Opioid Overdose Flashcards
What is the Substance Use From a Continuum of
Use Perspective
Situating substance use on a continuum of use allows for
a broader understanding of a wider range of substance
use across populations.
Knowing the severity of substance use enables the
health care team to work with the patient.
Pathway of Neurophysiology of Substances of
Misuse
Substances of misuse are psychoactive in nature.
Substances with a higher index of use engage the
brain reward system more intensely and quickly
creates substance use disorder
How do drugs work on the Brain reward system
: Most addictive
substances appear to increase the
availability of dopamine in the “pleasure”
area of the mesolimbic system of the brain
Psychoactive substances increase the
activity of the reward pathway by
increasing the neurochemical dopamine in
the synaptic cleft.
What are the attitudes towards people experiencing substance use-related issues
Stigma and prejudice are affected by
the media, misinformation, and
misconceptions.
What is the Harm-Reduction Perspective
Focuses on reducing or preventing the harms on a
continuum of use rather than on abstinence.
Harm reduction includes policies, programs, and
practices with the aim of reducing the harms associated
with substances in persons unable or unwilling to stop
use.
Health Complications of Substance Use (3)
- The inherent properties of the
substance itself will have specific
physiological harms. - The route by which the substance is
taken will pose specific harms. - High-risk sexual behaviours, exposure
to violence and trauma, and placing
one’s personal safety at risk
The first priority in an opioid overdose
ABCs (airway, breathing, and circulation)
Is withdrawal from opioids life-threatening?
Withdrawal from opioids is not life-threatening but can cause significant
discomfort.
Classes of opoids
Opiates, Opioids, Illicit opioids
What are Opiates
Natural substances (e.g., morphine, codeine) directly
derived from opium poppy
What are Opioids?
Include opiates in addition to many semisynthetic and
synthetic agents used as analgesics eg. Hydromorphone
What are Illicit opioids
eg Heroin and fentanyl; intravenous use of controlled-release oxycodone
Effects of opoids
Primary effects include
Euphoria
Analgesia
Drowsiness
Slurred speech
Decreased respiratory rate
Gastrointestinal (GI) peristalsis
Decreased pupil size
signs of opioid overdose
Pinpoint pupils
Clammy skin
Depressed respiration
Level of consciousness (may lead to coma or death)
Nursing Management of Opiod
Overdose
ABCs are the top priority – respiratory depression can lead
to hypoxia, coma, and death if not treated promptly
Check airways for obstructions, listen to breath sounds,
pattern of breathing, chest wall expansion, accessory muscle
use
Check pulses – assess for strength, rhythm, regularity
Assess for cyanosis, cap refill, ECG rhythm
Continuous vital sign monitoring
Blood pressure, respirations, heart rate, O2 saturation
Resuscitation measures if the patient’s condition
deteriorates
CPR and defibrillation
opioid overdose and blood glucose
Always check CBG
Opioid overdose can cause hypoglycemia
Patient may be transfused with a solution containing
dextrose (i.e. D50W)
The link is confusing, apparently, this is a new thing; here’s a study about it
https://www.nursingcenter.com/cearticle?an=01261775-202304000-00003&Journal_ID=646631&Issue_ID=6650341
Naloxene (Narcan)
Opioid Antagonist, antidote;
Used to treat overdose/opioid induced respiratory depression
Competes with opioids at opioid receptor sites
Naloxene (Narcan) Pharmacodynamics: For IV administration
Onset 1 minute
Peak- unknown
Duration 45 minutes
Half life of 1 hr. up to 3 hr. neonates
Nursing considerations for Naloxene (Narcan)
Assess for signs of opioid withdrawal in drug dependent persons:
Cramping, hypertension, vomiting; may occur up to 2 hr. after
administration
Opioid withdrawal symptoms
craving, abdominal cramps, diarrhea,
tremors, chills, overall body aches, sleep disturbances, anxiety,
nausea, and vomiting
Complications of prolonged opioid use
Opioid-induced constipation, bowel obstruction
Increased risk of hepatitis C or other blood-borne illness related to
method of use (i.e., injection)
Interprofessional care for opioid users
Long-term treatment approach
Psychosocial interventions plus pharmacotherapy
Opioid agonist therapy (methadone)
Withdrawal management
What is Methadone, why is it used
It is a synthetic opioid agonist
methadone has several advantages in the treatment of opioid use disorder:
Opioid Replacement Therapy: Methadone is often used as a long-acting opioid replacement therapy. It helps to reduce cravings and withdrawal symptoms without causing the intense euphoria associated with other opioids
Reduction of Illicit Drug Use: By providing a controlled and regulated dose of methadone, it can reduce the use of illicit opioids and associated health risks, including the risk of overdose.
Harm Reduction: Methadone maintenance programs are considered a harm reduction strategy. They aim to minimize the negative consequences associated with opioid use, such as the spread of infectious diseases (e.g., HIV, hepatitis C) through the sharing of needles.
Avoid using other sedating substances such as alcohol and
benzodiazepines
Buprenorphine
There are similar reasons for use with methadone
Less sedating than methadone
Available as sublingual tab
Lower risk of overdose than methadone
When is a nurse “Incapacity”
1. the member must have a physical or mental condition and
2. the condition must warrant that the member not be
permitted to practice, or that her or his practice be restricted
Most commonly arises when a member is affected by a mental health or
addiction disorder
CNO expects a facility operator to make a report only when a
current health condition is accompanied by concerns
