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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

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Acute opioid overdose

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  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

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