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Specific Diseases and Procedures
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Drugs. Combine with cardiac massage epinephrine 0.01 mg/kg IV.Doxapram is a respiratory stimulant and also will partially antagonize sedation from xylazine or detomidine passed through the placenta from the mare. Inject 0.5 mg/kg, approximately 1.25 ml for a large foal, intravenously.Antagonism of drugs administered to the mare that may have crossed to the foal. Naloxone is an opioid antagonist. Inject 0.01 mg/kg, approximately 1.0 ml (0.4 mg/ml, for a large foal). Atipamezole will antagonize an alpha-2 agonist sedative.Dopamine and dobutamine are cardiovascular stimulants. Dopamine is more effective for resuscitation because it increases heart rate in addition to myocardial contractility. Add 50 mg dopamine (1.25 ml of 40 mg/ml) to 500 ml saline to make a solution of 100 µg/ml. Infuse IV at 7–10 µg/kg/min; for a 50 kg/110 lb foal, 8 µg/kg/min using a 15 drops/ml administration set is one drop/second.Tactile stimulation by rubbing with a towel; tickle inside the nostrils and ears and the perineum.
Drug Overdoses during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Naloxone, an opioid-specific antagonist, is available and used as antidote. Naloxone competitively binds to opioid receptors and opioid analgesics, blocking uptake. Naloxone causes an almost immediate onset of withdrawal symptoms in patients addicted to opioids. In those patients not addicted to opioids, naloxone reverses the CNS and respiratory depression. Most narcotic analgesic preparations also contain other substances, such as acetaminophen and/or aspirin. In documented opioid overdose is encountered, naloxone should be given according to directions in the manufacturer’s package insert. Opioids cross the placenta freely and affect the fetus. Accordingly, naloxone acts as a fetal antidote as well. Therefore, treatment of maternal overdose will treat the fetal overdose.
Pharmacology of Opioids
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Naloxone is the opioid antagonist most commonly used to treat opioid overdose. Its half-life of about 60 minutes is much shorter than those of the drugs listed earlier (Ogura & Egan, 2019). As a result, if naloxone is required to antagonize the effects of most opioid agonists, repeated doses or an infusion may be needed. By titrating the dose of naloxone carefully, it is possible to reverse OIVI, while still retaining reasonable analgesia. However, this balance may be more difficult to obtain when opioids are being administered by other than epidural or intrathecal routes.
Costs of opioid overdose education and naloxone distribution in New York City
Published in Substance Abuse, 2022
Czarina N. Behrends, Sarah Gutkind, Emily Winkelstein, Monique Wright, Jennifer Dolatshahi, Alice Welch, Denise Paone, Hillary V. Kunins, Bruce R. Schackman
Our estimated ongoing program cost per kit dispensed, excluding naloxone kit costs, (median $19 per kit for SSPs and $27 to $62 per kit for non-SSPs) is higher than other estimates used in the US cost-related studies of $10 or $13 per kit dispensed.10,13,15 Our cost estimates exceed previous estimates because it includes administrative and training costs beyond the cost of the time spent providing OEND. Costs previously cited in the literature were estimated based on the type of person who is dispensing naloxone (i.e., lay person, emergency medical services, law enforcement), but only one study focused on the setting (secondary schools) for estimating costs.9 Our setting-specific estimates may help inform future studies that examine the efficiency of distributing naloxone through different organizations and inform funders of the resources required to support various types of OEND programs. Future studies should not only take into account differences in costs among programs, however, but also differences in program effectiveness of reaching individuals who are most likely to observe an overdose.
Naloxone therapy for prescription and illicit opioid poisoning cases aged 50 + in the national poison data system, 2015–2020
Published in Clinical Toxicology, 2022
Namkee G. Choi, Bryan Y. Choi, Diana M. DiNitto, C. Nathan Marti, S. David Baker
Table 3 shows that CNS and respiratory depression were the most common effects among both prescription and illicit opioid cases followed by confusion, nausea/vomiting, tachycardia, and hypotension in prescription opioid cases, and miosis, bradycardia, tachycardia, and agitation in illicit opioid cases. In prescription opioid cases, most clinical effects except nausea/vomiting, dizziness/vertigo, and diaphoresis were associated with higher odds of naloxone administration, with the highest odds in cases with cyanosis, CNS depression, and respiratory problems. In illicit opioid cases, in addition to these same three clinical effects, hypotension, bradycardia, and acidosis were associated with higher odds, but nausea/vomiting, agitation, dizziness/vertigo, hypertension, and tachycardia were associated with lower odds of naloxone administration.
The role of overdose reversal training in knowing where to get naloxone: Implications for improving naloxone access among people who use drugs
Published in Substance Abuse, 2021
Kristin E. Schneider, Lauren Dayton, Abigail K. Winiker, Karin E. Tobin, Carl A. Latkin
Training lay persons and first responders to administer naloxone (Narcan®) to individuals experiencing an opioid overdose has been a commonly implemented public health response to this crisis.6 Naloxone is an opioid antagonist that can effectively reverse the effects of an opioid overdose.7,8 Take-home naloxone programs, which provide naloxone to people at risk for an overdose, have been credited with saving tens of thousands of lives.9 Policy changes have also been made in many locales to improve naloxone access among marginalized populations, such as people who use drugs (PWUD). Many states and localities have implemented “standing orders” for naloxone which provide community-level prescriptions for naloxone to all citizens in order to improve community access.10 Standing orders allow pharmacists to dispense naloxone to individuals without those individuals needing their own personal prescription. For example, Baltimore City implemented a standing order for naloxone in October 2015, giving all residents blanket coverage to purchase naloxone at a pharmacy without having to obtain a prescription from a doctor. However, access to naloxone sold at pharmacies may be limited by factors such as high out-of-pocket costs for naloxone obtained from pharmacies, not all insurance carriers covering all forms of naloxone, standing order programs not including funding to reduce costs at pharmacies, and PWUD experiencing stigma in pharmacies.11–15