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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.
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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
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Acute Intoxication?
- • Vestibular disturbance, disorientation
- • Nystagmus
- • Poor psychomotor control
- • Poor reaction times
- • Dehydration
- • Hypoglycaemia
- • Hypoxia?
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Longer Term?
- • Medical consequences and fitness to fly
- • Mental health co- morbidities
- • Suicide risk
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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
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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
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Tobacco issues and flying?
- • Carbon monoxide
- • Impaired oxygen diffusion
- • Respiratory consequences
- • Cardiovascular risk
- • Occupational imposed abstinence and withdrawal
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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
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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
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Nicotine replacement therapy?
Gum and patches
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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
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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
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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
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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)
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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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