human psychopharmacologyHum Psychopharmacol Clin Exp 2005; 20: 183–187. Published online 7 February 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hup.676A comparison of donepezil and galantamine in thetreatment of cognitive symptoms of Alzheimer’sdisease: a meta-analysisRobin D. J. Harry and Konstantine K. Zakzanis*University of Toronto at Scarborough, Toronto, Canad
Bardzo tanie apteki z dostawą w całej Polsce kupic levitra i ogromny wybór pigułek.
Tcaa.go.tzUNITED REPUBLIC OF TANZANIA
TANZANIA CIVIL AVIATION AUTHORITY
Aeronautical Information Services
AERONAUTICAL INFORMATION CIRCULAR
P.O. Box 2819 DAR ES SALAAM.
FAX: (255 22) 2118905 PHONE: (255 22) 2115079/80, 2111951.
1 November 2004
Email: [email protected], [email protected]Website:http//www.tcaa.go.tz The following circular is hereby promulgated for information, guidance and necessary action. MEDICATION, ALCOHOL AND FLYING.
1. Accidents and incidents have occurred as a result of pilots flying whilst medically unfit and the majority have been associated with minor ailments rather than overwhelming medical catastrophes.
Although the symptoms of colds, sore throats, diarrhoea and other abdominal upsets may cause relatively little problem whilst on the ground, they may become dangerous when flying by distracting the sufferer from the various flying tasks. Symptoms may also increase in severity in the altered environmental conditions in flight. The side effects of medication prescribed or bought over the counter for the treatment of such ailments may also be highly undesirable. The following are some of the more widely used medicines which are normally considered incompatible with flying.
2. Antibiotics such as the various penicillin, tetracycline etc may have short term or delayed side effects which affect pilot performance. More importantly, their use usually indicates that a fairly severe infection is present and apart from any effect of the medication taken, the effects of the infection will almost always mean that the pilot is not fit to fly.
Tranquillizers, antidepressants and sedatives affect the ability to respond to a particular situation. Anxiety is a normal response to danger which alerts and primes the body for action. Inability to react due to the use of this group of medicines has been a contributory cause to fatal aircraft accidents. You must not fly when taking them.
4. Stimulants such as caffeine, amphetamines etc. (often called “pep’ pills) used to maintain wakefulness or suppress appetite are often habit forming. Susceptibility to the various drugs varies from one individual to another. But all of them may cause disturbance. The use of ‘pep’ pills while flying cannot be permitted. If coffee is insufficient you are not fit to fly and remember that excessive coffee drinking has harmful effects.
5. Ant-histamines can cause drowsiness. They are widely used in cold cures and in the treatment of hay fever, asthma and allergic rashes. They may be in tablet form or be a constituent of nose drops or sprays. In many cases, the condition itself may preclude flying, so that if treatment is necessary, expert advice should be sought.
6. Drugs for the relief of high blood pressure can cause a change in the mechanism of blood circulation and impairment of intellectual performance which could be disastrous when flying. If the blood pressure is such that drugs are needed, the pilot must be temporarily grounded. Any treatment instituted should be discussed with an aviation expert in Aviation medicine before return to flying.
7. Following local and general dental and other anaesthetics, a period of time should elapse before returning to flying. This period will vary depending on individual circumstances but will usually be at least 24 hours. The dentist or anaesthetist should be asked about this.
8. The more potent analgesics may have marked effects on performance. In many cases the pain for which they are being taken indicates a condition which is a bar to flying.
Many preparations are now marketed containing a combination of medicines. It is essential therefore that if there is any change in medication or dosage however slight, the effect should be observed by the pilot on the ground prior to flying. Although the above are the commonest medicines with adverse effects on pilot performance, it must be noted that many other forms of medication although not normally affecting pilot performance, may do so in individuals who are ‘oversensitive’ to the particular preparation. You are therefore exhorted not to take any medication before or during flight unless you are completely familiar with their effects on your body. If you are in doubt at all, ask a doctor experienced in Aviation Medicine.
10. Recent blood donation is incompatible with flying. The resulting disturbance to the circulation takes several weeks to return completely to normal and although effects are slight whilst at ground level, there are risks when flying during this period. It is recommended that pilots do not volunteer as blood donors whilst actively flying. If blood has been given, an appropriate doctor should be consulted before returning to flying.
11. If you are taking any medicine you should ask yourself the following three questions:- i) Do I feel fit to fly?ii) Do I really need to take medication at all? iii) Have I given this particular medication a personal trial on the ground of at least 24 hours before flight to ensure that it will not have any adverse effects whatever on my ability to fly? 12. Confirming the absence of adverse effects may well need expert advice and assistance of airline medical examiners and Civil Aviation authorized doctors should be sought if in doubt. If you are ill and need treatment, do make sure the doctor you consult knows you are a member of an aircrew and whether you have recently been abroad.
13. DRUGS OF ADDICTION- Drugs in this group cover a wide field ranging from heroin and
morphine to hypnotic, tranquillizers and marijuana. All have a basic effect which is to ‘detach’ the person, taking them from the realities of their environment. As such, they are not compatible with control of an aircraft, and a person using them is not fit to be a member of a flight crew.
14. ALCOHOL - Alcohol is a contributory factor in at least one aircraft accident almost every
year. It is well established that even small amounts of alcohol in the blood produce a measurable deterioration in the performance of skilled tasks. Research has confirmed that blood alcohol concentrations of 40 mgs per 100 milliliters are associated with highly significant increases in the errors committed by the experienced and inexperienced pilots even in simple aircraft. This is half the legal driving limit, and may result from drinking one double whisky or one pint of beer. Alcohol is removed from the body at a relatively constant rate regardless of the concentration present. Pilots should not fly for at least 8 hours after taking small amounts of alcohol and proportionately longer if larger amounts are consumed.
15. Your attention is drawn to the following regulations in the Tanzanian Air Navigation Regulations 2003. Regulation 110 (3)-Under this regulation, it is an offence for a person to be on board an aircraft as a member of its flight crew if under the influence of drink or drug to such an extent as to impair his ability to perform his duties. Regulation 42(1) requires the holder of a licence granted or rendered valid by the Director General to inform the Director General in writing of:- (a) any personal injury involving incapacity to undertake his crew duties (b) any illness involving incapacity to undertake his duties for 20 days or more. Regulation 42 (4) automatically suspends the licence of a crew during the period that she is pregnant. Furthermore Regulation 53 (1) notes that a person shall not be entitled to perform any of the functions to which his licence relates if he knows or has reason to believe that physical condition renders him temporarily or permanently unfit to perform such functions.
16. To sum up, the taking of medication drugs or alcohol when you are flying, or intending to fly, is generally a dangerous practice. Do not take any drugs or medication unless positively proven to be safe. Under no circumstances should you take those drugs considered as being dangerous or potentially dangerous. Alcohol is strictly forbidden before or during flight.
Cancel AIC 22/2000
Narcotic Equivalents * Pain (Adjuvants) Urinary Incontinence Approximate Equi-analgesic Doses: Special Note codeine [120 mg; 200 mg] Wound Management fentanyl Reflux (GERD) [0.1 mg; n/a] hydrocodone IN-SIGHT HOSPICE [n/a; 30 mg] DRUG FORMULARY hydromorphone & Cost Index [1.3-1.5 mg; 7.5 mg] COMMUNITY HOSPICES OF AMERICA