POINSON. Opioid intox/withdrawal

Question 1

Opioid overdose. CP?

Answer 1

Decr. mental status
Decr. Resp rate + shallow breathing
Miosis (normal/enlarged if coingestion)
Decr. bowel sounds

Brady, hypo/normothermia

Question 2

Opioid overdose. workup. ABG?

Answer 2

Resp. acidosis

Question 3

Opioid overdose. workup. fingerstick glucose?

Answer 3

hypoglycemia

Question 4

Opioid overdose. workup. Evaluate for presence of other drugs

Answer 4

.

Question 5

Opioid overdose. workup. ECG why and in what case?

Answer 5

ECG for prolonged QTc with methadone overdose

Question 6

Opioid overdose. treatment?

Answer 6

naloxone

Question 7

Opioid overdose. naloxone titrate to achieve what?

Answer 7

aim to achieve RR >= 12 k/min, not no achieve a normal mental status

Question 8

Opioid overdose. treatment –> airway management and ventilation

Answer 8

.

Question 9

Opioid overdose. treatment - when consider continuous ecg?

Answer 9

consider continuous cardiac monitoring (If QTc > 500 msec)

Question 10

Opioid overdose. also exclude other altered mental states causes, eg hypoglycemia

Answer 10

.

Question 11

Opioid withdrawal. onset?

Answer 11

within 6-12h of the last dose of a short acting opioid, with a peak 24-48h after symptom onset.

Question 12

Opioid withdrawal. symptoms caused by natural opioid cessation (ie not triggered by administration of an antagonist) are not life-threatening

Answer 12

.

Question 13

Opioid withdrawal. CP GI?

Answer 13

nausea, vomiting, diarrhea, cramping, incr. bowel sounds

Question 14

Opioid withdrawal. CP cardiac?

Answer 14

incr. pulse, incr. BP, diaphoresis

Question 15

Opioid withdrawal. CP psyho?

Answer 15

insomnia, yawning, dysphoric mood

Question 16

Opioid withdrawal. CP other?

Answer 16

myalgia, arthralgias, lacrimation, rinorrhea, piloerection, mydriasis

Question 17

Opioid withdrawal. CP - acute opioid cessation/dose reduction after prolonged use

Answer 17

.

Question 18

Opioid withdrawal. Management. what 2 components?

Answer 18

Opioid agonist + adjunctive drug for symptoms

Question 19

Opioid withdrawal. Management. what opioid agonist?

Answer 19

Methadone - preferred.
or buprenorphine

Question 20

Opioid withdrawal. Management. what nonopioid (adjunctive)?

Answer 20

clonidine or adjunctive medication (antiemetics, loperamide=antidiarrheal, BZD, for myalgias = ibuprofen)