## Opioid Overdose Management **Key Point:** Naloxone is a competitive opioid antagonist and the gold standard for acute opioid toxicity. It rapidly reverses respiratory depression, sedation, and hypotension by blocking μ-opioid receptors. ### Clinical Presentation Recognition The triad of respiratory depression, pinpoint pupils, and altered mental status is pathognomonic for opioid overdose. Accidental double-dosing in a chronic user precipitates acute toxicity despite tolerance. ### Naloxone Mechanism & Dosing 1. **Competitive antagonism** at opioid receptors (higher affinity than morphine) 2. **Onset:** 1–2 minutes IV; duration 30–90 minutes (shorter than most opioids) 3. **Dosing:** 0.4–0.8 mg IV bolus; repeat every 2–3 minutes if no response (max 10 mg) 4. **Caution:** Risk of acute withdrawal syndrome (agitation, tachycardia, hypertension) in chronic users, but life-saving in respiratory depression **High-Yield:** Naloxone duration is shorter than morphine — repeat dosing or continuous infusion may be needed to prevent re-sedation. ### Supportive Care - Bag-mask ventilation until naloxone takes effect - Oxygen supplementation - IV fluids for hypotension - Continuous cardiac monitoring ### Why Other Agents Fail - **Flumazenil:** Reverses benzodiazepines, not opioids; inappropriate here - **Methadone:** Long-acting opioid agonist; would worsen overdose - **Doxapram:** Non-specific respiratory stimulant; inferior to naloxone and carries seizure risk **Clinical Pearl:** In opioid-dependent patients, naloxone may precipitate acute withdrawal, but respiratory arrest is more immediately life-threatening. Withdrawal is uncomfortable but not fatal; respiratory failure is.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.