Opioid Toxicology

Question 1

Important question to ask while taking history

Answer 1

• What substances did the patient have access to?
• What prescribed medications are available in the house? or illegal drug/peraphernalia
• When was the patients “last seen norma;” time?
• What were the initial signs and symptoms and have they changed at all?

Question 2

Considerations in Opioid emergency

Answer 2

Alcohol/Acidosis
Epilepsy
Infection
Overdose
Under dose
Trauma
Insulin
Psychosis
Stroke/sepsis

Question 3

Basic approach (first before meds) in opioid emergency

Answer 3

• Supportive care
• Airway considerations
• Breathing (depressed)
• Circulation

Question 4

Opioid Triad

Answer 4

• ALOC
• Respiratory depression
• Pin point pupils (miosis)

Question 5

Classification of Naloxone

Answer 5

Narcotic Antagonist

Question 6

Actions of Naloxone

Answer 6

Reverses respiratory depression secondary to opiate drugs by competing with opioid receptors

Question 7

Indications for Naloxone

Answer 7

Known or suspected overdose induced by opioid intoxication with respiratory and neurological depression

Question 8

Contraindications of Naloxone

Answer 8

• Hypersensitivity
• None in emergency setting
• Use with caution in narcotic dependant patients and mixed substances

Question 9

Side Effects of Naloxone

Answer 9

• Restlessness
• Seizures
• Narcotic withdrawal
• Combative

Question 10

Pharmacokinetics of Naloxone

Answer 10

Onset: IV 1-2 mins, IM 5 minutes
Duration: dependant on route an pre-existing opioid present

Question 11

Adult Dosage of Naloxone

Answer 11

IV/IO: 0.05 mg q 2 mins, max 1 mg (preferred route)

IM: 0.8mg q 5 mins, max 3.2 mg

IN: q 3-5 mins prn (half each nare), max 4 mg

Question 12

Pediatric Dose for Naloxone

Answer 12

IV/IO: 0.1 mg, single max dose 2 mg q 2 mins, max 10 mg

IM: 0.1mg/kg, single max dose 2 mg in divided doses (1/2 in each 2 sites) q 2 min, max 10 mg

IN: 0.1mg/kg, single max dose 2mg (dived into each notstril), q 5 mins prn, max 4 mg