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Pharmacology Duration of effect: 30–60 minutes, may require redosing

Competitive opioid antagonist Onset: 2 minutes IV; 2–5 minutes IM/SC Hepatic metabolism Renal excretion Histamine receptor (H1) antagonist Hepatic metabolism Renal excretion

Side-Effects and Notes Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood Short duration of action relative to longer-acting narcotics (e.g., morphine); may need to redose before narcotic effect May potentiate the effect of other sedative agents May cause paradoxical CNS stimulation (e.g., agitation or Mild anticholinergic and may cause dry secretions (dry mouth, constipation, urina

Withdrawal reaction precipitated pressure, and tremulousness has worn off May reduce seizure threshold anxiety) and/or psychosis flushing, fever, tachycardia May reduce nausea citrate; PO, per os (by mouth); PRN, as needed; RR, respiratory rate; SC, subcutaneous; TBI, traumatic brain injury; TCCC, Tactical Combat Casualty Care. Lower likelihood of accumulating in the setting of organ dysfunction (particularly renal injury/insufficiency)

Purpose/Dose For reversal of opioid overdose 0.4–2mg IV/IM/SC/IN; repeat every 2–3 minutes PRN; not For itching or allergic reaction (may also cause drowsiness) 25–50mg IV/IO/PO every 4–6 hours PRN (maximum: *Hydromorphone is selected as the opioid medication of choice in the PFC setting for the following reasons: 3. Smaller doses produce greater effect; thus, less medication needs to be carried for longer duration of treatment 4. Less hista

Appendix D Cont. Name to exceed 10mg (0.01mg/kg) (Narcan) Naloxone 400mg daily) (Benadryl) Diphenhydramine 1. Long acting **Morphine 1. Long acting 2. Can give IM if necessary, but not preferred ***Fentanyl 1. Short acting 2. Faster onset 4. Be prepared to support breathing if necessary 5. Reserved for severe pain or procedures

2.

116 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017