Toxicology - Opioids

Question 1

Opioid Overdose - Clinical Manifestations

Answer 1

decreased mental status
pinpoint pupils
decreased bowel sounds
depressed respiration

Question 1

Opioid Overdose - Management

Answer 1

administer antidote (naloxone)
protect airway

Question 2

Naloxone - Dosing

Answer 2

non-opioid-dependent patient: 0.4 mg IV
opioid-dependent patient: 0.4 mg IV and titrate to effect
bystanders: 2 mg IM or 4 mg IN

Question 3

Naloxone-Induced Pulmonary Edema - Treatment

Answer 3

nitroglycerin
diuretics
positive pressure ventilation

prevention - smaller initial doses of naloxone

Question 4

Loperamide - MoA

Answer 4

inhibits intestinal peristalsis through mu-opioid receptor agonism

Question 5

Loperamide Overdose - Clinical Presentation

Answer 5

opioid overdose
severe cardiac arrhythmias

Question 6

Loperamide - Doses

Answer 6

therapeutic - 16 mg / day
toxic - > 30 mg

Question 7

Loperamide - DDIs

Answer 7

pgp inhibitors increase penetration through BBB and enhance effects

Question 8

Loperamide Overdose - Management

Answer 8

naloxone
IV magnesium
sodium bicarbonate
IV isoproterenol
transcutaneous pacing