Review Question - QID 106594

This patient's clinical presentation is consistent with drug overdose, most likely due to acute opioid intoxication.

Opioid intoxication leads to depressed mental status, decreased respiratory drive, and characteristic pinpoint (miotic) pupils. Overdose may be complicated by hypothermia, rhabdomyolysis, coma, seizure, traumatic brain injury, and aspiration pneumonia. Death generally occurs secondary to respiratory arrest and hypoxia.

Given that opioid abuse is a worldwide problem, Berland and Rodgers discuss the judicious use of opioids for chronic, non-terminal pain. Opioids should be prescribed on a trial basis and only continued if achieving functional improvement, not just providing analgesia. Red flags such as lost or stolen prescriptions, requests for early refills, or abusive behavior should alert physicians to stop prescribing immediately.

Naloxone is an opioid antagonist that may prevent and/or reverse the effects of opioids including CNS and respiratory depression. Opioid education and naloxone distribution (OEND) programs were created to educate and equip bystanders to prevent, recognize, and use naloxone on patients who overdose. An analysis by Walley et al. found a statistically significant decrease in opioid-related fatalities among communities where OEND was implemented. From 1996 to 2010, OEND programs have resulted in over 10,000 rescues in the U.S.

Incorrect Answers:
Answer 1: Alcohol intoxication may result in slurred speech, ataxia, coma, and blackouts.
Answer 3: Benzodiazepine intoxication may lead to ataxia and minor respiratory depression, but have a greater safety margin in overdose.
Answer 4: Amphetamines cause pupillary dilatation (mydriasis), increased attention, hallucinations, and impaired judgment.
Answer 5: PDE-5 inhibitors prolong penile erection and also decrease pulmonary vascular pressure. Use of PDE-5 inhibitors with nitrates or alpha-blockers can result in severe hypotension.