Noloxone Flashcards
What classification is Naloxone under?
Narcotic antagonist
Explain the pharmacodynamics of Naloxone
- Reverses the effects of opioids including respiratory depression, sedation, hypotension
- Antagonizes the opioid effects by competing for the same receptor sites, especially the opioid mu receptor
- Also shown to all three opioid receptors (mu, kappa and gamma) with the strongest binding to the mu receptor
What is the onset timing for IM Naloxone?
3-5 Minutes
What is the onset timing for IV Naloxone?
1 Minute
What is the peak timing for Naloxone
Unknown
What is the duration for Naloxone
45 Minutes
What are the indications for Naloxone?
To reverse respiratory depression/depressed mental status secondary to actual or suspected narcotic use.
What are the contraindications for Naloxone?
Allergy or known hypersensitivity to naloxone
List the precautions for Naloxone
- Be prepared for patient combativeness
- In the chronic narcotic abuser, may precipitate withdrawal symptoms
- Miscarriage or premature labour
- Very short half life; monitor patient closely and prepare to re-dose if deterioration occurs
List the adverse effects for Naloxone
- Reversal of narcotic effect and combativeness
- Signs and symptoms of severe drug withdrawal
- Hypotension, hypertension
- Nausea and vomiting, sweating, tachycardia
- Ventricular fibrillation, asystole
List Examples of Narcotics
- Codeine
- Demerol
- Diphenoxylate (Lomotil)
- Heroin
- Hydrocodone (Vicodin)
- Hydromorphone (Dilaudid)
- Methadone
- Meperidine (Demerol)
- Morphine
- Oxycodone (Percocet or Oxycontin)
- Oxymorphone (Numorphan)
- Propoxyphene (Darvon)
- Pentazocine (Talwin).
What is the Naloxone dosing for adult PTs?
1st dose: 0.4 mg
2nd dose: 0.4 mg (after 3 mins if needed)
3rd dose: 0.8 mg (after 3 mins if needed)
4th dose: 2 mg (after 3 mins if needed)
What is the Naloxone dosing for pediatric PTs?
0.1 mg/kg (max 2 mg/dose)
Maximum total of 2 mg/dose
Repeat q3 mins as needed to reverse respiratory depression.
Higher dose prescribed as pediatric patients are unlikely to experience withdrawal
Never give to neonates
How should an narcotic induced cardiac arrest be handled?
Focus on high-performance CPR, ventilation and defibrillation
May consider 2 mg IM or IV (IV preferable) with the possibility that the patient is not in cardiac arrest
What is a possibility for 1% of PTs who receive Naloxone?
- Status seizures
- Asystole
It is further hypothesized that these episodes may be related to an acute withdrawal syndrome associated with reversal of opioid-induced epinephrine blockade rather than to a direct intrinsic effect of Naloxone.
