Opiate Overdose

Question 1

What is Opiate overdose?

Answer 1

Opiate OD occurs when larger quantities than physically tolerated are taken, resulting in CNS + respiratory depression, miosis, + apnoea, which can be fatal if not treated rapidly

Question 2

List 7 drugs that contain opiodes

Answer 2

Codeine  
Dihydrocodeine 
Tramadol
Morphine
Diamorphine  
Methadone  
Fentanyl

Question 3

List 3 risk factors for opiate overdose

Answer 3

Mental health conditions
Alcoholics
Morphine toxicity at a lower dose

Question 4

Describe the epidemiology of opiate overdose

Answer 4

ELDERLY are at greater risk as are more likely to be on opiates
Heroin + morphine are responsible for most drug-related deaths

Question 5

List 5 symptoms of opiate overdose

Answer 5

N+V
Craving the next dose  
Drowsiness (if acute overdose)  
Loss of appetite  
Constipation (if chronic)

Question 6

List 8 signs of opiate overdose

Answer 6

Hypotension
Tachycardia  
Pinpoint pupils (miosis) 
Decreased BS  
Sedation 
Urticarial like rash with itching 
Respiratory depression  
Resp acidosis as retaining CO2

Question 7

What investigations should be performed in suspected opiate overdose?

Answer 7

Toxicology screen
Paracetamol blood level (in pts who have self-poisoned)
If in doubt, give a small test dose of naloxone
ABG
FBC

Question 8

What is the treatment for opiate overdose?

Answer 8

Naloxone 400mg

Question 9

List 5 conditions that cause morphine toxicity at a lower dose

Answer 9

Hepatic impairment 
Renal impairment 
Hypotension 
Hypothyroidism 
Asthma (decreased respiratory reserve)

Question 10

Why does impaired renal function cause morphine toxicity at a lower dose?

Answer 10

Excreted renally so impaired renal function will build up metabolite

Question 11

Differentiate between the terms opiate and opiode

Answer 11

Opiate: all natural opioids e.g. heroin, morphine+ codeine.
Opioids: all natural, semisynthetic, + synthetic opioids.