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Opioids and Sedatives

Updated: May 13, 2022

#CEN #CPEN tip of the day

Opiates (Opioids, Narcotics)

  • S/S: Central nervous system and respiratory depression, miosis, pulmonary edema, apnea, coma.

  • TX: Assist breathing, Naloxone (Narcan) IM, IM, SQ, or IN, in 0.2 mg increments to improve respiration only, repeating as needed every 20-60 minutes (short half-life) or titrate a continuous infusion.

  • Full and sudden awakening with 2 to 4 mgs is dangerous for everyone.

Heroin withdrawal causes restlessness, insomnia, vomiting, diarrhea, abdominal pain.

TX: Methadone, buprenorphine, or naltrexone.


Sedative-Hypnotics (Benzodiazepines) and Barbiturates

  • Often co-ingestion with alcohol.

  • S/S: Central nervous system and respiratory depression, slurred speech, incoordination, drowsiness.

  • TX: Assist breathing, Flumazenil (Romazicon) competes with benzodiazepines at the receptor sites so can induce seizures so consider the benefit versus the risk.

Rohypnol (flunitrazepam) Benzodiazepine

  • S/S: drowsiness, amnesia, blackout, impaired motor coordination, bradycardia.


Gamma-hydroxybutyrate (GHB, “date-rape” drug)

  • Odorless with salty taste so typically added to alcoholic beverages.

  • S/S: Drowsiness, confusion, and amnesia last 3-6 hours.

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