opioid OD

Question 1

def opiate OD

Answer 1

An opioid is any synthetic or natural agent that stimulates opioid receptors and produces opium-like effects. Opiates are opioids naturally derived from the opium poppy, Papaver somniferum, and include morphine and codeine.

An overdose occurs when larger quantities than physically tolerated are taken, resulting in central nervous system and respiratory depression, miosis, and apnea, which can be fatal if not treated rapidly.

Question 2

RF for opiate OD

Answer 2

opioid abuse and dependence

recent abstinence in chronic users

chronic pain

Question 3

aetiology opiate OD

Answer 3

Complications of substance abuse in regular users/abusers of illicit or prescription opioids

Unintentional overdose in patients prescribed opioids for pain by taking larger amounts than tolerated

Intentional overdose and intent of self-harm (suicidality)

Therapeutic drug error; iatrogenic overdose by a practitioner unfamiliar with opioid prescribing, or an adverse drug reaction

Question 4

pathophysiology opiate OD

Answer 4

Opioids are used in the treatment of pain. They reduce the patient’s perception of pain by inhibition of synaptic neurotransmission in the central nervous system and peripheral nervous system by binding to opioid receptors

Opioids can be administered by injection, orally, insufflated, transdermally, and by smoking. Injection is the most potent route because many opioids have significant first-pass hepatic metabolism; most deaths occur after opioids are injected.

Tolerance occurs rapidly with opioids, but in overdose, patients usually succumb to respiratory failure.

• Mu receptors cause a medullary decrease response to hypercarbia and a decrease in respiratory response to hypoxia, resulting in no stimulus to breathe and apnea
• Tolerance to loss of hypercarbic drive may take longer to develop than other euphoric effects, but opioid-tolerant patients never develop complete tolerance to loss of hypoxic stimulus, which leaves these patients particularly susceptible to death from overdose.

Question 5

epi opiate O D

Answer 5

Opioid abuse and overdose is a growing problem worldwide.

The sharp increase in prescription opioid overdoses since the late 1990s may be due in part to more aggressive pain management strategies

Recent abstinence, resulting in loss of tolerance (such as during incarceration), increases the risk of overdose. Because of this, drug overdose is the most common cause of death of former inmates after prison release; the risk of death in the 2 weeks after release is 12 times that of the general population

Question 6

sx opiate OD

Answer 6

history of opioid abuse and dependence

miosis

altered mental status

Question 7

signs opiate OD

Answer 7

• miosis
• bradypnea
• altered mental status
• dramatic response to naloxone
• needle marks
• drug paraphernalia nearby
• decreased GI motility
• old track marks

Question 8

ix opiate OD

Answer 8

therapeutic trial of naloxone - reversal of OD signs

ECG = abnormal ECG (e.g., QRS prolongation or signs of myocardial ischemia)

ABG - resp acidosis