Opiate overdose Flashcards
What are 3 key effects of opioids?
- Coma
- Respiratory depression
- Pinpoint pupils
In what situation is the specific opioid antidote indicated?
if there is coma or bradypnoea
What is the specific opioid antidote?
naloxone hydrochloride
What must be done once naloxone has been given to treat opioid poisoning?
naloxone has a shorter duration of action than many opioids so close monitoring and repeated injections are necessary according to the respiratory rate and depth of coma
What is the BNF recommended dosage for naloxone in opioid overdose?
- initially 400 micrograms IV
- 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding
- increase to 2mg for 1 dose if still no response (4mg may be required in seriously poisoned patients)
- then review diagnosis
How can naloxone be given if repeated administration is required?
continuous intravenous infusion, rate adjusted according to vital signs
If IV access is not available how can naloxone be administered?
subcutaneously or intramuscularly
What is an example of an opioid which is only partially reversed by naloxone?
buprenorphine
What are 2 examples of opioids with long durations of action which may need monitoring for long periods?
- Methadone
- Dextropropoxyphene
What is an additional problem caused by dextropropoxyphene, in addition to the opioideffects?
produces metabolite norpropoxyphene which also has cardiotoxic effects which may require treatment with sodium bicarbonate or magnesium sulfate (or both)
arrhythmias may occur for up to 12h
What are 2 options for treating cardiotoxic effects of norpropoxyphene (metabolic of dextropropoxyphene)?
- sodium bicarbonate
- magnesium sulfate