Opioids Exam 1 Flashcards
Which opioid has the longest half life?
methadone (20-30h)
triad of symptoms
- Miosis
- Respiratory depression
- Decreased mental status
signs and symptoms of opioid overdose: Vital signs
Hypothermia or hyperthermia and hypotension may develop
signs and symptoms of opioid overdose: HEENT
The pupils are normally pinpoint, but may be dilated when acidosis or hypoxia is severe
signs and symptoms of opioid overdose: Musculoskeletal
Rhabdomyolysis may cause acute renal failure
signs and symptoms of opioid overdose: Cardiovascular
- Hypotension, bradycardia, pulmonary hypertension, cardiac dysrhythmia, and cyanosis can occur with all opioids
- Norpropoxyphene, the metabolite of propoxyphene, may cause heart block, conduction delays, and ventricular dysrhythmias
- Pentazocine overdose can cause ventricular dysrhythmia
signs and symptoms of opioid overdose: Pulmonary
Respiratory depression, noncardiogenic pulmonary edema, respiratory arrest, hypoxia, bronchoconstriction, acute asthma, and pneumonitis may occur
signs and symptoms of opioid overdose: Gastrointestinal
Constipation, decreased intestinal motility, and ileus occur commonly
signs and symptoms of opioid overdose: Renal
Urinary retention, myoglobinuria, proteinuria, glomerulonephritis, acute tubular necrosis, and nephropathy may occur during chronic abuse
signs and symptoms of opioid overdose: Neurologic
- Lethargy and coma are common and responsive to naloxone
- Normeperidine, a metabolite of meperidine, can cause tremors and seizures
- Seizures can also occur with propoxyphene, tramadol, or high doses of fentanyl
- Serotonin syndrome may occur with tramadol abuse or overdose
Body packer
- individual who ingests or inserts into body orifices, then transports wrapped packages of an illegal substance in an attempt to evade detection by law enforcement.
- aka “mule”
Body stuffer
individual who hastily ingests illegal drug packets to evade law enforcement officials
treatment for overdose
- ABCT
- Decontamination
- Antidotes
treatment for overdose: Decontamination
- NO emesis
- NO enemas
- NO endoscopy
- Activated charcoal (1-2 g/kg) may be administered if patient presents within reasonable amount of time since oral exposure; avoid is CNS depressed or drowsy
- WBI for body packer/stuffer
- PEG until rectal eflluent is clear
treatment for overdose: Antidotes
- naloxone (Narcan®)
- naltrexone (ReVia®) – an opioid antagonist used for the treatment of opioid dependence. NOT for use in the overdose setting
initial naloxone dosing
- Initial dose is 0.4 – 2 mg IV push, may be repeated in 2 mg increments
- In the habituated patient, smaller doses (0.1 or 0.2 mg increments) may be used intravenously and titrated to desired effect to minimize the precipitation of a withdrawal syndrome
- If response occurs, patients should be observed for 4 hours
naloxone routes of administration
IV, endotracheal route, intramuscular, intranasal, intralingual, intraosseous, or subcutaneous injection
continuous-infusion naloxone dosing
- May be used in patients with persistent or recurrent effects
- Use 2/3 of the initial effective naloxone bolus on an hourly basis -> multiply this by ten, add in D5W 1000mL, administer at 100mL/hour
- observe 2 hours after completion of infusion
supportive treatment: Pulmonary edema
- Adequate ventilation and oxygenation should be maintained.
- Positive end-expiratory pressure (PEEP) should be considered if adequate oxygenation cannot be maintained.
- Care should be taken to avoid fluid overload
supportive treatment: Hypotension
- The primary treatment is correction of opioid effects and dysrhythmia.
- Also, 10 to 20 mL/kg of 0.9% saline should be administered, and the patient should be placed in the Trendelenburg position and given a vasopressor if needed
supportive treatment: Seizures
- A patent airway must be ensured
- A benzodiazepine is administered for initial control. If seizures persist or recur, another anticonvulsant such as phenobarbital may be added
coma cocktail: DONT
- Dextrose
- Oxygen
- Naloxone
- Thiamine (give BEFORE dextrose)
When do you use the coma cocktail?
to patients with CNS depression of unknown origin
Why do you administer dextrose in the coma cocktail?
in case the pt is hypoglycemic
Why do you administer oxygen in the coma cocktail?
in case the CNS depression is caused by hypoxia
Why do you administer naloxone in the coma cocktail?
in case the cause is an opioid overdose
Why do you administer thiamine in the coma cocktail?
to help avoid Wernicke’s encephalopathy
What is Wernicke’s encephalopathy?
- ataxia, mental confusion, ophthalmoplegia
- caused by thiamine deficiency
- often seen in alcoholics
