A model didactic and clinical substance abuse curriculum developed for schools of nurse anesthesia


DIDACTIC UNIT B: Pharmacology - III



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DIDACTIC UNIT B: Pharmacology - III


Total Time: 2-3 hours


Overview: This unit serves as a final consolidation of pharmacological principles and the pharmacology of the substances commonly abused. The session is intended to familiarize the participant with the substance abuse as it relates to anesthesia.
Terminal Objective: The student will understand the pharmacologic basis and principles of abused substances, their characteristics, and clinical manifestations as they relate to the administration of anesthesia. They will be able to describe the anticipated interaction of abused drugs with anesthetics as well as the effects from polysubstance substance use/abuse.
Recommended Teaching Methods:

Group Process

Lecture

Discussion



Readings

Clinical patient case


Course Outline:

LVII. Pre Anesthetic considerations for SA

A. Laboratory tests

1. Toxicology assays

2. Liver function tests

3. CBC


4. Electrolyte

5. Hepatitis

6. HIV

7. Systemic infections



a.Cultures

b.Tuberculosis

c.Syphilis

d.Sepsis


8.Neuroreceptors and transmitters

a.Kappa/Mu/others

b.Alpha2-receptor agonists

B. Drug dependence and premedication

1. Alcohol dependence

2. Opioid dependence

3. Nicotine dependence

4. Other drug dependencies

5. Recovering addict

6. Use of Disulfiram (Antabuse) and Naltrexone

7. Use of AZT

C.Pharmacokinetic and Pharmacodynamic considerations of abused substances and anesthesia

1. Alcohol

2. Marijuana

3. CNS stimulants

4. Cocaine

5. CNS depressants

6. Narcotics/Heroin/other controlled substances

7. Opiates

8. Semi-synthetic

9. Synthetic

10. Hallucinogens

11. Phencyclidine (PCP)

12. Volatile Inhalants

13. Nicotine

14. Caffeine

15. Anabolic steroids

LVIII. Metabolism, clearance, and elimination of substances with regards to anesthesia

A. Metabolism

1. Hepatic

2. Renal

3. Biliary

4. Metabolic degradation

5. GABA receptors

B. Pharmacologic management of withdrawal

1. Intermittent or recurrent withdrawal

2. Complicated withdrawal

3. Unrecognized withdrawal

4. Preanesthetic transition from abuse to withdrawal

5. Unrecognized medical events interpreted as withdrawal

LIX. Anesthetic technique (Drugs used for anesthesia)

A. Pharmacologic considerations for anesthetic selection

B. Nonpharmacologic intervention (TENS)

C. Limitations of the anesthetic technique

D. Anesthetic requirements for SA patients

LX. Post anesthetic considerations

A. Post operative pain control

1. Use of naloxone

2. Methadone use

3. Patient controlled analgesia (PCA) units

4. Nonsteroidal antiinflammatory drugs (e.g. Ketorolac)

5. Agonists/Antagonists

a. Dezocine

b. Butorphanol

c. Nalbuphine

d. Pentazocine

6. Pharmacologic cross-tolerance

B. Recovery and Relapse with pharmacologic intervention

1. Neurochemical mechanisms

2. Psychological mechanisms

a.Fear of pain

b.Pleasure seeking

c.Stress

C. Medical care in recovery

1. Treatment strategies

a. American Society of Addiction Medicine (ASAM) for medical care in recovery

2. Treatment of Chronic Pain

a.Discharge medication

b.In active SA patient

c.In Recovering SA patient


References:

Adger, H., DeAngelis, C., & McDonald, E.M. (1986). Model program and curriculum in alcohol and other drug abuse for pediatric medical students, residents and faculty. (National Institute on Drug Abuse. ADM 281-86-0009). Washington, DC: U.S. Government Printing Office.


Adler, G.R., Potts, F.E., Kirby, R.R. et al. (1985). Narcotics control in anesthesia training. Journal of the American Medical Association. 253, 3133.
Ahmad, G. (1987). Abuse of Phencyclidine (PCP): A laboratory experience. Journal of Clinical Toxicology. 25(4), 341-346.
American Society of Anesthesiologists Ad Hoc Committee on the Effect of Trace Anesthetics on the Health of Operating Room Personnel. (1974). Occupational diseases among operating room personnel: A national study. Anesthesiology. 41, 321.
Angell, M. (1982). The quality of mercy. New England Journal of Medicine. 306, 98.
Antelman, S.M. (1981) Amitriptyline provides long-lasting immunization against sudden cardiac death from cocaine. European Journal of Pharmacology. 69, 119.
Barash, P.G., Cullen, B.F. & Stoelting, R.K. (Eds.). (1989). Clinical anesthesia. Philadelphia: J.B. Lippencott Co.
Berkowitz, B.A. (1976, Jan.). Relationship of pharmacokinetics to pharmacological activity: Morphine, methadone, naloxone. Clinical Pharmacokinetics. pp. 219-230.
Boning, J. (1985). Benzodiazepine dependence: Clinical neurobiological aspects. Advances in Biochemical Psychopharmacology. 40, 185-192.
Bruce, D.L. (1983). Alcoholism and anesthesia. Anesthesia and Analgesia. 62, 84.
Buckley, M.M.T., Brogden, R.N. (1990). Ketorolac: A review. Drugs. 39, 86.
Busto, V. (1986). Patterns of benzodiazepine abuse and dependence. British Journal of Addictions. 81(1), 87-94.
Corbett, T.H. (1973). Retention of anesthetic agents following occupational exposure. Anesthesia and Analgesia. 52, 614.
Cushman, P. (1986). Sedative drug interactions of clinical importance. Recent Developments in Alcohol. 4, 61-83.
DeLander, G.E., Porthoghese, P.S. & Takemori, A.E. (1984). Role of spinal mu opioid receptors in the development of morphine tolerance and dependence. Journal of Pharmacologic Experimental Therapy. 231(1), 91.
Elliot, H.W. (1975). Effects of street drugs on anesthesia. International Journal of Clinical Pharmacology. 12, 134.
Fabiani, C.A. (1991). From coca chewing to cocaine smoking. Resident Staff Physician. 37, 101.
Farley, W.J. & Talbott, G.D. (Eds.). (1983). Anesthesiology and addiction. Anesthesia and Analgesia. 62, 465.
Filshie, J. (1988). The non-drug treatment of neuralgic and neuropathic pain of malignancy. Cancer Survey. 7(1), 161.
Freund, G. (1984). Biomedical causes of alcohol abuse. Alcohol. 1(2), 129-131.
Frost, E.A. (Ed.). (1988). Pre-anesthetic assessment. Boston: Birkhauser.
Gawin, F.H. & Ellingwod, E.H. (1988). Cocaine and other stimulants: Action, abuse and treatment. New England Journal of Medicine. 318(18), 1173-1182.
Gerard, D.L., Saenger, G. & Wile, R. (1962). The abstinent alcoholic. Archives of General Psychiatry. 6, 83.
Gold, M., Pottash, A., Sweeney, D. et al. (1980). Opiate withdrawal using clonidine. A safe, effective, and rapid non-opiate treatment. Journal of the American Medical Association. 243(4), 343.
Goldstein, D.B. (Ed.) (1983). The pharmacology of alcohol. New York: Oxford Press.
Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co.
Grabowski, J. (Ed.). (1984). Cocaine: Pharmacology, effects, and treatment of abuse, NIDA Research Monograph 50. (National Institute on Drug Abuse. ADM 87-1326) Rockville, MD: National Institute on Drug Abuse.
Guiffrida, J.G., Bizzarri, D.V., Saure, A.C. et al. (1970). Anesthetic management of drug abusers. Anesthesia and Analgesia. 49(2), 272.
Jacobs, M.R. & Fehr, K.O. (1987). Drugs and drug abuse: A reference text. Toronto, Canada: Addiction Research Foundation.
Land, W.E.M. & Zakhari, S. (1990). Alcohol and cardiovascular disease. Alcohol Health and Research World. 14(4), 304-312.
Malseed, R. (1985). Pharmacology: Drug therapy and nursing considerations. Philadelphia: J.B. Lippincott.
McQuay, H. (1988). Pharmacologic treatment of neuralgic and neuropathic pain. Cancer Survey. 7(1), 141.
Millan, M. (1986). Multiple opioid systems and pain. Pain. 27, 303.
Miller, R.D. (Ed.). (1990). Anesthesia. New York: Churchill Livingstone.
O'Brian, J., Benfield, P. (1989). Dezocine: A preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy. Drugs. 38(2), 226.
Orkin, L.R. & Chen, C.H. (1977). Addiction, alcoholism and anesthesia. Southern Medical Journal. 70, 1172.
Osborne, N.N. (1977). Naloxone alters pain perception and somatosensory evoked potentials in normal subjects. Nature. 270, 620.
Peterson, R.G. & Rumack, B.H. (1977). Treating acute acetaminophen poisoning with acetylcysteine. Journal of the American Medical Association. 237, 2406-2407.
Physicians' Desk Reference. (1993). Oradell, NJ: Medical Economics Co.
Physician' Desk Reference For Nonprescription Drugs. (1993). Oradell, NJ: Medical Economics Co.
Pickens, R.W., Svikis, D.S. (Eds.). (1988). Biological vulnerability to drug abuse, NIDA Research Monograph 89. Rockville, MD: National Institute on Drug Abuse.
Rogers, M.C., Tinker, J.H., Covino, B.G. & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book.
Scott, L.E., Clum, G.A., & Peoples, J.B. (1983). Preoperative predictors of postoperative pain. Pain. 15, 283.
Spiker, D.G., et al. (1975). Tricyclic antidepressant overdose: Clinical presentation and plasma levels. Clinical Pharmacologic Therapy. 18(5), 539-546.
Stuart, G. & Sundeen, S. (Eds.). (1986). Principles and practice of psychiatric nursing. St. Louis, MO: C.V. Mosby.
Sullivan, J.B. et al. (1979). Management of tricyclic antidepressant toxicity. Topics in Emergency Medicine. 1(3), 65-71.
Teped, H. (1985). Biochemical basis of alcoholism: Statements and hypotheses of present research. Alcohol. 2(6), 711-788.
Wesson, D. & Smith, D. (1977). Barbiturates: Their uses, misuse and abuse. New York: American Science Press.
West, R.J. & Russell, M.A. (1985). Dependence on nicotine chewing gum. Journal of the American Medical Association. 256(23), 3214-3215.

Substance Abuse Curriculum: MODULE 3

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