S15C180 - Opioids

Question 1

Naloxone

Answer 1

• start with 0.05mg IV if pt is opioid dependent
• 0.4mg IV if non-opioid dependent
• 2mg IV if in severe apnea or cyanosis regardless of hx repeated q3min to max of 10mg
• 0.01mg/kg IV in neonates

-infusion: 2/3 of dose it took to wake the pt up over an hour IV, if the 2/3 dose is 0.6mg add 6mg to IL of D5W at 100cc/h, titrate as needed

Question 2

Tramadol OD

Answer 2

• agitation, HTN, resp dpn, seizures, death
• > 500mg PO
• naloxone does not help with seizures

Question 3

Buprenorphine

Answer 3

• partial agonist at u-receptors
• long duration of action
• usually combined with naoloxone b/c naloxone doesn’t affect the SL preparations but is active if tried to use parenterally
• can either cause mental depression and resp depression in naive pts, or induce w/d in a pt on opioids, or help with w/d symptoms in a pt withdrawing

Question 4

Opioid acute lung injury

Answer 4

• usually seen in pts doing heroin

- pulmonary edema

Question 5

Opioid withdrawal

Answer 5

• anxiety, yawning, lacrimation, dipahoresis, rhinorrhea, myalgias
• then piloerection, mydriasis, n/v/d, abdo cramping
• usually occurs 6-12h after last exposure
• peak on 3rd day, resolve by 5th
• Tx: clonidine, antiemetic, antidiarrheal
  others: hydroxyzine, methadone,