It rapidly reverses opioid-induced respiratory depression, sedation, and pinpoint pupils.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client is prescribed buprenorphine-naloxone (a combination film) for opioid use disorder. Why is naloxone included in this combination product?
Answer: A. In the sublingual buprenorphine-naloxone product, naloxone is poorly absorbed sublingually and has little effect when taken as directed. It is included to deter misuse: if the product is dissolved and injected, the naloxone becomes active and precipitates withdrawal, discouraging diversion. It is not added to reverse buprenorphine when taken correctly, to boost the high, or to prevent constipation.
Question 2 of 3
A client on a heparin infusion develops bleeding from the gums and the aPTT is critically high. Which medication should the nurse anticipate administering as the antidote?
Answer: B. Protamine sulfate is the specific reversal agent for heparin. Vitamin K reverses warfarin, not heparin. Calcium gluconate treats hypocalcemia and magnesium toxicity, and naloxone reverses opioids.
Question 3 of 3
A nurse is preparing to give naloxone to a client with opioid-induced respiratory depression. Which response should the nurse anticipate and prepare to manage after administration?
Answer: B. Naloxone has a short half-life and reverses analgesia, so the client may experience the abrupt return of severe pain and acute withdrawal (agitation, tachycardia, hypertension). Because naloxone may wear off before the opioid does, re-sedation can occur and repeat dosing or monitoring is required.
Keep the streak going with more questions like these, each with a full rationale.
What is naloxone?
It competitively displaces opioids from receptors and restores breathing within minutes. Key principle: it has a short duration, so the patient must be monitored for re-sedation when the opioid outlasts it.
Key points to remember
- It rapidly reverses opioid-induced respiratory depression, sedation, and pinpoint pupils.
- Its duration is shorter than most opioids, so respiratory depression can return and repeat doses may be needed.
- It can precipitate acute opioid withdrawal: agitation, tachycardia, sweating, nausea, and pain.
- It is given IV, IM, subcutaneously, or intranasally and is titrated to restore adequate breathing.
- It has no effect in the absence of opioids.
Signs & symptoms
- Target: RR <12, pinpoint pupils
- Sedation, unresponsive, ↓BP
Nursing priorities
- Maintain airway and support breathing while administering naloxone.
- Monitor respiratory rate, oxygen saturation, and level of consciousness continuously.
- Reassess for re-sedation because naloxone wears off before the opioid does.
- Titrate the dose to restore breathing without causing severe withdrawal.
- Anticipate repeat dosing or a continuous infusion for long-acting opioids.
Patient teaching
- Caregivers should learn to give intranasal naloxone and always call 911 afterward.
- The effect is temporary; stay with the person until help arrives.
- More than one dose may be needed if breathing slows again.
Red flags: report now
- Continue monitoring after reversal; re-sedation and respiratory depression can recur.
- Report return of slowed breathing or decreased consciousness.
- Anticipate sudden withdrawal and possible combativeness after administration.
References
Clinical references for this topic
