Opioid Overdose

Question 1

What is the Substance Use From a Continuum of
Use Perspective

Answer 1

Situating substance use on a continuum of use allows for
a broader understanding of a wider range of substance
use across populations.

Knowing the severity of substance use enables the
health care team to work with the patient.

Question 2

Pathway of Neurophysiology of Substances of
Misuse

Answer 2

Substances of misuse are psychoactive in nature.

Substances with a higher index of use engage the
brain reward system more intensely and quickly

creates substance use disorder

Question 3

How do drugs work on the Brain reward system

Answer 3

: Most addictive
substances appear to increase the
availability of dopamine in the “pleasure”
area of the mesolimbic system of the brain

Psychoactive substances increase the
activity of the reward pathway by
increasing the neurochemical dopamine in
the synaptic cleft.

Question 4

What are the attitudes towards people experiencing substance use-related issues

Answer 4

Stigma and prejudice are affected by
the media, misinformation, and
misconceptions.

Question 5

What is the Harm-Reduction Perspective

Answer 5

 Focuses on reducing or preventing the harms on a
continuum of use rather than on abstinence.
 Harm reduction includes policies, programs, and
practices with the aim of reducing the harms associated
with substances in persons unable or unwilling to stop
use.

Question 6

Health Complications of Substance Use (3)

Answer 6

1. The inherent properties of the
   substance itself will have specific
   physiological harms.
2. The route by which the substance is
   taken will pose specific harms.
3. High-risk sexual behaviours, exposure
   to violence and trauma, and placing
   one’s personal safety at risk

Question 7

The first priority in an opioid overdose

Answer 7

ABCs (airway, breathing, and circulation)

Question 8

Is withdrawal from opioids life-threatening?

Answer 8

Withdrawal from opioids is not life-threatening but can cause significant
discomfort.

Question 9

Classes of opoids

Answer 9

Opiates, Opioids, Illicit opioids

Question 10

What are Opiates

Answer 10

Natural substances (e.g., morphine, codeine) directly
derived from opium poppy

Question 11

What are Opioids?

Answer 11

Include opiates in addition to many semisynthetic and
synthetic agents used as analgesics eg. Hydromorphone

Question 12

What are Illicit opioids

Answer 12

eg Heroin and fentanyl; intravenous use of controlled-release oxycodone

Question 13

Effects of opoids

Answer 13

Primary effects include
 Euphoria
 Analgesia
 Drowsiness
 Slurred speech
 Decreased respiratory rate
 Gastrointestinal (GI) peristalsis
 Decreased pupil size

Question 14

signs of opioid overdose

Answer 14

 Pinpoint pupils
 Clammy skin
 Depressed respiration
  Level of consciousness (may lead to coma or death)

Question 15

Nursing Management of Opiod
Overdose

Answer 15

 ABCs are the top priority – respiratory depression can lead
to hypoxia, coma, and death if not treated promptly

 Check airways for obstructions, listen to breath sounds,
pattern of breathing, chest wall expansion, accessory muscle
use

 Check pulses – assess for strength, rhythm, regularity

 Assess for cyanosis, cap refill, ECG rhythm

 Continuous vital sign monitoring

 Blood pressure, respirations, heart rate, O2 saturation

 Resuscitation measures if the patient’s condition
deteriorates
 CPR and defibrillation

Question 16

opioid overdose and blood glucose

Answer 16

 Always check CBG
 Opioid overdose can cause hypoglycemia
 Patient may be transfused with a solution containing
dextrose (i.e. D50W)

The link is confusing, apparently, this is a new thing; here’s a study about it
https://www.nursingcenter.com/cearticle?an=01261775-202304000-00003&Journal_ID=646631&Issue_ID=6650341

Question 17

Naloxene (Narcan)

Answer 17

 Opioid Antagonist, antidote;
 Used to treat overdose/opioid induced respiratory depression
 Competes with opioids at opioid receptor sites

Question 18

Naloxene (Narcan) Pharmacodynamics: For IV administration

Answer 18

 Onset 1 minute
 Peak- unknown
 Duration 45 minutes
 Half life of 1 hr. up to 3 hr. neonates

Question 19

Nursing considerations for Naloxene (Narcan)

Answer 19

 Assess for signs of opioid withdrawal in drug dependent persons:
 Cramping, hypertension, vomiting; may occur up to 2 hr. after
administration

Question 20

Opioid withdrawal symptoms

Answer 20

craving, abdominal cramps, diarrhea,
tremors, chills, overall body aches, sleep disturbances, anxiety,
nausea, and vomiting

Question 21

Complications of prolonged opioid use

Answer 21

 Opioid-induced constipation, bowel obstruction
 Increased risk of hepatitis C or other blood-borne illness related to
method of use (i.e., injection)

Question 22

Interprofessional care for opioid users

Answer 22

 Long-term treatment approach
 Psychosocial interventions plus pharmacotherapy
 Opioid agonist therapy (methadone)
 Withdrawal management

Question 23

What is Methadone, why is it used

Answer 23

It is a synthetic opioid agonist
methadone has several advantages in the treatment of opioid use disorder:

Opioid Replacement Therapy: Methadone is often used as a long-acting opioid replacement therapy. It helps to reduce cravings and withdrawal symptoms without causing the intense euphoria associated with other opioids

Reduction of Illicit Drug Use: By providing a controlled and regulated dose of methadone, it can reduce the use of illicit opioids and associated health risks, including the risk of overdose.

Harm Reduction: Methadone maintenance programs are considered a harm reduction strategy. They aim to minimize the negative consequences associated with opioid use, such as the spread of infectious diseases (e.g., HIV, hepatitis C) through the sharing of needles.

 Avoid using other sedating substances such as alcohol and
benzodiazepines

Question 24

Buprenorphine

Answer 24

There are similar reasons for use with methadone

 Less sedating than methadone
 Available as sublingual tab
 Lower risk of overdose than methadone

Question 25

When is a nurse “Incapacity”

Answer 25

 1. the member must have a physical or mental condition and
 2. the condition must warrant that the member not be
permitted to practice, or that her or his practice be restricted
 Most commonly arises when a member is affected by a mental health or
addiction disorder
 CNO expects a facility operator to make a report only when a
current health condition is accompanied by concerns