Opioids Exam 1

Question 1

Which opioid has the longest half life?

Answer 1

methadone (20-30h)

Question 2

triad of symptoms

Answer 2

• Miosis
• Respiratory depression
• Decreased mental status

Question 3

signs and symptoms of opioid overdose: Vital signs

Answer 3

Hypothermia or hyperthermia and hypotension may develop

Question 4

signs and symptoms of opioid overdose: HEENT

Answer 4

The pupils are normally pinpoint, but may be dilated when acidosis or hypoxia is severe

Question 5

signs and symptoms of opioid overdose: Musculoskeletal

Answer 5

Rhabdomyolysis may cause acute renal failure

Question 6

signs and symptoms of opioid overdose: Cardiovascular

Answer 6

• 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

Question 7

signs and symptoms of opioid overdose: Pulmonary

Answer 7

Respiratory depression, noncardiogenic pulmonary edema, respiratory arrest, hypoxia, bronchoconstriction, acute asthma, and pneumonitis may occur

Question 8

signs and symptoms of opioid overdose: Gastrointestinal

Answer 8

Constipation, decreased intestinal motility, and ileus occur commonly

Question 9

signs and symptoms of opioid overdose: Renal

Answer 9

Urinary retention, myoglobinuria, proteinuria, glomerulonephritis, acute tubular necrosis, and nephropathy may occur during chronic abuse

Question 10

signs and symptoms of opioid overdose: Neurologic

Answer 10

• 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

Question 11

Body packer

Answer 11

• 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”

Question 12

Body stuffer

Answer 12

individual who hastily ingests illegal drug packets to evade law enforcement officials

Question 13

treatment for overdose

Answer 13

• ABCT
• Decontamination
• Antidotes

Question 14

treatment for overdose: Decontamination

Answer 14

• 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

Question 15

treatment for overdose: Antidotes

Answer 15

• naloxone (Narcan®)
• naltrexone (ReVia®) – an opioid antagonist used for the treatment of opioid dependence. NOT for use in the overdose setting

Question 16

initial naloxone dosing

Answer 16

• 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

Question 17

naloxone routes of administration

Answer 17

IV, endotracheal route, intramuscular, intranasal, intralingual, intraosseous, or subcutaneous injection

Question 18

continuous-infusion naloxone dosing

Answer 18

• 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

Question 19

supportive treatment: Pulmonary edema

Answer 19

• 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

Question 20

supportive treatment: Hypotension

Answer 20

• 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

Question 21

supportive treatment: Seizures

Answer 21

• 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

Question 22

coma cocktail: DONT

Answer 22

• Dextrose
• Oxygen
• Naloxone
• Thiamine (give BEFORE dextrose)

Question 23

When do you use the coma cocktail?

Answer 23

to patients with CNS depression of unknown origin

Question 24

Why do you administer dextrose in the coma cocktail?

Answer 24

in case the pt is hypoglycemic

Question 25

Why do you administer oxygen in the coma cocktail?

Answer 25

in case the CNS depression is caused by hypoxia

Question 26

Why do you administer naloxone in the coma cocktail?

Answer 26

in case the cause is an opioid overdose

Question 27

Why do you administer thiamine in the coma cocktail?

Answer 27

to help avoid Wernicke’s encephalopathy

Question 28

What is Wernicke’s encephalopathy?

Answer 28

• ataxia, mental confusion, ophthalmoplegia
• caused by thiamine deficiency
• often seen in alcoholics