CNS Depressant Poisoning/Overdose

Question 1

Progressive doses of naloxone are given in ___ minute intervals

Answer 1

3

Question 2

When administering naloxone, titrating IV dose _____ (range) mg to target re-establishing respiration, circulation and airway control is often safer than giving higher doses initially

Answer 2

0.1-0.4

Question 3

Naloxone dosing for pediatric patients is ___ mg/kg to a maximum of ___ mg

Answer 3

0.1 mg/kg to a maximum of 0.4mg

note that any child with a mass of 4kg (8.8lb) or greater will receive the full 0.4mg dose of naloxone. Cases where titrated doses for pediatric patients occur (i.e. non-neonatal patients with a mass less than 4kg) will be exceedingly rare

Question 4

The maximum total dose of naloxone to be given in the pediatric population is ___mg

Answer 4

2.0mg

Question 5

The maximum total dose of naloxone to be given in the adult population is ___mg

Answer 5

0.4 + 0.4 + 0.8 + 2.0 = 3.6mg

individual doses to be given at 3 minute intervals

Question 6

The maximum volume of medication to be injected into the vastus lateralis muscle is ___ mL

Answer 6

2.0

Question 7

Adverse effects of naloxone administration may include: (5 total)

Answer 7

• Reversal of narcotic effect and combativeness
• Signs and symptoms of severe drug withdrawal
• Hypotension, hypertension
• Nausea and vomiting, sweating, tachycardia
• Ventricular fibrillation, asystole

Question 8

Dosing recommendations are _____ (the same / different) for IV and IM naloxone administration

Answer 8

The same

Question 9

_____ antidepressants are a common cause of CNS depressant overdose which is time critical and may require treatment with sodium bicarbonate or midazolam.

Answer 9

TriCyclic (TCA)

TCA overdoses may be best managed by ACP/CCP practitioners if these resources are available in a timely fashion

Question 10

_____ is a CNS depressant which may cause a characteristic presentation of rapidly fluctuating states from combative to unresponsive with respiratory depression

Answer 10

GHB

Question 11

For the purposes of naloxone administration, pediatric patients are considered to be ___ years old (age range)

Answer 11

<12

Question 12

Naloxone is _____ (often / rarely) not required in opioid overdose

Answer 12

often

Naloxone should only be given if the respiratory rate is depressed (<10/min) and there is altered LOC not responding to stimulation

Question 13

The maximum dose of naloxone to be delivered in a single push by PCP-level practitioners is ___ mg

Answer 13

2.0

Doses of this quantity are delivered as the last part of a progressive and staged dosing approach (0.4,0.4,0.8,2.0mg) or as an initial dose in cardiac arrest with suspected opioid overdose

Question 14

Contraindications for naloxone administration are __________ and __________

Answer 14

Allergy or known hypersensitivity to naloxone and neonatal patients

Question 15

Naloxone should initially delivered ___ (route) to provide a smoother emergence

Answer 15

IM/SC

Question 16

What level of license is required to administer a 5th dose of 4mg naloxone or a 6th dose of 10mg naloxone with clinicall consult?

Answer 16

ACP/CCP

Question 17

The goals of care in CNS depressant overdose are primary airway management, adequate oxygenation, and __________

Answer 17

support of ventilation and transport

note that naloxone administration is not a goal of care and should instead be considered an adjunct to the primary goals of care

Question 18

Naloxone administration _____ (is / is not) contraindicated in neonates

Answer 18

is

Question 19

The dosing progression for naloxone in suspected opioid overdose is ___, ___, ___, and then ___ (doses in mg)

Answer 19

0.4, 0.4, 0.8, 2.0

Question 20

The goals of care in CNS depressant overdose are primary airway management, __________, and support of ventilation and transport.

Answer 20

adequate oxygenation

note that naloxone administration is not a goal of care and should instead be considered an adjunct to the primary goals of care

Question 21

The preferred initial route and dose for naloxone administration in cardiac arrest with a suspected etiology of opioid overdose is __________

Answer 21

2.0mg IV

Question 22

Naloxone should only be given if the respiratory rate is _____ (range) breaths/min and there is altered LOC not responding to stimulation

Answer 22

<10

Question 23

The maximum volume of medication to be injected into the deltoid muscle is ___ mL

Answer 23

1.0

Question 24

In CNS depression with suspected opioid overdose etiology that is refractory to treatment, other correctable causes of ALOC may be considered, such as ______.

Answer 24

hypoglycemia

Question 25

The goals of care in CNS depressant overdose are __________, adequate oxygenation, and support of ventilation and transport.

Answer 25

primary airway management

note that naloxone administration is not a goal of care and should instead be considered an adjunct to the primary goals of care