1. AFAMS EO 005.01 Undercontrol/ Controlled Medications (Dari) 01/09/2013

2. AFAMS Importance of Lesson (Dari) Undercontrol/ Controlled Medications are a group of medications that require more stringent controls due to the potential for their misuse (e.g. diversion and abuse). More stringent controls include increased steps when: –Storing; –Ordering; –Receiving; –Accounting; and –Dispensing. AFAMS Insert Dari

3. AFAMS Importance of Lesson (Dari) These increased requirements exist at all medical facilities: –Hospitals –Polyclinic –Class VIII Warehouse These requirements extend beyond pharmacy to all occupations. The purpose of this lecture is make you familiar with these requirements. AFAMS Insert Dari

4. AFAMS Overview EO 005.01 (Dari) Define and list under control/controlled medications Define and group according to MEDCOM Review more indepth MEDCOM and NMH policies. Review Game (not graded) AFAMS Insert Dari

5. AFAMS Definitions Dari Undercontrol/ Controlled Medications “A group of medications which their usage can cause drug tolerance and drug addiction, drug toxicity, and some neurological effects like excitation, unable to concentrate, euphoria, unconsciousness, dizziness, also some patient can misuse the medications.” “Inconsequential use…may cause drug dependence and addiction.” MEDCOM Policy on Undercontrol/ Controlled Medications AFAMS Insert Dari

6. AFAMS Definitions Dari Drug Dependence: A physical dependence which is an adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped. It is usually associated with increased tolerance. Physical dependence alone does not imply addiction. Addiction: “It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving” CAMH AFAMS Insert Dari

7. AFAMS Definitions Dari Withdrawal: With regular use of a substance, biochemical and structural adaptations take place in the brain. Withdrawal is the group of unpleasant symptoms and signs that a person experiences when, after a period of regular use, the quantity of available substance in the brain is reduced. Upon stopping use, the brain takes days or weeks to return to normal. During this time withdrawal is experienced. AFAMS Insert Dari CAMH

8. AFAMS Definitions Dari Withdrawal Continued: Symptoms and signs of withdrawal are opposite to the main effect of the drug. For example: –Sedative withdrawal creates hyperactivity with dangerous medical complications. –Opioid withdrawal is accompanied by anxiety, powerful cravings and flu-like symptoms. –Stimulant withdrawal consists of depression, insomnia and cravings. Withdrawal symptoms are relieved by giving the same or similar drug. AFAMS Insert Dari CAMH

9. AFAMS Definitions Dari Tolerance: Tolerance is a condition in which higher doses of a drug are required to produce the same effect experienced during initial use. Tolerance is often associated with physical dependence. In therapeutic use of a drug with psychoactive effects (e.g., morphine for chronic pain relief), patients tend to become tolerant to the psychoactive effects (e.g., euphoria, reduced anxiety or sleep inducement), but not the therapeutic effects. A patient seeking higher doses of, for example, a narcotic may be seeking the euphoria, relaxation, increased concentration to which they have hdeveloped tolerance. AFAMS Insert Dari CAMH

10. AFAMS Why are some drugs more addictive than others? (DARI) Drugs are potentially addicting in that they produce a marked difference between altered and drug-free psychic states. A drug’s addictive potential is determined by its ability to produce: –a rapid onset of action –a powerful euphoric effect –a short duration of action –tolerance and withdrawal. The more of the above features, the greater a drug’s addictive potential. Tolerance and withdrawal increase the addictive potential of a drug by making it difficult for a person to stop using it without experiencing discomfort.

11. AFAMS Under Control/ Controlled Drugs Dari The British National Formulary Groups Undercontrol/ Controlled Medications into Three Groups. AFAMS Insert Dari

12. AFAMS MoD Under Control/ Controlled Drugs (Dari) AFAMS Insert Dari

13. AFAMS MoD Under Control/ Controlled Drugs (Dari) AFAMS Insert Dari Commonly Used

14. AFAMS Hint to Help Indentify (Dari) AFAMS Insert Dari End in “pam or lam”

15. AFAMS Hint to Help Indentify (Dari) AFAMS Insert Dari From opium poppy

16. AFAMS Policies Dari OTSG Policy18 – Management of Controlled Substances MEDCOM Policy regarding Under Control Medication

17. AFAMS Review OTSG 18 Policy Dari Purpose: To provide guidance and minimum physical security standards for the safeguarding and maintenance of controlled medical substances. Puts requirements of Counter Narcotics Drug Law in place within ANA Only units authorized by OSTG G- 4 can request controlled substances from the Medical Stocks Command. Otherwise the unit must request permission from the OSTG. Orders are done on MOD 14 Forms Fix Dari هدف:دستورالعملها وکمترین استندردهای امنیتی تاسیسات را برای نگهداری و حفظ و مراقبت ادویه جات نارکوتیک طبی را فراهم مینماید.

18. AFAMS Review OTSG 18 Policy Dari Key Points: The following personnel may administer controlled substances upon the order of an authorized prescriber: 1.Professional nurses, including RNs, Practical Nurses, and Medical Technicians personnel. 2.Veterinary technicians for the treatment of animals. 3.A prescriber authorized to prescribe the substance being administered.  Pharmacy is responsible to check narcotic usage in the facility. Fix Dari 5.4 صلاحیت توزیع ادویه جات نارکوتیک: پرسئونل آتی ادویه جات نارکوتیک را نظر به حکم مقام باصلاحیت ان توزیع خواهد نمود: 1.4.5 نرسهای مسلکی، که شامل نرسهای مسجل ، معاون نرس، و پرسئونل تکنیشن صحیه میباشد. 2.4.5 تکنیشن های وترنری برای معالجه حیوانات توسط موظئف وترنری اجازه داده میشود. 3.4.5 برای تجویز کننده اجازه داده شده است که ادویه یکه توصیه شده است تجویز نمایند.

19. AFAMS Authority for access to, or possession of, controlled substances is limited to: 1.Medical Treatment Facilities: Medical, dental and veterinary personnel commissioned officers, NCOs, or ANA Civilians, if qualified to administer controlled substances while administering. 2.Medical Supply Personnel: Individuals whose duties include receipt, storage, transportation, inventory, or issue of controlled substances. (e.g Quartermaster) Fix Dari. 6.4 پرسئونل اکمالات صحیه : افرادیکه وظایف شان شامل دریافت ،ذخیره ، انتقال ، موجودی و توذیع ادویه جات نارکوتیک میباشد. 3.6.4 پرسئونل لابراطوار: افرادیکه باید ادویه جات نارکوتیک در جریان وظایف لابراطواری شان استعمال مینمایند. 4.6.4 پرسئونل خدمات دواخانه: افرادیکه وظایف انها شامل ترکیب ،توذیع ،صدور، دریافت،ذخیره، انتقال ویا موجودی ادویه جات نارکوتیک میباشد. 5.6.4 امربرها :افرادیکه توسط قومندان در جریان وظیفه شان برایشان صلاحیت داده میشود. 6.6.4 صلاحیت تجویزکننده ها : درهنگام اجرای مسئولیت های مسلکی شان. Review OTSG 18 Policy Dari

20. AFAMS Authority for access to, or possession of, controlled substances is limited to: 3.Laboratory Personnel: Individuals who are required to handle controlled substances in the course of their laboratory duties. 4.Pharmacy Service Personnel: Individuals whose duties include compounding, dispensing, issuing, receiving, storage, transportation or inventory of controlled substances. Dari Review OTSG 18 Policy Dari

21. AFAMS Authority for access to, or possession of, controlled substances is limited to: 5.Couriers: Individuals as authorized by the Commander in the course of their courier duties. 6.Authorized Prescribers: When in the course of their professional responsibilities Dari Review OTSG 18 Policy Dari

22. AFAMS Stock levels: Hospital pharmacies: 30-day stock level Units and clinics: 15-day stock level. Loss or Theft Reported with OTSG Policy Letter - 16 Serious Incident Report. Inventory shortages from Pharmacy or Logistics require serious incident reporting when theft is suspected and/or the shortage exceeds normally experienced operational losses Dari Review OTSG 18 Policy Dari

23. AFAMS Documentation: Each time a controlled substance is administered, record: –day –hour –patient’s name –initial and last name of the prescriber –signature of the individual administering the medication –amount of the substance administered –new balance recorded Dari Review OTSG 18 Policy Dari

24. AFAMS MEDCOM: Under Control Medication Dari Provides a detailed list of Under Control Medications and how they should be managed within ANA. Drafted by NMH staff for OTSG approval. Insert Dari

25. AFAMS MEDCOM: Under Control Medication Dari Key Aspects of Policy: Insert Dari

26. AFAMS MEDCOM: Under Control Medication Dari Key Aspects of Policy: Insert Dari

27. AFAMS MEDCOM: Under Control Medication Dari Key Aspects of Policy: These 8 points form the basis of how Under Control medications are ordered, received, stored, issued, and disposed of within the ANA. The processes developed from these points will be reviewed in the next couple lectures. Insert Dari

28. AFAMS Questions?

29. AFAMS Review (Dari) AFAMS

30. MoD Under Control/ Controlled Drugs (Dari) AFAMS Insert Dari

31. AFAMS MoD Under Control/ Controlled Drugs (Dari) AFAMS Insert Dari Commonly Used

32. AFAMS Hint to Help Indentify (Dari) AFAMS Insert Dari End in “pam or lam”

33. AFAMS Hint to Help Indentify (Dari) AFAMS Insert Dari From opium poppy

34. AFAMS Game (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of lectures material. Instructors will provide drug names which students must correctly identify as being Under Control/ Controlled Medications. Instructor will provide a debrief at the end of the quiz. Time estimate (including debrief): 20-30 mins Insert Dari

35. AFAMS Game

36. AFAMS End of Lecture Dari