1 / 13

Acute opioid overdose

Acute opioid overdose. Seyed Mostafa Mirakbari MD. Assistant Professor of clinical toxicology & Chair , QUMS. Opioid overdose syndrome sensitivity for diagnosing heroin overdose, 92%; specificity, 76%. Abnormal mental status Decreased respiration Miotic pupils

gsterling
Download Presentation

Acute opioid overdose

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Acute opioid overdose SeyedMostafaMirakbari MD Assistant Professor of clinical toxicology & Chair, QUMS

  2. Opioid overdose syndromesensitivity for diagnosing heroin overdose, 92%; specificity, 76% • Abnormal mental status • Decreased respiration • Miotic pupils • The response of naloxone does not improve the sensitivity of this diagnosis.

  3. The algorithm for the diagnosis of the drug intoxication and withdrawal current research grant stock; speaker Constricted

  4. Symptoms of stimulant Withdrawal Each person quitting stimulants will have slightly different symptoms. They vary based on a number of factors, like the person’s tolerance and metabolism, as well as their history of use. Withdrawal from stimulants is characterized by a dysphoric mood and the presence of two or more of the following symptoms: *Jittery reactions/ Chills *Hallucination/Paranoia *Anxiety *Weight loss or gaunt appearance * Dehydration * Insomnia or hypersomnia *Dulled senses * Drug cravings *Slowed speech *Unpleasant dreams *Loss of interest *Body aches *Slowed movement *Impaired memory * Slow heart rate *Increased appetite * Irritability *Depression *Fatigue

  5. The algorithm for the diagnosis of the drug intoxication and withdrawal Dilated

  6. Sedation

  7. Binding profile (affinity, nM) µ-ORNE 5-HT Morphine 0.3IA IA Buprenorphine 4IA IA Oxycodone 9IA IA Hydrocodone 10IA IA d-Propoxyphene 30IA IA Codeine 200IA IA Dextromethorphan 1,300 20 200 Tramadol 2,100 800 1,000 (+) enantiomer 1,300 2,500 500 (–) enantiomer 24,800 430 2,400 Imipramine 3,700 20 7 Source: Raffa et al., J Pharmacol Exp Ther 260:275-85, 1992 Raffa et al., J Pharmacol Exp Ther 267:331-40, 1993

  8. Early discharge criteriae of patients with presumed opioid overdose • tramadol is a racemate with only weak opioid binding • the enantiomers have synergistic pharmacologies • M1 metabolite is opioid () • No other metabolites are active M1

  9. Adverse events within 24 hours after the one-hour assessment • more tramadol than M1 enters the brain • the ratio increases with dose mice rats Source: Tao et al., J Clin Pharm Ther 27:99-106, 2002

  10. Remember: • 60% of patients will suffer adverse events if they do not meet discharge criteria. • It does not guarantee methadone patients.

  11. The end

  12. Lack of naloxone block: humans • Randomized, placebo-controlled, crossover study • Transcutaneous electrical stimulation of the sural nerve Analgesia assessment • Objective test (R-III Reflex) • Subjective test (Pain Visual Analog [PVA] scale) • Tramadol (100 mg, po)  naloxone (0.8 mg, iv) Mean maximal inhibition of tramadol analgesia by naloxone was 26% (R-III) and 31% (PVA) Reduced >50% by yohimbine Source: Desmeules et al., Brit J Clin Pharmacol 41:7-12, 1996

More Related