Case study 5 Taylor is a 30-year-old plumber who is currently on medical leave after a work-related accident. He required surgery on his ankle that involved implantable hardware. Taylor was prescribed a short-acting opioid after each surgery, which he has continued to use due to difficulty completing his prescribed physical therapy. He is requesting an ER/LA opioid since the short-acting medication, he says, is not relieving his pain completely between doses. He says friends have suggested that a long-acting opioid would be easier to use and would provide him more steady pain relief. Questions 1. What options exist prior to prescribing a trial of ER/LA medication? _______________________________________________________________________________________________ 2. What functional goal would be reasonable to discuss prior to a pain agreement with Zeke? _______________________________________________________________________________________________ 3. What cautions would you provide to this patient if you decided to give a trial of an ER/LA opioid? _______________________________________________________________________________________________ Acute treatment of overdose: Naloxone (Narcan) Overdose involving opioids continues to be
laypersons to revive individuals who are unresponsive due to opioid overdose. Naloxone is combined with oral buprenorphine in some formulations like Suboxone (buprenorphine + naloxone) to discourage intravenous injection. When a combination medication like Suboxone is ingested, the buprenorphine gets absorbed in the stomach while the naloxone is inactivated by stomach acid and does not result in opiate withdrawal. Administration of naloxone in the setting of overdose or suspected overdose presents little to no risk to the patient if the overdose or alteration in mental status is not from opiates. It is important to communicate this to families or friends and the public to encourage the use of naloxone. Naloxone distribution campaigns vary between states, with some states providing free naloxone kits from pharmacies, distribution events, and even vending machines. In March 2023, the FDA approved 4 mg naloxone nasal spray for over-the-counter, nonprescription use. source/education-docs/cows_induction_flow_sheet. pdf. Some adjunct medications can serve to lessen the symptoms and bridge the patient to more definitive therapy, or past the duration of action of the naloxone. It is important to note that the duration of action of naloxone is typically less than 1 hour, while the duration of action of the opioid agent that was responsible for the overdose initially may be multiple hours. This is important when creating a treatment plan for those who are treated in the ED or on the street and refuse to be monitored or evaluated after they wake from their sedation.
common, and acute treatment of opioid overdose typically utilizes naloxone (Narcan) to reverse the dangerous respiratory depression and sedation associated with severe toxicity. Scientists looking to treat constipation caused by chronic opioid use first patented naloxone in New York in 1961. In 1971, the Food and Drug Administration approved naloxone for treating opioid overdoses by intravenous or intramuscular injection. In 1996, piloted use of take- home naloxone kits started in 15 states. Naloxone is a strong opioid antagonist. Dosing of naloxone in medical settings should start low to reverse severe respiratory depression but with the intent of avoiding full withdrawal. Acute withdrawal results in dysphoria, insomnia, pupillary dilation, piloerection, yawning, muscle aches, lacrimation, rhinorrhea, nausea, fever, sweating, vomiting, and diarrhea. 123 Currently, intranasal (IN) naloxone kits are widely distributed throughout the United States and can be used by Opioid withdrawal Successful treatment of opioid overdose frequently results in withdrawal symptoms for the patient habituated to opioids. Treatment of opioid withdrawal symptoms can be complex. In the acute care setting the withdrawal can be abrupt and severe following the use of naloxone or due to precipitated withdrawal related to the inappropriate use of buprenorphine. Clinical evaluation of withdrawal should utilize the Clinical Opiate Withdrawal Scale (COWS) score to assist in decisions related to treatment. This 11-item scale can be used in both inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time. A template of this scale can be found at this site: https://www.asam.org/docs/default-
NATIONAL INSTITUTES OF HEALTH HEAL INITIATIVE ®
Helping to End Addiction Long-term initiative ® is an effort to stem the national opioid public health crisis. NIH is a research program that optimizes the delivery of services for individuals with opioid use disorders,
mental health disorders, and suicide risk. 130 Long term solutions for the evolving opioid crisis include the following:
Book Code: TN24CME
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