Hypoglycemia and Opioid Toxicity Flashcards
What are the indications for the hypoglycemia medical directive?
Suspected hypoglycemia
What are the conditions for dextrose (hypoglycemia m.d.)
Age ≥ 2 years
LOA altered
Hypoglycemia
What are the drugs that can be administered under the hypoglycemia m.d.
Dextrose and glucagon
What are the conditions for glucagon (hypoglycemia m.d.)
LOA altered
Hypoglycemia
What are the contraindication to dextrose (hypoglycemia m.d.)
Allergy or sensitivity to dextrose
What are the contraindications to glucagon (hypoglycemia m.d.)
Allergy or sensitivity to glucagon
Pheochromocytoma
What is dextrose
It’s a liquid formula of carbohydrates
What is glucagon
It’s a hormone (made by the liver) in powder form. It stimulates the liver to move stored glycogen into glucose (glycogenolysis) to be released into the bloodstream.
Produced by pancreas
What are the values of hypoglycemia, normal, and hyperglycemia in an adult
Normal: 4-7 mmol/L
Hypoglycemia: < 4 mmol/L
Hyperglycemia: > 8-9 mmol/L
What are the values of pediatric hypoglycemia
< 2 years old: < 3 mmol/L
≥ 2 years old: < 4 mmol/L
What kind of drug is Naloxone
Non-selective and competitive opioid receptor antagonist
What kind of drug is Buprenorphine
Mixed opioid agonist-antagonist
What is the treatment of dextrose (hypoglycemia m.d.)
D10W
- Dose: 0.2g/kg (2mL/kg)
- Max single dose: 25 g (250mL)
- Dosing interval: 10 minutes
- Max # of doses: 2
D50W
- Dose: 0.5g/kg (1mL/kg)
- Max single dose: 25 g (50 mL)
- Dosing interval: 10 minutes
Max # of doses: 2
What is the treatment for glucagon (hypoglycemia m.d.) for a patient <25 kg
Route: IM
Dose: 0.5 mg
Max single dose: 0.5 mg
Dosing interval: 20 minutes
Max # of doses: 2
What is the treatment of glucagon (hypoglycemia m.d.) for a patient ≥ 25 kg
Route: IM
Dose: 1mg
Max single dose: 1mg
Dosing interval: 20 minutes
Max # of doses: 2
What are the indications for the opioid toxicity and withdrawal medical directive?
Suspected opioid toxicity
What are the conditions for naloxone? (opioid tox. m.d.)
Age: ≥ 24 hours
LOA: altered
RR: <10 breaths/min
Other: Inability to adequately ventilate OR persistent need to assist ventilations
What are the conditions to buprenorphine (opioid tox. m.d.)
Age: ≥ 16 years
LOA: unaltered
Other: Received naloxone for current opioid toxicity episode AND patient is exhibiting acute withdrawal with a COWS score ≥ 8
What are the 11 categories of the COWS scale (opioid tox. m.d.)
Resting pulse rate
Sweating
Restlessness
Pupil size
Bone of Joint aches
Runny nose or tearing
GI upset
Tremor
Yawning
Anxiety or iterability
Gooseflesh skin
What are the contraindication to naloxone (opioid tox. m.d.)
Allergy or sensitivity to naloxone
What are the contraindication to buprenorphine
Allergy or sensitivity to buprenorphine
Taken methadone in the past 72 hours
What’s the treatment for naloxone (opioid tox. m.d.)
IV
Dose: up to 0.4mg
Max single dose: 0.4 mg
Dosing interval: 5 mins
Max # of doses: 3
IM
Dose: 0.4 mg
Max single dose: 0.4 mg
Dosing interval: 5 min
Max # of doses: 3
IN
Dose: 2-4mg
Max single dose: 2-4 mg
Dosing interval 5 minutes
Max # of doses: 3
SC
Dose: 0.8 mg
Max single dose: 0.8 mg
Dosing interval: 5 minutes
Max # of doses: 3
What is the treatment for buprenorphine (opioid tox. m.d.)
Route: PO
Initial dose: 16 mg
Subsequent dose: 8 mg
Dosing interval: 10 minutes
Max cumulative dose: 24 mg
What are the s/s of hypoglycemia
- Rapid radial pulse
- shaky
- Confused
- Irritable
- Sweaty
What does COWS stand for
Clinical Opiate Withdrawal Scale
Why is methadone a contraindication for buprenorphine/naloxone
- It has an agonist effect
- Long half life
- If mixed it can cause an OD
Why don’t we give glucagon to someone with a pheochromocytoma?
- It will cause a sympathetic response.
- It will increase HR, RR, BP, BGL, and contractility of the heart
Over how many minutes should you gradually administer dextrose IV?
Gradually over 3 minutes
