SCREENING AND SAFETY IN IBOGAINE PATIENTS CLARE WILKINS-DIRECTOR, IBOGAINE ASSOCIATION

STRATEGIES Preparation Preparation Develop situational attention Develop situational attention Stimulate team work Stimulate team work Compensate for stressful factors Compensate for stressful factors

ANTICIPATION – PLANNING – OPTIMIZATION - INFORMATION < MORBIMORTALITY > WELL-BEING OF THE PATIENT > CARE QUALITY

The cardiopulmonary function & the psychological state must be evaluated constantly The cardiopulmonary function & the psychological state must be evaluated constantly

Objectives of the Evaluation: Relationship between doctor-patient: To be a comfortable experience; to be aware of all current illness and comorbidities Relationship between doctor-patient: To be a comfortable experience; to be aware of all current illness and comorbidities MEDICAL HISTORY and PARACLINICALS (Laboratory and Electrocardiogram) MEDICAL HISTORY and PARACLINICALS (Laboratory and Electrocardiogram) Therapeutic plan as a team Therapeutic plan as a team Obtain the informed consent of the patient Obtain the informed consent of the patient

MAIN OBJECTIVE: SAFETY

SCREENING Contact by Phone & Contact by Phone & Medical Exam / Para-Clinicals Medical Exam / Para-Clinicals Clinical history Clinical history Anamnesis (medical intake) Anamnesis (medical intake) Psychological examination Psychological examination Physical examination Physical examination Treatment plan Treatment plan

SCREENING CLINICAL HISTORY CLINICAL HISTORY Labor (work) Labor (work) Relatives. Relatives. - obesity, sedentarismo Habits: Habits: - alcoholism ( abstinence sydrome, liver disease). - alcoholism ( abstinence sydrome, liver disease). - nicotinism. - nicotinism. - BZD, Opiáte’s, other drugs (tolerance, Sd abstinence). - BZD, Opiáte’s, other drugs (tolerance, Sd abstinence). Allergies and adverse reactions to medicines: Allergies and adverse reactions to medicines: Allergic reactions Allergic reactions -Medicines: antibiotics, NSAI, Antidepressants, Muscle Relaxants (succinilcolina), -Medicines: antibiotics, NSAI, Antidepressants, Muscle Relaxants (succinilcolina), - Food - Food

Screening Personal history Personal history Habits (alcohol, cigarettes, drugs) Habits (alcohol, cigarettes, drugs) Use of medicines Use of medicines Illnesses (Cardiovascular and respiratory, UTI) Illnesses (Cardiovascular and respiratory, UTI) Allergies and Cx (Surgeries) Allergies and Cx (Surgeries) Pregnancy Pregnancy Acute Infections Acute Infections Family History Family History HBP, Diabetes, Heart disease HBP, Diabetes, Heart disease

Screening Illnesses that compromise cardiopulmonary function: HEART FAILURE, CORONARY HEART DISEASE, ARRHYTHMIAS (cardiac disorder), PULMONARY VENOUS THROMBOEMBOLISM, VENOUS THROMBOSIS, RENAL FAILURE, ACTIVE INFECTIONS, PERIPHERAL NEUROPATHIES, THYROTOXICOSIS HEART FAILURE, CORONARY HEART DISEASE, ARRHYTHMIAS (cardiac disorder), PULMONARY VENOUS THROMBOEMBOLISM, VENOUS THROMBOSIS, RENAL FAILURE, ACTIVE INFECTIONS, PERIPHERAL NEUROPATHIES, THYROTOXICOSIS

PHYSICAL EXAMINATION Cardiovascular Cardiovascular Arrhythmias Arrhythmias Pulses and peripheral perfusión, circulation Pulses and peripheral perfusión, circulation Thórax Thórax Depth of respiratory movements and respiratory frequency Depth of respiratory movements and respiratory frequency Use of accesory muscles of respiration Use of accesory muscles of respiration Respiratory sounds ( wheezing, crackles, rhonchi) Respiratory sounds ( wheezing, crackles, rhonchi) Abdominal Abdominal Distention Distention Extremites Extremites Probable vascular accesses Probable vascular accesses swelling swelling Neurological Neurological Mental state Mental state March and muscular force March and muscular force

General aspect Color (paleness, cianosis) Color (paleness, cianosis) Nutritional state Nutritional state Hydration Hydration Mental state Mental state

COMPLEMENTARY TESTS They detect disorders not suspected by the clinical history They detect disorders not suspected by the clinical history Individualized Individualized LABORATORY : The normality in EKG does not exclude coronary heart disease; there are some abnormalities that lack relevancy in asymptomatic patients. ELECTROCARDIOGRAM : The normality in EKG does not exclude coronary heart disease; there are some abnormalities that lack relevancy in asymptomatic patients.

LABORATORY They must be chosen according to the medical condition of the patient They must be chosen according to the medical condition of the patient Recommendations for a healthy patient Recommendations for a healthy patient SMAC 21 PLUS AND CBC SMAC 21 PLUS AND CBC WBC (infection) WBC (infection) RBC : Recent Hematocrito-hemoglobin (30 %) RBC : Recent Hematocrito-hemoglobin (30 %) QS (glucose,cholesterol,trig) QS (glucose,cholesterol,trig) TGO, TGP, GGT (liver function) TGO, TGP, GGT (liver function) CREATININE, BUN, UREA (RENAL FUNCTION) CREATININE, BUN, UREA (RENAL FUNCTION) TP,TPT (study of coagulation) TP,TPT (study of coagulation) CARDIAC ENZYMES CARDIAC ENZYMES URINE TEST URINE TEST

ELECTROCARDIOGRAM ECG ( over 40 years) ? ECG ( over 40 years) ? EVERYONE EVERYONE Dx, Tx Dx, Tx Used for the detection of arrhythmias, acute myocardial infarction, electrolytic imbalances and function of the pacemaker Used for the detection of arrhythmias, acute myocardial infarction, electrolytic imbalances and function of the pacemaker

TREATMENT PREPARATIONS BEFORE BEGINNING PREPARATIONS BEFORE BEGINNING

FASTING The gastric emptying of clear liquids delay 1 hour and of solid 6 hours The gastric emptying of clear liquids delay 1 hour and of solid 6 hours Stress, pain, anxiety and opioids delay the emptying Stress, pain, anxiety and opioids delay the emptying

PREMEDICATION Prophylaxis for gastrointestinal symptoms: Prophylaxis for gastrointestinal symptoms: Omeprazol (Anti-Acid, Proton Inhibitor) 20 mg Oral Omeprazol (Anti-Acid, Proton Inhibitor) 20 mg Oral Meclizine & Piridoxine (antiemetic) 25/50mg OA Meclizine & Piridoxine (antiemetic) 25/50mg OA Metoclopramide (Anti-Emetic,Pro Kinetic)10 mg OA Metoclopramide (Anti-Emetic,Pro Kinetic)10 mg OA

Monitorization: The first and most important monitor is the human observer Constant Vitals : HR, Pulse, BP, Respirations. Constant Vitals : HR, Pulse, BP, Respirations. Medicate for nausea Medicate for nausea 60 minutes test dose 60 minutes test dose minutes full dose minutes full dose

Monitorization: Monitor during the following 12 hours, constantly Monitor during the following 12 hours, constantly Initiate with BP, pulse and saturation of O2 Initiate with BP, pulse and saturation of O2 Note down pulse and saturation of oxygen first 4 hours every 30 minutes and check BP depending on clinical judgment Note down pulse and saturation of oxygen first 4 hours every 30 minutes and check BP depending on clinical judgment Later, every 1hr up to completing 12 hours Later, every 1hr up to completing 12 hours Check BP every 8 hrs up to finishing treatment Check BP every 8 hrs up to finishing treatment

MONITOR CONSTANTLY Ventilation Ventilation Oximetry (saturation) Oximetry (saturation) A saturation of 90 % can mean a Pao2 of 65 % mm Hg. A saturation of 90 % can mean a Pao2 of 65 % mm Hg. To be trustworthy it needs a good peripheral perfusión To be trustworthy it needs a good peripheral perfusión pulse pulse BP BP

Monitorization: Check for abstinence symptoms Check for abstinence symptoms Rhinorrea, piloerection, mydriasis, yawning, lacrimation, tremors, hot or cold flashes, restlessness, vomiting, abdominal cramps, anxiety and muscle twitches Rhinorrea, piloerection, mydriasis, yawning, lacrimation, tremors, hot or cold flashes, restlessness, vomiting, abdominal cramps, anxiety and muscle twitches