Episode 903: Treating Precipitated Opioid Withdrawal

Episode 903: Treating Precipitated Opioid Withdrawal

Contributor: Aaron Lessen MD

Educational Pearls:

  • Opioid overdoses that are reversed with naloxone (Narcan), a mu-opioid antagonist, can precipitate acute withdrawal in some patients

  • Treatment of opioid use disorder with buprenorphine can also precipitate withdrawal

  • Opioid withdrawal symptoms include nausea, vomiting, diarrhea, and agitation

  • Buprenorphine works as a partial agonist at mu-opioid receptors, which may alleviate withdrawal symptoms

    • The preferred dose of buprenorphine is 16 mg

  • Treatment of buprenorphine-induced opioid withdrawal is additional buprenorphine

  • Adjunctive treatments may be used for other opioid withdrawal symptoms

    • Nausea with ondansetron

    • Diarrhea with loperamide

    • Agitation with hydroxyzine

References

1. Quattlebaum THN, Kiyokawa M, Murata KA. A case of buprenorphine-precipitated withdrawal managed with high-dose buprenorphine. Fam Pract. 2022;39(2):292-294. doi:10.1093/fampra/cmab073

2. Spadaro A, Long B, Koyfman A, Perrone J. Buprenorphine precipitated opioid withdrawal: Prevention and management in the ED setting. Am J Emerg Med. 2022;58:22-26. doi:10.1016/j.ajem.2022.05.013

Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit

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Episode 926: Supraventricular Tachycardia

Episode 926: Supraventricular Tachycardia

Contributor: Taylor Lynch MD Supraventricular tachycardias (SVTs) arise above the bundle of His The term SVT includes AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardi...

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Episode 925: Table Sugar for Tongue Entrapment

Episode 925: Table Sugar for Tongue Entrapment

Contributor: Aaron Lessen, MD Educational Pearls: Pediatric case study where the child's tongue was stuck in the opening of a hard plastic drink lid Entrapment restricts circulation which causes f...

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Episode 924: Pregnancy Cold Remedies

Episode 924: Pregnancy Cold Remedies

Contributor: Megan Hurley, MD Educational Pearls: Fevers Tylenol Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated Can limit the amount of amniotic fluid produced Ca...

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Episode 923: Blunt Cerebrovascular Injury

Episode 923: Blunt Cerebrovascular Injury

Contributor: Travis Barlock MD Educational Pearls: Assessment of head and neck vascular injury due to blunt trauma Symptomatic patients require screening head and neck CT angiography EAST guid...

30 Syys 20243min

Episode 922: Chest Tube Irrigation

Episode 922: Chest Tube Irrigation

Contributor: Aaron Lessen, MD Educational Pearls: Hemothorax: blood in the pleural cavity, most commonly due to chest trauma Treatment: thoracostomy tube for blood drainage helps to avoid clott...

23 Syys 20242min

Episode 921: Pediatric Hypoglycemia

Episode 921: Pediatric Hypoglycemia

Contributor: Taylor Lynch, MD Educational Pearls: When it comes to hypoglycemia, the age dictates possible causes Neonate: Hormonal deficiency Congenital Adrenal Hyperplasia (21-hydroxylase de...

22 Syys 20244min

Laboring Under Pressure Episode 3: Hypertensive Disorders of Pregnancy with Dr. Kiersten Williams

Laboring Under Pressure Episode 3: Hypertensive Disorders of Pregnancy with Dr. Kiersten Williams

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS3 Show Pearls Hypertensive disorders of pregnancy are one of the leading causes of maternal mortality worldwide. Hypertension ...

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Episode 920: Pediatric Growth Estimates

Episode 920: Pediatric Growth Estimates

Contributor: Sean Fox, MD Educational Pearls: Newborns may lose up to 10% of their birth weight in the first week of life Weight loss is greatest in exclusively breastfed infants Should regain ...

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