Opioid Excess (Learning Hub) Flashcards
What are risk factors for opioid excess in palliative care patients.
- older age and frailty
- neuromuscular disease
- neurological disease
- COPD
- liver or renal disease
- morbid obesity
- sleep apnea or snoring
- metabolic abnormalities
- infection or sepsis
- polypharmacy
Define “opioid naive.”
someone who hasn’t received the equivalent of 60 mg of PO morphone equivalents for at least 7 continuous days
What are the different scores of POSS?
- S: sleep, easy to rouse
- 1: awake and alert
- 2: slight drowsy, easily roused
- 3: frequently drowsy, rousable, drifts off to sleep in conversation
- 4: somnolent, minimal or no response to stimuli
What is opioid excess? How do we assess for it?
- progression sedation happens before respiratory depression (higher doses of opioids are required to cause significant respiratory depression)
- pinpoint pupils are not a reliable indication (if someone if hypozemic or hypercarbin, pupils may be dilated)
What is the recommended starting dose for an opioid naive patient (who is not in crisis)?
5 - 10 mg morphine Q4H
reduce by 50% for older adults
What are the different interventions for managing a patient in opioid excess.
POSS 1 or 2, RR >10: no intervention needed
POSS 1 or 2, RR<10: discuss with MRP
POSS 3 or 4, RR 7 - 10: contact MRP, hold next opioid dose, continue to monitor POSS and RR (q2-5min)
POSS 3 or 4, RR<6 or RR 7-10 + SpO2<90%: contact MRP, hold opioids, give naloxone per orders/protocol
What is the recommended starting dose for an opioid naive patient (who is not in crisis)?
5 - 10 mg morphine Q4H
(reduce by 50% for older adults)
*may see Q6H for patients with reduced kidney function (because metabolites may accumulate)
What is the goal of naloxone administration in the context of patients receiving opioids?
- establish adequate ventillation (RR>12)
- avoid precipitating withdrawal or pain crisis
- NOT intended to reverse all sedation effects
