Opioid Overdose Response and Naloxone Flashcards

What are the three classic signs of opioid overdose, known as the 'opioid overdose triad'?

Answer: Pinpoint pupils, unconsciousness, and respiratory depression (slow or absent breathing)

The opioid overdose triad: miosis (pinpoint pupils), unconsciousness/unresponsiveness, and respiratory depression—recognize these to respond quickly.

How does naloxone (Narcan) reverse opioid overdose?

Answer: It competitively binds to opioid receptors, displacing opioids and reversing their effects

Naloxone is an opioid receptor antagonist that displaces opioids from receptors in the brain and reverses respiratory depression, sedation, and miosis.

What is the recommended initial adult dose of intranasal naloxone for opioid overdose reversal?

Answer: 4 mg intranasally (one full actuation of the 4 mg/0.1 mL device)

The FDA-approved Narcan nasal spray delivers 4 mg per actuation and is the standard first-line dose for opioid overdose reversal in community settings.

After administering naloxone to a suspected opioid overdose victim who is not responding, what is the appropriate next action?

Answer: If no response in 2-3 minutes, administer a second dose of naloxone and continue rescue breathing

If there is no response after 2-3 minutes, a second dose should be given; rescue breathing should continue throughout as naloxone may take time to work.

What is 'renarcotization' in the context of naloxone administration?

Answer: The return of overdose symptoms when naloxone wears off before the opioid has been metabolized, requiring repeat doses or continued monitoring

Renarcotization occurs when naloxone's effect wears off (30-90 min) before the opioid is fully metabolized, causing overdose symptoms to return.

Which of the following opioid reversal routes is preferred for rapid emergency use by bystanders?

Answer: Intramuscular (IM) or intranasal (IN)

IM and intranasal routes are preferred for bystanders and first responders because no needles or IV access are required, allowing rapid administration.

What is the 'Evzio' auto-injector in the context of opioid overdose response?

Answer: An FDA-approved naloxone auto-injector that provides voice instructions to guide lay users through administration

Evzio is an FDA-approved naloxone auto-injector designed for community use, providing step-by-step electronic voice instructions during administration.

Why might multiple doses of naloxone be required when treating a fentanyl overdose compared to a heroin overdose?

Answer: Fentanyl and its analogs are significantly more potent than heroin, binding mu-opioid receptors with much higher affinity, requiring larger or repeated naloxone doses to displace

Fentanyl's extremely high receptor affinity (50-100x more potent than morphine) means more naloxone may be needed to competitively displace it from receptors.

What should a bystander do if a suspected opioid overdose victim begins to vomit after naloxone administration?

Answer: Roll the person into the recovery position (on their side) immediately to prevent aspiration

Place the person in the recovery position (on their side) to prevent aspiration of vomit into the lungs, a potentially fatal complication.

Does administering naloxone to a non-opioid-dependent person who has overdosed on opioids cause withdrawal symptoms?

Answer: No, withdrawal symptoms from naloxone only occur in opioid-dependent individuals; non-dependent people simply wake up and recover

Opioid withdrawal syndrome from naloxone only occurs in physically opioid-dependent individuals; non-dependent people experience simple reversal of overdose effects.

What is the proper disposal method for a used naloxone auto-injector (Evzio) or syringe?

Answer: Place in a puncture-resistant sharps container or take to a medication disposal site

Used needles and auto-injectors must be disposed of in puncture-resistant sharps containers to prevent needle-stick injuries and drug diversion.

In the context of opioid overdose response, what does the 'Good Samaritan Law' provide in many U.S. states?

Answer: It provides legal protection from drug possession charges for people who call 911 or assist during a drug overdose

Good Samaritan laws protect people who call for help during an overdose from prosecution for drug-related offenses, reducing hesitation to seek help.

What is 'harm reduction' in the context of opioid use and overdose prevention?

Answer: A public health philosophy that aims to reduce negative consequences of drug use through practical strategies without requiring abstinence

Harm reduction encompasses pragmatic, evidence-based strategies to reduce drug use-associated harms—including naloxone distribution, syringe programs, and fentanyl test strips.

What is the difference between opioid tolerance and opioid physical dependence?

Answer: Tolerance is the need for increasing doses to achieve the same effect; dependence is a physical adaptation where stopping the drug causes withdrawal symptoms

Tolerance (need for higher doses for same effect) and dependence (withdrawal upon cessation) are distinct pharmacological adaptations that can occur independently.

What is 'medication-assisted treatment' (MAT) for opioid use disorder, and what medications are used?

Answer: FDA-approved medications (methadone, buprenorphine, naltrexone) combined with counseling and behavioral therapies to treat opioid use disorder

MAT uses FDA-approved medications (methadone, buprenorphine/Suboxone, naltrexone/Vivitrol) with behavioral support to treat opioid use disorder and reduce overdose risk.

How should naloxone be administered intramuscularly (IM) in the field by a trained community responder?

Answer: Into the outer thigh or upper arm at a 90° angle, using the auto-injector against the skin or with a syringe and needle, even through clothing if necessary

IM naloxone is given at a 90° angle into the outer thigh or deltoid, even through clothing, using the Evzio auto-injector or a standard IM syringe.

What is the role of fentanyl test strips in opioid overdose prevention?

Answer: They allow people who use drugs to test their substances for the presence of fentanyl before use, enabling them to avoid or take precautions with contaminated drugs

Fentanyl test strips detect fentanyl contamination in illicit drugs, empowering people to make informed decisions and reduce overdose risk.

What does 'naloxone standing orders' or 'pharmacy standing orders' mean in the context of opioid overdose prevention?

Answer: A protocol allowing pharmacists to dispense naloxone to individuals without a traditional individual prescription, using a physician or public health officer's blanket order

Standing orders allow pharmacies to dispense naloxone directly to anyone who requests it without an individual prescription, dramatically expanding access.

What are the primary reasons opioids cause respiratory depression at toxic doses?

Answer: Opioids bind to mu-receptors in the brainstem respiratory centers (medulla and pons), reducing the sensitivity of chemoreceptors to CO2 and decreasing respiratory drive

Opioids suppress brainstem respiratory centers, reducing CO2 chemoreceptor sensitivity and decreasing both rate and depth of breathing.

After successfully reversing a suspected opioid overdose with naloxone, what is the most important next step?

Answer: Call or ensure 911 has been called, stay with the person, and transport to the hospital for monitoring and evaluation

Always call 911 and ensure hospital transport even after successful reversal—renarcotization is a real risk, and medical evaluation for underlying causes is needed.