Opioid OD

Question 1

Opioid receptors

Answer 1

Mu, delta, kappa

Question 2

Mu receptor effects

Answer 2

central pain analgesia, respiratory depression

Question 3

Kappa receptor effects

Answer 3

Spinal analgesia, miosis

Question 4

Delta receptor effects

Answer 4

central and spinal analgesia, cough suppression

Question 5

Opioid toxidrome presentation

Answer 5

Decreased mental status, pinpoint pupils, decreased bowel sounds, depressed respiration

Question 6

Opioid OD management

Answer 6

Protect the airway and administer Naloxone

Question 7

If someone is going to die from an opioid OD, what’s it going to be from?

Answer 7

They’re going to lose respiration and the ability to oxygenate themselves

Question 8

Do you need to intubate someone with an opioid OD?

Answer 8

Not all the time; depends on if they respond well to Naloxone

Basically: don’t intubate someone if you don’t have to

Question 9

When should you administer Naloxone?

Answer 9

ASAP

Question 10

Naloxone MoA

Answer 10

opioid ANTAGONIST

Question 11

Formulations of Naloxone

Answer 11

IV, IN (IM used to be a thing before it got D/C’ed)

Question 12

Onset of action of IV vs. IN Nalxone

Answer 12

IV starts working immediately, IN takes about 6-10 minutes to work

Question 13

Non-opioid dependent Naloxone dosing

Answer 13

0.4mg IV

Question 14

Opioid-dependent Naloxone dosing

Answer 14

0.04mg IV, titrate to effect by doubling the dose

Question 15

Goal of getting an opioid-dependent patient out of an OD

Answer 15

Don’t reverse it immediately, get them slowly out of the OD so they can start breathing on their own but not to the extent where they may become combative and agitated

Question 16

Patients are more likely to exhibit withdrawal signs and symptoms with _____ doses of naloxone

Answer 16

higher

Question 17

Bystanders naloxone dosing

Answer 17

4mg IN

Question 18

Continuous infusion of naloxone dose

Answer 18

1/2 the initial bolus dose, followed by 2/3 of the new bolus dose per hour

Question 19

Duration of action of naloxone vs. other opioids

Answer 19

The duration of action of the opioid may extend beyond the duration of action of naloxone

Question 20

What to do if the duration of action of the opioid extends beyond naloxone’s duration of action

Answer 20

decrease naloxone and/or consider a continuous IV infusion if this is the case

Question 21

Opioid with the longest duration of action compared to naloxone

Answer 21

Methadone

Question 22

Opioid with the same duration of action compared to naloxone

Answer 22

Heroin

Question 23

ADEs of naloxone

Answer 23

runny nose, flash pulmonary edema, acute precipitated withdrawal with high doses

Question 24

Proposed mechanism of naloxone-induced pulmonary edema

Answer 24

Adrenergic response, catecholamine surge → tachycardia, tachypnea, HTN

Shift in blood volume into the pulmonary vasculature → pulmonary vasoconstriction, pulmonary HTN, fluid leakage into lungs

Question 25

Treatment of naloxone-induced pulmonary edema

Answer 25

Diuretics

Question 26

Prevention of naloxone-induced pulmonary edema

Answer 26

smaller initial doses of naloxone

Question 27

Loperamide MoA

Answer 27

Inhibits intestinal peristalsis through mu-receptor agonism

Question 28

Loperamide toxidrome and clinical presentation

Answer 28

Has the opioid toxidrome, may have severe cardiac arrhythmias

Question 29

Loperamide and the BBB

Answer 29

Large doses will break into the BBB and stay there

Question 30

Loperamide and P-glycoprotein

Answer 30

Usually, p-glycoprotein will shunt loperamide out of the BBB, but in an OD, it will be overcome and can’t work as efficiently

Question 31

Normal loperamide dose

Answer 31

2-4mg PRN, MDD 16mg

Question 32

Loperamide toxicity dose

Answer 32

30-200mg+

Question 33

Management of loperamide toxicity: respiratory depression

Answer 33

Naloxone

Question 34

Management of loperamide toxicity: cardiac disturbances

Answer 34

IV Mg, sodium bicarb, IV isoproterenol, transcutaneous pacing

Question 35

Management of loperamide toxicity: non-pharm treatment

Answer 35

CPR, ALS