GMCH Chandigarh - 2019
Pharmacology
Easy
An emergency room nurse is assessing a 22 year old male who has been using opioids. What symptoms indicate that the client has overdosed?
Appeared in: GMCH Chandigarh - 2019
Explanation
- Opioid overdose classically presents with a triad of symptoms: central nervous system (CNS) depression (e.g., stupor, coma), respiratory depression, and miosis (constricted or pinpoint pupils).
- Hypotension (low blood pressure) and bradycardia (slow heart rate) are also characteristic cardiovascular findings due to the depressant effects of opioids on the body.
- Constricted pupils (miosis) occur because opioids stimulate the parasympathetic nervous system, which controls pupil constriction.
- These signs are a direct result of opioids binding to and activating mu (μ) receptors in the brain and other parts of the body.
Why Other Options Were Wrong
- Option B: Tachypnoea (rapid breathing) is the opposite of what occurs in an opioid overdose. Opioids are potent respiratory depressants, leading to bradypnea (slow breathing) or apnea (cessation of breathing).
- Option C: Papillary dilatation (mydriasis) and hypertensive crisis are classic signs of a sympathomimetic or stimulant overdose (e.g., cocaine, amphetamines), not an opioid overdose.
- Option D: Tremors and ataxia are not primary or specific indicators of an opioid overdose. While ataxia (poor coordination) can be a non-specific sign of CNS depression, tremors are more characteristic of withdrawal syndromes (like alcohol withdrawal) or toxicity from other substances.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Recognition of opioid overdose symptoms in acute care settings.
- Rapid recognition of the opioid overdose triad (CNS depression, respiratory depression, miosis) is a critical nursing skill in the emergency setting, as it allows for prompt intervention to prevent respiratory arrest and death.
- The priority nursing intervention for a suspected opioid overdose is to support the patient's airway and breathing (e.g., with a bag-valve-mask) and administer the opioid antagonist naloxone as prescribed.
- Nurses must monitor patients closely after naloxone administration, as its half-life can be shorter than that of the opioid, leading to a return of respiratory depression (renarcotization).
How to Approach the Question
- First, identify the key terms in the question: 'opioids' and 'overdose'. This immediately directs your thinking to the specific toxidrome associated with this class of drugs.
- Recall the primary effect of opioids: they are central nervous system depressants.
- Think about what a 'depressant' does to the body's key functions: it slows them down. This includes breathing (respiratory depression), heart rate (bradycardia), and blood pressure (hypotension).
- Remember the classic triad of opioid overdose: CNS depression, respiratory depression, and pinpoint pupils (miosis).
- Evaluate each option against this knowledge. 'Constricted pupils and hypotension' directly aligns with the known effects of an opioid overdose.
- Eliminate options that describe stimulant effects (dilated pupils, hypertension, tachypnea) or are less specific to opioid overdose (tremors).
Concept Tested & Keywords
- Concept Tested: Recognition of opioid overdose symptoms
- Stem keywords: emergency room, opioids, overdosed, symptoms
- Lead-in keywords: What symptoms indicate
- Clinical cues: 22 year old male
- Clinical cues: using opioids
Question ID
QP2CnIjYS0GHHKaDxW0-0b
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1219-1221
E6 Pharmacology Nursing Lilley 11e Part 1 p. 297-299
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 943-945
Practise the full GMCH Chandigarh - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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