Naloxone Flashcards
Common Risks for Opioid Overdose
- Opioid Dose and Changes in Purity
- Previous Overdose
- Substance Use Disorder History
- Social Isolation
- Chronic Medical Illness (lung/liver/kidney)
- Recent Abstinence
- Mixing Substances/ Polypharmacy
911 Good Samaritan Laws
• Like CPR-based Good Sam Laws
• Protect caller, bystanders, and victim from arrest for drug charges when 911 is called in event of overdose
• Meant to minimize fear of police when calling 911
• CA law went into effect January 1, 2013
• Does not provide immunity against:
- sales or distribution
- forcibly administering a drug against a person’s will
- DUI or drugged driving
Response Strategies: Overdose Education and Naloxone Distribution Programs
- AB 635 CA Overdose Treatment Act: effective January 1, 2014
- Non-med personnel are able to distribute naloxone (w. doctor’s standing orders)
- Encouraged to prescribe naloxone to patients on chronic opioid pain meds
- Provides protection to healthcare professionals from civil/criminal liability
- Permits individuals to possess/administer naloxone in an emergency + protects responder from civil or criminal prosecution
Pharmacists and Naloxone
• 2013 AB 1535 (Bloom) – Effective 2015
• Amended pharmacy practice act to authorize pharmacists to furnish naloxone
- 1 hour CE
- Education of recipient
- Referral and drug treatment information
• Screen the potential recipient: - any hx of opioid use or contact with someone who does? rxn to naloxone? • Provide recipient training - opioid overdose prevention, recognition, response / naloxone administration • Appropriate medication counseling - MAY NOT WAIVE • Resources/referrals on drug treatment • Answer any questions on naloxone
Naloxone: Onset, Peak, Duration
Onset: Depends on route
• IN = 3-5min
• IM = 6 min., if pt not responding repeat 2nd dose
- Peak effect: 15 – 20 minutes
- Duration: 20 – 90 minutes
- Oxycodone IR: 4 hours
- Oxycodone ER: 12 – 24 hours
- Morphine: 4 hours
- Fentanyl oral: 1 – 2 hours
- Fentanyl transdermal: 72 hours
Naloxone Safety and Tolerability
- Works at the opioid receptor site to displace the opioid
- Show little to no effect in pt with no opioids in their system
- Naloxone does not produce tolerance or lead to dependence
- Naloxone adverse events/hypersensitivity are extremely rare
- They are most likely related to hypoxic brain injury caused by the overdose of opioids (seizures) or withdrawal symptoms
Naloxone Safety: Pregnancy
• Induce withdrawal sx in opioid-dependent pregnant patients
- Risk of inducing premature labor and fetal distress-crosses the placenta, evaluate the fetus for signs of withdrawal and distress after naloxone is used
- Animal studies show no teratogenicity
- Opioid overdose threatens lives of mother and fetus, do not hesitate to treat!
• Unknown if excreted in breast-milk
- Not bioavailable if ingested
Opioid Withdrawal Symptoms
• Can induce withdrawal symptoms (common)
- Agitation/aggression
- Flu-like symptoms
- Nausea & vomiting (aspiration risk)
- Sweating
- Confusion/Anxiety
- Cravings
• Rare Adverse Effects
- Seizures
- Pulmonary edema (sympathetic surge)
- Arrhythmias
When Giving Nalaxone
- Any FDA-approved formulation, may provide in advance, may refill
- Labeling must follow law (include expiration)
- Provide BoP fact sheet
- Notify pt/recipient and PCP (w. consent)
- Documentation (med record for 3 yrs)
Step1: Intoxicated or Overdose?
Intoxication
- Miosis (small pupils)
- Drowsiness, but arousable/breathing
- Slurred speech
- STIMULATE AND OBSERVE
Overdose
- Miosis
- Not arousable or speaking
- Slow breathing / stopped (<8b/min)
- GIVE NALOXONE AND CHEST COMPRESSIONS AND BREATHS
- After: call 911, say someone is unresponsive and not breathing, with clear address
Rescue Breathing + Stay Until Help Arrives
- Perform anytime during rescue
- Make sure there are no airway obstructions
- Open airway by tilting head back and pinch nose closed
- Administer 2 slow rescue breaths into mouth
- Continue 1 breath every 5 seconds
- If unresponsive after 3 minutes repeat 2nd dose of naloxone
- Do not leave person alone after giving naloxone
- Ensure they do not take any more opioids
Intranasal Kits and Narcan Nasal Spray
Intranasal Kits
- 2 naloxone 1mg/1ml (2ml) prefilled needless syringes
- 2 atomizers
- Step-by-step instructions on fact sheet
- Sig: Call 911. Attach white cone. Spray
1⁄2 of syringe into each nostril upon signs of opioid overdose. May repeat in 3 min. x 1 if patient not breathing.
Narcan Nasal Spray
- Sig: Call 911.
- Administer a single intranasally into one nostril for opioid overdose.
- May repeat in 3 min. if patient is not breathing.
Adv. and Dis. of Nasal Routes
Advantages of nasal spray: • ↓risk of needle stick injury • ↓risk of blood-borne pathogen transmission • Easy access to nasal passages • Narcan NS already assembled
Disadvantages of nasal spray:
• May have ↓ bioavailability
• Slightly ↓ responder rate
• Nasal abnormalities and prior intranasal drug use may ↓effectiveness
Intramuscular Naloxone and Syringe
Intramuscular Naloxone
- Sig: Call 911. Inject 1 ml into upper arm or thigh muscle. May repeat after 3 min. x 1 if patient not breathing.
Syringe
- Sig: Use to withdraw naloxone from vial
and inject 1ml for opioid overdose. Use a new syringe for each dose.
Adv. and Dis. of Injectables
Advantages:
• Formulation is manufactured for route
• Paid for by most insurances
Disadvantages of Injectable:
• Risk of blood-borne pathogen transmission
• Risk of needle stick injuries & injury from improper injection technique
• Requires competence in technique
• Requires adequate muscle mass
