Opiates toxicity

Respiratory predominant -> acute respiratory acidosis

pupillary constriction, constipation, bradycardia, hypothermia, and hypotension

Opiate overdose is fatal ==> Give naloxone immediately. (it can be both therapeutic and diagnostic)

Withdrawal is uncomfortable, but not fatal

Opiate withdrawal symptoms:

3-4 hrs:  fear, anxiety, and drug craving

8-14 hrs:  insomnia, yawning, rhinorrhea, diaphoresis, mydriasis, anxiety

1-3 days:  tremor, muscle spasms, vomiting, diarrhea, tachycardia, chills, piloerection

Usually treated with methadone or buprenorphine

Benzodiazepines

somnolence, dysarthria, ataxia, and stupor

very rarely cause death from respiratory depression

Most deaths from benzodiazepine ingestion are in association with ethanol or barbiturate ingestion.

Tx

Benzodiazepine overdose by itself is not fatal and acute withdrawal causes seizures. Do NOT give flumazenil if you are not sure of dependency or chronic use.

Barbiturates

respiratory and CNS depression