidizing system]
    • Familiar Consequnces of Alcohol
  3. Acute Intoxication?
    • • Vestibular disturbance, disorientation
    • • Nystagmus
    • • Poor psychomotor control
    • • Poor reaction times
    • • Dehydration
    • • Hypoglycaemia
    • • Hypoxia?
  4. Longer Term?
    • • Medical consequences and fitness to fly
    • • Mental health co- morbidities
    • • Suicide risk
  5. Alcohol and TMUFF: A Reminder?
    • • Before undertaking aviation or controlling related duties:
    • • BAL must be ZERO
    • • No symptoms of hangover
    • • Observe minimum abstinence period
    • • TMUFF self-imposed or by medical/supervisors
    • Minimum Abstinence Period Prior To Duty
    • Number of standard drinks consumed Minimum period of abstinence from the last drink to commencement of duty (hrs)
    • 1–4 8
    • 5–6 12
    • 7–10 18
    • 11–20 30
    • >20 48
  6. Clinical Effects of Caffeine?
    • • Short Term
    • • Palpitations
    • • Tremor
    • Diuresis
    • • Insomnia
    • • Agitation
    • • Increases alertness
    • • Increases vigilance
    • • Improves performance
    • • Long Term
    • • Hypertension
    • • Contribution to cardiovascular risk
    • • Dependence
    • • Withdrawal symptoms
  7. Tobacco issues and flying?
    • • Carbon monoxide
    • • Impaired oxygen diffusion
    • • Respiratory consequences
    • • Cardiovascular risk
    • • Occupational imposed abstinence and withdrawal
  8. Nicotine Pharmacology?
    • • 0.1 – 2mg in a typical cigarette (60mg fatal)
    • • Rapidly absorbed, t½ = 2 hours
    • • Stimulates nicotinic ACh receptors
    • • Increases GI motility, blood pressure, HR
    • • Highly addictive
    • • conditioning
    • • tolerance
    • • physical dependence
    • • withdrawal
  9. Nicotine Withdrawal?
    • • Psychological
    • • Irritability, tension, aggression, confusion, depression, impulsivity
    • • Cognitive
    • • Concentration, tracking and reaction time, digit recall, calculation, attention/arousal
    • • Physical
    • • Increased BP, decreased HR
  10. Nicotine replacement therapy?
    Gum and patches
  11. Bupropion (Zyban)?
  12. PRESCRIPTION MEDICATIONS First Principles?
    • • The condition itself is often reason for grounding
    • • Will the treatment affect fitness to fly?
    • • Any possible treatment interactions?
    • • Rule out known side effects
    • • Be aware of idiosyncratic reactions/allergy
    • • Treat medically, not occupationally
  13. PRESCRIPTION MEDICATIONS Treatment principles?
    • • Regard all medications with suspicion
    • • Simple regimes preferred, eg. once daily
    • • Lowest effective doses
    • • Avoid new drugs – stick to the tried and true
    • • Use widely available agents
    • • Withdrawal should not cause problems
  14. Is there a definitive list of safe medications?
    • • Not really!
    • • Too simplistic and impractical
    • • Every patient and clinical presentation is different
    • • Drug therapy constantly evolving
    • • Call AVMED if unsure
  15. Ground Trials?
    • • For first time, long term or recurrent treatment
    • • Used to assess:
    • • Treatment efficacy
    • • Side effects
    • • Idiosyncratic reactions
    • • Interactions
    • • Variable duration, up to 28 days
    • • MECR undertaken to document fitness to fly while taking ADF approved medication (usually UAMECR)
  16. Caveats?
    • • Examples only
    • • Details discussed in specific clinical topics
    • • Not meant to be prescriptive or definitive
    • • GT = Ground Trial period in days
    • • MECR = pending Medical Employment
    • Category Review

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Author:
david_hughm
ID:
328905
Filename:
1Topic 3.18 Pharmacology AVMO 0019
Updated:
2017-02-25 12:54:50
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Pharmacology
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