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Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
MOUD should be continued throughout labor and delivery as it is not part of the labor analgesia. Similarly, complaints of pain should be taken seriously and not assumed to be drug seeking behavior. Opioid antagonists or agonist-antagonists can precipitate acute withdrawal [107]. Examples of these drugs are Nubain®, Talwin®, Stadol®, and Narcan®. If any of these drugs are accidentally given, withdrawal can also be reversed with any opioid [107]. Regional anesthesia is safe. However, hypotension may occur more frequently because of concomitant malnutrition and/or liver disease. If general anesthesia becomes necessary, poor dentition, airway burns, chronic lung disease, and decreased gastric emptying may result in airway compromise [12]. Peripheral intravenous access can be difficult in chronic intravenous drug abusers.
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.
Opioids Analgesics and Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
R. Rachana, Tanya Gupta, Saumya Yadav, Manisha Singh
A drug that dampens the biological activity by blocking some or all the subtypes of opioid receptor(s) is referred as opioid antagonists. Majorly, they are utilized to treat acute opioid overdose management, addiction treatment, and for the management of that patient population which cannot obtain adequate analgesia from opioids (e.g., Crohn’s disease, fibromyalgia, sickle cell anaemia, and neuropathy etc.). The most widely studied opioid antagonists are naloxone and naltrexone, which have higher affinity toward the receptors than agonists, but do not activate them. They effectively block the receptor, preventing the body from responding to exogenously administered opioids like morphine, heroin, meperidine, endorphins, and so on (Leavitt, 2009). These drugs have higher affinity for μ receptors in comparison to others and can pass through membranes (including blood–brain barrier) easily as; they have similar structure and equivalent lipophilicity. As shown in Figure 19.3, the evolution of opioid antagonists is also based on the morphine core structure.
Are People Who Die by Intentional Medication Poisoning Dispensed Those Medications in the Year Prior to Death?
Published in Archives of Suicide Research, 2023
Jennifer M. Boggs, Gregory E. Simon, Arne Beck, Rebecca C. Rossom, Frances L. Lynch, Christine Y. Lu, Ashli A. Owen-Smith, Stephen C. Waring, Brian K. Ahmedani
A policy initiative in Great Britain for packaging medications that are commonly used for self-poisoning in blister packs was shown to decrease self-poisoning deaths by those medications (Hawton, 2002). Providing opioid antagonists (naloxone) alongside opioid prescriptions is another prevention opportunity (Wheeler, Jones, Gilbert, & Davidson, 2015). Limiting quantities of medications dispensed to patients with suicide risk has also been suggested as another important strategy, although there is little effectiveness data on this approach (Cleary, Kelleher, Lane, & Malone, 2019). Hypnotic medications, such as benzodiazepines, which have higher toxicity than non-hypnotic psychotropics and often contribute to poisoning mortality when combined with opioids or other medications, were continuously dispensed in the year prior to death in our sample. There is guidance on limiting hypnotic medications, particularly benzodiazepines, to 2–4 weeks (Baldwin et al., 2014), although there may be suboptimal adherence to these guidelines (Olfson, King, & Schoenbaum, 2015). Suicide risk may be reduced when benzodiazepines are dispensed in shorter duration and alongside antidepressants for patients with anxiety disorders (Boggs, Lindrooth, et al., 2020).
Safety considerations for the management of cholestatic itch
Published in Expert Opinion on Drug Safety, 2021
Naltrexone is an oral μ-opioid receptor blocker that has been used for cholestatic itch once other medications have failed to provide adequate relief. Its beneficial effect on pruritus has been demonstrated in small clinical trials and a meta-analysis [26,55,56]. Naloxone, another MOR blocker, is only available in intravenous formulation and has been used in select hospitalized patients with pruritus and as induction therapy before starting long-term naltrexone [57]. The main safety concern with this group of medications is the development of opiate-like withdrawal reactions including nausea, abdominal pain, dizziness, tremors and anorexia in patients with higher levels of endogenous opioids at baseline [58]. These symptoms have been described in up to 32% of patients on treatment with MORs but are usually self-limited lasting no longer than three days in most cases [56]. Also, the use of opioid antagonists has been associated with episodes of pain exacerbation in individuals with underlying chronic pain syndromes like post-herpetic neuralgia [59].
Implementation of a collaborative model for opioid overdose prevention on campus
Published in Journal of American College Health, 2020
Lucas G. Hill, Lori K. Holleran Steiker, Lubna Mazin, Mark L. Kinzly
Ingesting opioids (eg heroin, oxycodone) may result in respiratory depression, a potentially fatal condition in which the brain and other vital organs do not receive sufficient oxygen to sustain life.8 Naloxone, an opioid antagonist, can rapidly reverse these effects when it is administered to an overdose victim. Community-based distribution of naloxone to laypersons, such as people who use drugs and their friends and family members, resulted in more than 26,000 lives saved from 1996–2014.9 Recognizing this, all 50 U.S. states and the District of Columbia have enacted legislation to expand access to naloxone.10 These laws typically provide liability protection to overdose responders and enable naloxone purchasing directly from pharmacists under a prescriber’s standing order. In at least 15 states, including Texas, they also authorize any person to possess naloxone without a prescription. This unique legal status facilitates making naloxone available for emergency access by staff and visitors to address suspected overdoses on campus, similar to the approach employed for fire extinguishers and automated external defibrillators. It also removes barriers to allowing students, faculty, and staff to distribute naloxone directly to students.