Emergency Room Use of Opioid Antagonists in Drug Intoxication and Overdose
Opiate Receptors and Antagonists(2009)
摘要
Opioid receptor antagonists are effective at reversing the clinical features of opioid toxicity; however, if administered
overenthusiastically, they can precipitate acute withdrawal symptoms (AWS) in regular opioid users. These symptoms may cause
the patients to discharge themselves against medical advice and they are in danger of renarcotization either due to the effect
of the antagonists wearing off or because of the patients seek further opioids, often in larger doses, to overcome AWS. Clinicians
treating opioid overdose are therefore walking a clinical tightrope between undertreating the patient and precipitating AWS.
The three opioid antagonists that have been licensed for clinical use are naloxone, naltrexone, and nalmefene. Unfortunately,
the latter two have long durations of action which may cause prolonged AWS, and they are not recommended for Emergency Department
treatment of acute opioid toxicity. The evidence base for the appropri ate dose, route of administration, and observation
of opioid-intoxicated patients is presented, and a clinical algorithm has been developed. Optimal therapy includes careful
titration of intravenous boluses of naloxone so that patients are able to main tain their own airway and breathe adequately,
without precipitating AWS, followed by at least 2-h observation. The subcutaneous and intramuscular routes should only be
used if intravenous access cannot be established.
更多查看译文
关键词
intravenous,naltrexone,acute withdrawal symptoms aws,naloxone,intramuscular,subcutaneous,nalmefene,room,emergency
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要