Opioids ingestion

Opioids have noted effects on ingestive behavior and appetite (Bodnar 1996). Morphine increases food intake, and jl/ antagonists conversely... 

Bodnar RJ. (1996). Opioid receptor subtype antagonists and ingestion. In Drug Receptor Subtypes and Ingestive Behavior, Cooper SG, Ciifton PG, eds. London Academic Press, pp. 127-46. 

Severe opioid withdrawal syndromes Severe opioid withdrawal syndromes precipitated by accidental naltrexone ingestion have occurred in opioid-dependent individuals. Withdrawal symptoms usually appear within 5 minutes or less of ingestion and may last up to 48 hours. 

The body s natural painkilling system, then, involves the interaction of endogenous opioids with neurons that transmit and process pain signals. Opioid medications such as codeine mimic the effects of certain endogenous opioids. However, ingested/injected opioids tend to produce much stronger effects than those of the endogenous variety. 

The street versions of fentanyl are ingested in the same ways as heroin. It is usually sold in a powder form and either smoked, snorted, or injected into a vein. Since fentanyl is water-soluble, the powder form can be cold-stirred into a solution and does not need to be boiled like other opioids. However, injection is the most common method used for ingestion on the street. It is so much more potent than heroin that in many of the overdose deaths, the user is found with the needle still in an arm, in some instances with plunger not fully compressed. Some of the designer fentanyl today is made into pill form, but in this form of ingestion, more time elapses before the user feels its effects. 

Although the BZDs have minimal depressant effects on respiration, when combined with other CNS depressants (alcohol, opioids), BZDs can cause fatal respiratory suppression. However, most non-BZD sedatives may also cause death by suppression of breathing and heart failure if taken in sufficient quantity. Benzodiazepines can also cause some degree of memory loss called anterograde amnesia—a form of amnesia that involves the formation of memories after a specific event a person with anterograde amnesia cannot remember information presented to them after ingesting the BZD, a process similar to an alcohol black-out. 

Codeine Phosphate The presence of aspirin along with codeine, even at a low moisture level, leads to acetylation of codeine phosphate in solid dose forms and is incompatible.36 Codeine sulfate solutions are more stable than phosphate salts.37 Drug dependence and withdrawal resemble that of opioid analgesics. Overdose causes acute intoxication in children, as accidental or deliberate ingestion of cough preparations containing codeine.38... 

Methadone is used to substitute for a variety of opioid drugs. It is well absorbed after oral ingestion, with peak blood concentrations after about 4 hours. Steady-state concentrations are reached after about 5 days. By virtue... 

In one instance keratoconjunctivitis occurred in a patient taking co-phenotrope, confirmed by rechallenge but not with diphenoxylate alone (SEDA-16, 425). Adverse effects are rare during ordinary use in adults, but children can be particularly sensitive to the adverse effects of both components, and in cases of poisoning complex and prompt measures may be needed, particularly since respiratory depression can be delayed until a day after ingestion and can recur even after a good response to opioid antagonists. 

Only six of 36 children who took overdoses of co-phenotrope had signs of atropine overdose (central nervous system excitement, hypertension, fever, flushed dry skin) (1). Opioid overdose (central nervous system and respiratory depression with miosis) predominated or occurred without any signs of atropine toxicity in 33 cases (92%). Diphenoxylate-induced hjrpoxia was the major problem and was associated with slow or fast respiration, hypotonia or rigidity, cardiac arrest, and in three cases cerebral edema and death. Respiratory depression recurred 13-24 hours after the ingestion in seven cases and was probably due to accumulation of difenoxine, an active metabolite of diphenoxylate. Recommended treatment is an intravenous bolus dose of naloxone, followed by a continuous intravenous infusion, prompt gastric lavage, repeated administration of activated charcoal, and close monitoring for 24 hours. 

A 24-year-old woman, with a history of polysubstance abuse and extensive psychiatric history, presented with acute opioid overdose caused by the intentional oral ingestion of a fentanyl patch (Duragesic) (74). 

Diphenoxylate is a narcotic-like substance that slows gastrointestinal motility and depresses the central nervous system producing coma and respiratory depression. Anticholinergic effects (secondary to the presence of atropine as an abuse deterrent) can be seen early after exposure with opioid effects occurring later. There is no correlation between the dose ingested and the severity of effects in children. Severe poisonings with coma and respiratory depression have been reported in children with small ingestions. 

Basic and advanced life support measures should be initiated immediately. Activated charcoal may be utilized to adsorb illicit fentanyl derivatives following ingestion. Naloxone is the specific pharmacologic antagonist for fentanyl derivatives. Naloxone displaces these agents at the opioid receptor and reverses their clinical effects however, higher than customary doses may be needed to successfully overcome the opioid receptor. 

Basic and advanced life-support measures should be utilized as needed. In patients presenting within 1 h of ingestion, activated charcoal may be considered. Supportive care should be provided as needed. Use of the narcotic antagonist naloxone may be beneficial in patients displaying opioid symptoms. 

Gastrointestinal decontamination should be considered for patients who have ingested pentazocine only after initial supportive care has been provided and airway control has been assured. Activated charcoal (1 gkg ) may be administered. Syrup of ipecac is contraindicated after overdose with pentazocine due to the potential for rapid clinical deterioration. Gastric lavage is not indicated. Naloxone can be infused in an attempt to reverse respiratory and CNS depression. Naloxone administration may precipitate opioid withdrawal and should be administered slowly. Recent case series have demonstrated that naloxone may not result in clinical improvement in the majority of patients who have overdosed on pentazocine. 

The cardiovascular, CNS, and anticholinergic symptoms of phenothiazine toxicity are similar to, but generally much less severe than, those for the tricyclic antidepressants. Phe-nothiazines are relatively safe, and few deaths have occurred when toxic doses have been ingested alone. Much more severe toxicity occurs when phenothiazines are co-ingested with tricyclic antidepressant drugs or other CNS depressant drugs, such as ethanol, opioids, barbiturates, or benzodiazepines. 

Overall the anthiistamines are relatively safe. However, their CNS depressant actions are enhanced by co-ingestion of ethanol, sedative-hypnotic drugs, and opioids their anticholinergic actions are potentiated by co-ingestion of tricyclic antidepressants and phenothiazines. Therefore the... 

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