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2017 HCHB_digital

Drugs in Aviation

Drugs in Aviation AVIATION – PRECAUTIONS FOR OTC MEDICINES USE The aviation environment is complex and demanding on human performance. Everyone who works in aviation needs “a clear head”, good mental alertness, unimpaired vision and balance, the ability to concentrate (often for long periods), the ability to respond quickly and appropriately to emergencies, and good coordination and motor skills. Medicines which interfere with these safety requirements must not be taken prior to, or while on, duty. These include products which cause: •• behaviour problems, including excitement or agitation •• sedation •• memory, concentration, vigilance impairment •• locomotor impairment, tremor •• disturbances of the special senses, particularly vision and balance. Some nonprescription medicine ingredients such as antihistamines, even some labelled as non-sedating, can have significant side effects which may compromise safety in the aviation workplace. Treatments that may not be safe Many common products may not be safe to use. These include products used to treat: •• abdominal pain •• colds •• diarrhoea •• hay fever •• itchy eyes •• motion sickness •• pain or inflammation •• smoking addiction (specifically varenicline). All over the counter medication or health preparations should be regarded with caution, including preparations used for body-building, which may contain anabolic steroids. Complementary remedies, including Chinese herbals and even homeopathic remedies may be unsafe as their content is not subject to the same stringent requirements as registered medicines, or they may cause side effects such as drowsiness, or interfere with other medicines the person may be taking. Medicine side effects can be further aggravated in the flight environment when combined with other environmental stressors such as hypoxia, reduced barometric pressure, accelerations, noise, and reduced humidity and temperature. There are other aggravating factors to consider, such as working at night, jet lag and fatigue. Interactions with prescription medicines should also be considered. An important factor is the condition being treated. A pilot requiring treatment may be unable to safely exercise the privileges of any licence held. It is essential that anyone involved in prescribing or recommending medicines for aviation workers ensures patients/purchasers are cautioned about possible adverse side effects and safety implications in the workplace. Individuals are ultimately responsible to establish the safety of the medicines they are taking. It is best to seek medical opinion, preferably from a medical examiner designated by the Civil Aviation Authority, and inform their operations manager. It may be necessary to declare that they are unfit for flying or Air Traffic Control duties. The safety of the individual, co-workers and passengers depends on responsible and informed users of non-prescription and medically prescribed drugs or complementary remedies. Licence holders should be aware of their obligation under Section 27C of the Civil Aviation Act – see In particular, licence holders are reminded of their duty to report any change of medical condition to the Director of Civil Aviation (preferably via their Medical Examiner), unless it is a temporary condition specifically exempted by the Director of Civil Aviation in a General Direction (GD); there is currently no GD defining temporary medical conditions that do not need to be reported. Civil Aviation Authority of NZ central medical unit help desk: 04 560 9466 or REVIEWED BY Dr CLAUDE PREITNER, Senior Medical Officer, Civil Aviation Authority of New Zealand, March 2017. Page 208 HEALTHCARE HANDBOOK 2017-2018 References Charts

Drugs in Diving DIVING – PRECAUTIONS FOR OTC MEDICINES USE Any drug which acts on a physiological or psychological parameter of an individual may well impact on diving and diving safety. If a person has a condition which is a contraindication to diving, it is better not to dive than to take a medicine to ameliorate the symptoms. The following classes of drugs may be unsafe to use while diving. Analgesics Analgesics may contain a combination of products including codeine or sedating antihistamines such as doxylamine. These ingredients may cause drowsiness or contribute to the deterioration in mental function associated with nitrogen narcosis. Bronchodilators Theophylline may be associated with cardiac arrhythmias and central nervous system effects such as anxiety and restlessness. Salbutamol is short-acting and may stop working during diving. Diving should be avoided if a bronchodilator is considered necessary. Decongestants (short acting) Short-acting decongestants such as phenylephrine may wear off during the dive, and cause a reverse block. Although their use by divers is widespread, decongestant use may encourage diving with underlying conditions that are contraindicated, for example, upper respiratory tract infections or allergies. Decongestants can cause tachycardia, and vertigo or disorientation have also been reported during diving. Ear wax softening drops Although the use of ear wax softening drops is not contraindicated for diving, ear wax should be removed before diving. Nicotine/smoking Nicotine increases production of carboxyhaemoglobin, which lowers the oxygencarrying capacity of the blood, and causes an overall decrease in cardiovascular fitness. The acute effect of nicotine is to increase heart rate and blood pressure. Smoking also increases mucus production and reduces the ability for the lungs to clear secretions, which could increase the risk of air trapping and pulmonary barotrauma. Recreational drugs All recreational drugs such as alcohol, marijuana, cocaine, opiates, etc., are strongly advised against when diving. Sedating drugs Antihistamines used for allergy or as an antiemetic could cause drowsiness or contribute to the deterioration in mental function associated with nitrogen narcosis. Herbal remedies Herbal remedies should be avoided in combination with diving, as many of these are inadequately labelled as to their contents. Some “herbal” remedies have been found to contain steroids, opiates and even Viagra. Anyone intending to dive after having taken ANY kind of medicine should first seek a medical opinion, preferably from a Dive Doctor. REVIEWED BY Dr Chris Sames, Senior Medical Officer, Slark Hyperbaric Unit, Waitemata DHB, March 2017. Page 209

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