Narcotic antagonists
Naloxone (Narcan)
In suspected narcotic overdose, small increments (< 0.1 mg) may be used IV until the desired effect is obtained or until 10 mg have been administered with no response. Small increments are used rather than a large bolus injection in order to prevent narcotic withdrawal in the patient who is dependent on opioids. Large bolus injections of naloxone may also unmask adverse effects of co-ingestants (eg, scopolamine, amphetamines, cocaine), resulting in a sympathetic or an anticholinergic crisis. When desired effect is obtained and patient requires continuous infusion, a drip solution is mixed so that two thirds of the originally effective dose is administered qh. To prepare drip, add 40 mg naloxone to 1 L D5W or NS and infuse at 10 mL/h (0.4 mg/h).
GI decontaminants
Polyethylene glycol (GoLYTELY, Colyte)
Polyethylene glycol is a laxative with strong electrolyte and osmotic effects that has cathartic actions in the GI tract. It is used in whole-bowel irrigation.
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Heroin-related noncardiogenic pulmonary edema.
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Track marks in a heroin intravenous drug user.
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Necrotizing fasciitis in a heroin user.
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Endocarditis-related septic pulmonary emboli in a heroin user.
