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 - IIITotal 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 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 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. 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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 Download 0.69 Mb. Share with your friends:
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