A client is admitted with needle tracks on his arm, stuporous and with pinpoint pupil will likely be managed with:
A. naltrexone (Revia)
B. naloxone hydrochloride (Narcan)
C. disulfiram (Antabuse)
D. methadone (Dolophine)
Correct Answer: B. naloxone hydrochloride (Narcan)
Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Common opioid overdoses treated with naloxone include heroin, fentanyl, carfentanil, hydrocodone, oxycodone, methadone, and others.
Option A: This is an opiate receptor blocker used to relieve the craving for heroin. Naltrexone is an opioid antagonist used to treat alcohol use disorder and opioid dependence. Naltrexone is a mu-opioid antagonist. It is FDA-approved for alcohol abuse and opioid dependence treatment. Off-label use includes treatment of cholestatic pruritus in adults. Researchers are studying its use in patients with stimulant addiction, particularly for patients with polydrug dependence on opioids, heroin, and amphetamine.
Option C: Disulfiram is used as a deterrent in the use of alcohol. Disulfiram is one of three drugs approved by the FDA for the treatment of alcohol dependence. It is a second-line option (acamprosate and naltrexone are first-line treatments) in patients with sufficient physician supervision. Disulfiram is safe and efficient in supervised short-term and long-term treatment of individuals dependent on alcohol but who are motivated to discontinue alcohol use.
Option D: Methadone is used as a substitute in the withdrawal from heroin. Methadone and buprenorphine are FDA approved to treat opioid use disorder as part of federally regulated opioid treatment programs. Methadone prescriptions are for detoxification and maintenance therapy. Methadone is a useful agent for opioid withdrawal symptoms such as tachycardia, diaphoresis, nausea, vomiting, diarrhea, etc.