Opioid OD Flashcards
Opioid receptors
Mu, delta, kappa
Mu receptor effects
central pain analgesia, respiratory depression
Kappa receptor effects
Spinal analgesia, miosis
Delta receptor effects
central and spinal analgesia, cough suppression
Opioid toxidrome presentation
Decreased mental status, pinpoint pupils, decreased bowel sounds, depressed respiration
Opioid OD management
Protect the airway and administer Naloxone
If someone is going to die from an opioid OD, what’s it going to be from?
They’re going to lose respiration and the ability to oxygenate themselves
Do you need to intubate someone with an opioid OD?
Not all the time; depends on if they respond well to Naloxone
Basically: don’t intubate someone if you don’t have to
When should you administer Naloxone?
ASAP
Naloxone MoA
opioid ANTAGONIST
Formulations of Naloxone
IV, IN (IM used to be a thing before it got D/C’ed)
Onset of action of IV vs. IN Nalxone
IV starts working immediately, IN takes about 6-10 minutes to work
Non-opioid dependent Naloxone dosing
0.4mg IV
Opioid-dependent Naloxone dosing
0.04mg IV, titrate to effect by doubling the dose
Goal of getting an opioid-dependent patient out of an OD
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
Patients are more likely to exhibit withdrawal signs and symptoms with _____ doses of naloxone
higher
Bystanders naloxone dosing
4mg IN
Continuous infusion of naloxone dose
1/2 the initial bolus dose, followed by 2/3 of the new bolus dose per hour
Duration of action of naloxone vs. other opioids
The duration of action of the opioid may extend beyond the duration of action of naloxone
What to do if the duration of action of the opioid extends beyond naloxone’s duration of action
decrease naloxone and/or consider a continuous IV infusion if this is the case
Opioid with the longest duration of action compared to naloxone
Methadone
Opioid with the same duration of action compared to naloxone
Heroin
ADEs of naloxone
runny nose, flash pulmonary edema, acute precipitated withdrawal with high doses
Proposed mechanism of naloxone-induced pulmonary edema
Adrenergic response, catecholamine surge → tachycardia, tachypnea, HTN
Shift in blood volume into the pulmonary vasculature → pulmonary vasoconstriction, pulmonary HTN, fluid leakage into lungs
