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Opioids

Opioids. Tintinalli Chapter 167. Substances that have morphine like effects Opiates – Morphine Codeine Thebaine All others are Opioids. Opioids. Modulates nociception of nerves of CNS and peripheral nervous system. Pharmacology. Wide variety of symptoms Respiratory depression AMS

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Opioids

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  1. Opioids Tintinalli Chapter 167

  2. Substances that have morphine like effects Opiates – Morphine Codeine Thebaine All others are Opioids Opioids

  3. Modulates nociception of nerves of CNS and peripheral nervous system Pharmacology

  4. Wide variety of symptoms Respiratory depression AMS Miosis N/V, orthostasis Histamine release Clinical

  5. ABC Narcan IV / ET / IM / SQ / intralingually Lasts 20 to 60 min Consider charcoal Opioid Overdose Treatment

  6. Meperdine Proconvulsant (as well as metabolite) Renally excreted Special Considerations

  7. Serotonin Syndrome Can occur when mixing Meperdine or dextromethorphan MAOIs Symptoms Disorientation Severe hyperthermia Hypo / hypertension Muscle rigidity Treatment Benzodiazepines Aggressive cooling Avoid narcan Special Considerations

  8. Propoxyphene Cardiotoxic Neurotoxic Overdose IV conduction problems Heart block Prolonged QT Bigeminy Seizure Require at least 6 hours of cardiac monitoring before discharge / transfer Special Considerations

  9. Mixed Agonist – Antagonists Talwin Stadol Nubain These may cause significant respiratory depression Responds to narcan Special Considerations

  10. Lomotil Can cause anticholinergic toxidrome Flushing, tachycardia Hyperthermia Hallucinations, dry mouth Urinary retention Overdose May take 6-12 hours Under 6 Require 24 hour observation Special Considerations

  11. Tramadol Overdose Agitation HTN Respiratory distress Seizures Nalaxone ineffective Withdrawal possible Special Considerations

  12. Questions?

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