Pharmacy Practice III > Naloxone > Flashcards

Naloxone Flashcards

(19 cards)

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1
Q

Common Risks for Opioid Overdose

A
  1. Opioid Dose and Changes in Purity
  2. Previous Overdose
  3. Substance Use Disorder History
  4. Social Isolation
  5. Chronic Medical Illness (lung/liver/kidney)
  6. Recent Abstinence
  7. Mixing Substances/ Polypharmacy
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2
Q

911 Good Samaritan Laws

A

• Like CPR-based Good Sam Laws
• Protect caller, bystanders, and victim from arrest for drug charges when 911 is called in event of overdose
• Meant to minimize fear of police when calling 911
• CA law went into effect January 1, 2013
• Does not provide immunity against:
- sales or distribution
- forcibly administering a drug against a person’s will
- DUI or drugged driving

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3
Q

Response Strategies: Overdose Education and Naloxone Distribution Programs

A
  • AB 635 CA Overdose Treatment Act: effective January 1, 2014
  • Non-med personnel are able to distribute naloxone (w. doctor’s standing orders)
  • Encouraged to prescribe naloxone to patients on chronic opioid pain meds
  • Provides protection to healthcare professionals from civil/criminal liability
  • Permits individuals to possess/administer naloxone in an emergency + protects responder from civil or criminal prosecution
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4
Q

Pharmacists and Naloxone

A

• 2013 AB 1535 (Bloom) – Effective 2015
• Amended pharmacy practice act to authorize pharmacists to furnish naloxone
- 1 hour CE
- Education of recipient
- Referral and drug treatment information

• Screen the potential recipient:
- any hx of opioid use or contact with someone who does? rxn to naloxone?
• Provide recipient training
- opioid overdose prevention, recognition, response / naloxone administration
• Appropriate medication counseling
- MAY NOT WAIVE
• Resources/referrals on drug treatment 
• Answer any questions on naloxone
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5
Q

Naloxone: Onset, Peak, Duration

A

Onset: Depends on route
• IN = 3-5min
• IM = 6 min., if pt not responding repeat 2nd dose

  • Peak effect: 15 – 20 minutes
  • Duration: 20 – 90 minutes
  • Oxycodone IR: 4 hours
  • Oxycodone ER: 12 – 24 hours
  • Morphine: 4 hours
  • Fentanyl oral: 1 – 2 hours
  • Fentanyl transdermal: 72 hours
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6
Q

Naloxone Safety and Tolerability

A
  • Works at the opioid receptor site to displace the opioid
  • Show little to no effect in pt with no opioids in their system
  • Naloxone does not produce tolerance or lead to dependence
  • Naloxone adverse events/hypersensitivity are extremely rare
  • They are most likely related to hypoxic brain injury caused by the overdose of opioids (seizures) or withdrawal symptoms
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7
Q

Naloxone Safety: Pregnancy

A

• Induce withdrawal sx in opioid-dependent pregnant patients
- Risk of inducing premature labor and fetal distress-crosses the placenta, evaluate the fetus for signs of withdrawal and distress after naloxone is used
- Animal studies show no teratogenicity
- Opioid overdose threatens lives of mother and fetus, do not hesitate to treat!
• Unknown if excreted in breast-milk
- Not bioavailable if ingested

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8
Q

Opioid Withdrawal Symptoms

A

• Can induce withdrawal symptoms (common)

  1. Agitation/aggression
  2. Flu-like symptoms
  3. Nausea & vomiting (aspiration risk)
  4. Sweating
  5. Confusion/Anxiety
  6. Cravings

• Rare Adverse Effects

  1. Seizures
  2. Pulmonary edema (sympathetic surge)
  3. Arrhythmias
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9
Q

When Giving Nalaxone

A
  • Any FDA-approved formulation, may provide in advance, may refill
  • Labeling must follow law (include expiration)
  • Provide BoP fact sheet
  • Notify pt/recipient and PCP (w. consent)
  • Documentation (med record for 3 yrs)
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10
Q

Step1: Intoxicated or Overdose?

A

Intoxication

  • Miosis (small pupils)
  • Drowsiness, but arousable/breathing
  • Slurred speech
  • STIMULATE AND OBSERVE

Overdose

  • Miosis
  • Not arousable or speaking
  • Slow breathing / stopped (<8b/min)
  • GIVE NALOXONE AND CHEST COMPRESSIONS AND BREATHS
  • After: call 911, say someone is unresponsive and not breathing, with clear address
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11
Q

Rescue Breathing + Stay Until Help Arrives

A
  • Perform anytime during rescue
  • Make sure there are no airway obstructions
  • Open airway by tilting head back and pinch nose closed
  • Administer 2 slow rescue breaths into mouth
  • Continue 1 breath every 5 seconds
  • If unresponsive after 3 minutes repeat 2nd dose of naloxone
  • Do not leave person alone after giving naloxone
  • Ensure they do not take any more opioids
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12
Q

Intranasal Kits and Narcan Nasal Spray

A

Intranasal Kits
- 2 naloxone 1mg/1ml (2ml) prefilled needless syringes
- 2 atomizers
- Step-by-step instructions on fact sheet
- Sig: Call 911. Attach white cone. Spray
1⁄2 of syringe into each nostril upon signs of opioid overdose. May repeat in 3 min. x 1 if patient not breathing.

Narcan Nasal Spray

  • Sig: Call 911.
  • Administer a single intranasally into one nostril for opioid overdose.
  • May repeat in 3 min. if patient is not breathing.
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13
Q

Adv. and Dis. of Nasal Routes

A 
Advantages of nasal spray:
• ↓risk of needle stick injury
• ↓risk of blood-borne pathogen transmission 
• Easy access to nasal passages
• Narcan NS already assembled

Disadvantages of nasal spray:
• May have ↓ bioavailability
• Slightly ↓ responder rate
• Nasal abnormalities and prior intranasal drug use may ↓effectiveness

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14
Q

Intramuscular Naloxone and Syringe

A

Intramuscular Naloxone
- Sig: Call 911. Inject 1 ml into upper arm or thigh muscle. May repeat after 3 min. x 1 if patient not breathing.

Syringe
- Sig: Use to withdraw naloxone from vial
and inject 1ml for opioid overdose. Use a new syringe for each dose.

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15
Q

Adv. and Dis. of Injectables

A

Advantages:
• Formulation is manufactured for route
• Paid for by most insurances

Disadvantages of Injectable:
• Risk of blood-borne pathogen transmission
• Risk of needle stick injuries & injury from improper injection technique
• Requires competence in technique
• Requires adequate muscle mass

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16
Q

Intramuscular Auto-Injector (Evzio)

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A
  • Call 911
    1. Remove from the outer case
    2. Pull off red safety guard
    3. Place the black end against the middle of the patient’s outer thigh and press firmly
    • Hold in place for 5 seconds
    • Will inject through clothing
17
Q

Adv. and Dis. of Evzio

Study These Flashcards
A 
Advantages:
• Easy to use
• Talk patient through process
• ↓risk of needlestick injury
• ↓risk of blood-borne pathogen transmission

Disadvantages:
• Price (2017): $4,920/2 pack

18
Q

Furnishing Naloxone

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A

*Request for naloxone: discuss fees/process

  1. Screen patient/recipient
  2. Provide training
    • Opioid overdose prevention, recognition, response
    • Naloxone administration
  3. Naloxone medication counseling
  4. BoP fact sheet
    • Other info if patient/recipient interested
  5. Notification
    • Patient
    • PCP
  6. Document
19
Q

Required Documentation

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A
  • Primary Care Physician notification, ff patient allows consent, otherwise refusal should be documented
  • If furnishing to another person, no notification is required, but should be documented
  • Prescription order
  • Documentation should be maintained for 3 years
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