Naloxone Hydrochloride

Question 1

Drug code for Naloxone Hydrochloride?

Answer 1

NLX

Question 2

Presentation of Naloxone Hydrochloride?

Answer 2

Naloxone Hydrochloride 400 micrograms per 1ml ampoule

Question 3

Indications for use of Naloxone Hydrochloride?

Answer 3

The reversal of acute opioid or opiate toxicity for respiratory arrest or respiratory depression.
Unconsciousness, associated with respiratory depression of unknown cause, where opioid overdose is a possibility.
In cardiac arrest, where opioid toxicity is considered to be the likely cause
Patients exposed to high-potency veterinary or anaesthetic preparations should be given naloxone urgently if consciousness is impaired or exposure occurred within the last 10 minutes, even if asymptomatic
If antidote is supplied with the opioid medication

Question 4

Actions of Naloxone Hydrochloride?

Answer 4

Complete or partial reversal of the respiratory depression effects of opioid drugs
The aim of Naloxone administration is to restore adequate respirations but not necessarily to restore full consciousness

Question 5

Contra-indications of Naloxone Hydrochloride?

Answer 5

Neonates born to opioid addicted mothers can result in serious withdrawal effects
Emphasis should be on bag-valve-mask ventilation and oxygenation

Question 6

Side effects of Naloxone Hydrochloride when given to a patient with a physical dependency to opioids?

Answer 6

In patients who are physically dependent on opioids, naloxone may precipitate violent withdrawal symptoms, including cardiac arrhythmias

Question 7

In cases where a patient needs to be administered Naloxone Hydrochloride but they are physically dependent on opioids, what would you do?

Answer 7

Titrate the dose of naloxone to effectively reverse the cardiac and respiratory depression, but still leave the patient in a ‘groggy’ state with regular reassessment of ventilation and circulation

Question 8

Common side effect of Naloxone Hydrochloride administration?

Answer 8

Vomiting, ensure access to suction is available as a precaution

Question 9

What administration would be required when giving Naloxone Hydrochloride to very ill patients?

Answer 9

Intravenous

To ensure rapid absorption of the total dose

Question 10

Possible routes of administration of Naloxone Hydrochloride?

Answer 10

Intravenous 
Intramuscular 
Intraosseous
Subcutaneous
Intranasal

Question 11

Additional information when administering Naloxone Hydrochloride IM?

Answer 11

The drug should be undiluted
Injected into the outer aspect of the thigh or upper arm
Absorption may be unpredictable

Question 12

True or False? Explain why

‘All cases of opioid overdose should be transported to hospital, even if the initial response to naloxone has been good’

Answer 12

True
The duration of action of naloxone is usually 30 to 90 minutes and this is shorter than some opioids such as methadone; therefore additional doses of naloxone may be necessary to maintain reversal of opioid influenced respiratory depression.

Question 13

How many hours does a patient require observation following methadone ingestion?

Answer 13

8 hours

To prevent accidental death

Question 14

If a patient refuses to go to hospital following methadone overdose what is the course of treatment?

Answer 14

A loading dose of 800 micrograms naloxone IM to minimise the risk of death, but only if the patient consents
Leave in the care of a responsible adult, if possible, and leave an advice leaflet advising of action to be taken in the event the symptoms return.

Question 15

True or False? Explain why

‘Some patients at risk of opiate misuse (or their carers) may be given naloxone to take home’

Answer 15

True

As a harm-reduction measure

Question 16

Explain the difference in doses between adults and children, not considering body weight when treating an opioid overdose?

Answer 16

Reflects the likely aetiology of the opiate ingestion and aims of treatment
In children under 12, the aetiology is likely to be accidental ingestion and they are unlikely to be dependent on opiates so the aim is to totally reverse the opiate

Question 17

When is the likely scenario a child under the age of 12 might be dependent on opiates?

Answer 17

If they are an end of life care patient

Question 18

What should you do if you feel a child under the age of 12 might require additional doses of naloxone following opioid overdose?

Answer 18

They MUST be reviewed by a senior healthcare professional

Seen senior clinical advice

Question 19

What precautions should be taken when administering naloxone to reverse opiate overdose in adults?

Answer 19

Adults are more likely to be dependent opiate users
They may become aggressive if the opiate is reversed
Therefore a controlled reversal technique should be used

Question 20

What is methadone?

Answer 20

A long-acting synthetic opioid that Is used in opioid harm reduction and substance misuse programs
Methadone has an elimination half-life of between 15 and 60 hours, in contrast to the shorter-acting naloxone which has a half life of 1 to 1.5 hours

Question 21

The use of naloxone is palliative care is not routinely practised, why?

Answer 21

Patients in end of life care on regular opioids can be physically dependant.

Question 22

When would naloxone be used in palliative care patients?

Answer 22

It is only indicated in circumstances where a clinician suspects opioid induced toxicity, from either intentional or unintentional overdose.
The aim is to reverse life-threatening respiratory depression only i.e. if the respiratory rate is <8 breaths per minute and the patient is unconscious and or cyanosed.

Question 23

What is meant by the term cyanosis?

Answer 23

refers to a bluish cast to the skin and mucous membranes
Peripheral cyanosis is when there is a bluish discloration to your hands or feet
It’s usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood to your body.