Question

Narcotics, Narcotic Antagonists, and Antimigraine Agents Case Study Assignment

DJ is a 30 year old female admitted to the ED with a complaint of severe pain to her upper back and neck that started after she was rear ended 3 days ago.

Recent History

DJ denies any history of surgeries or ongoing medical problems. She states she works as a physical therapist. She exercises regularly and eats healthy. She states she drinks alcohol rarely and does not smoke. She states she is on oral birth control and is not pregnant.

Medication Reconciliation List

Ibuprofen 200 mg PRN as needed for pain

Orthro Tri-Cyclen LO 1 tab PO daily

Additional Information for Consideration

After examination by the ED provider DJ is given Morphine 4 mg IM, Zofran 4 mg ODT, and Valium 5 mg PO for pain. She is awaiting laboratory and x-ray results when she is noted to have a decreased level of consciousness and slow respirations.

What is the primary focus of treatment at this point?

Name at least 2 medications that could be used to improve her condition.

Are there any other support measures that should be instituted?

Answer 1

DJ is given Inj. Morphine 4 mg which is powerful opioid analgesic which works by blocking the transmission of signals and thus reducing pain. Along with morphine DJ is also given valium 5 mg orally which both causes sleepiness and makes you drowsy.

DJ is experiencing decreased level of consciousness and slow respirations indicating the toxicity of morphine. DJ has to be given antidote of morphine which increases her consciousness and improves respiratory rate.

1. Naloxone is an opioid antagonist which reverses the effects of morphine. It helps in removal of the opioid drugs from the receptors. Naloxone is available in Intramuscular , intravenous infusions, nasal sprays or subcutaneous injection. It acts within 5 minutes and also has few side effects.

2. Permanganate of potash is also antidote for morphine toxicity which is available orally, subcutaneously and intramuscular form.

Other support measures include :

• Oxygen has to be administered.
• If the respiratory rate is too low with decreased SPO² , orotracheal intubation is performed along with ventilation for continuous oxygen support. This also ensures further control of respiratory system and prevents respiratory depression which is common in morphine overdose .
• Hydration too has to be maintained to prevent further complications.

Thank you.