translate the following text into Persian language, conserve the structure and use clinical voice:
Slide 1: Title Slide
Opioid Poisoning
Comprehensive Overview for Medical Professionals
Presented by:
Jennifer S. Love
Jeanmarie Perrone
Affiliation:
[Your Institution]
Slide 2: Introduction to Opioids
Definition and Classification
Opioids: Compounds related to opium with analgesic and sedative properties
Opiates vs. Narcotics
Opiates: Naturally occurring alkaloids (e.g., codeine, morphine)
Narcotics: Broader group, often used by law enforcement
Public Health Impact
Significant increase in opioid abuse in the U.S.
Rising Emergency Department (ED) visits over the past 20 years
Overdose Statistics
66% of drug overdose deaths in the U.S. (2016)
Key factors: Diversion, doctor shopping, nonmedical use
Slide 3: Pharmacology of Opioids
Mechanism of Action
Modulation of nociception in CNS, peripheral nervous system, and GI tract
Agonists at µ (mu), κ (kappa), and δ (delta) opioid receptors
Receptor Specificity and Effects
µ-Receptors: Analgesia, sedation, respiratory depression
κ-Receptors: Weaker analgesia, dysphoria, hallucinations
δ-Receptors: Analgesia, antidepressant effects
Types of Opioid Agonists
Full Agonists: Morphine, Hydromorphone
Partial Agonists–Antagonists: Buprenorphine, Pentazocine
Slide 4: Pharmacokinetics of Opioids
Absorption and Bioavailability
Peak blood levels: 30-60 minutes post-ingestion (oral)
Bioavailability varies: 10% to 80% after PO administration
Formulations and Duration
Short-acting vs. Long-acting vs. Sustained-release
Examples: Methadone (long-acting), Morphine SR (sustained-release)
Metabolism Considerations
First-pass hepatic metabolism
Impact of genetic variations (e.g., CYP2D6 polymorphisms)
Slide 5: Classification of Major Pharmaceutical Opioids
Naturally Occurring (Opiates)
Codeine, Morphine
Semisynthetic Derivatives
Buprenorphine, Hydrocodone, Oxycodone
Synthetic Opioids
Fentanyl, Meperidine, Methadone, Tapentadol, Tramadol
Equianalgesic Dosing and Characteristics
Refer to Table 186-1 for detailed comparisons
Slide 6: Opioid Intoxication - Clinical Features
Classic Toxidrome
Triad: Miosis, Lethargy, Respiratory Depression
Additional Symptoms
Orthostatic hypotension, Nausea, Vomiting
Histamine release: Urticaria, Bronchospasm
Severe Manifestations
Acute lung injury, Rhabdomyolysis, Seizures (Tramadol, Meperidine)
Slide 7: Opioid-Induced Acute Lung Injury
Incidence and Presentation
Occurs in ~10% of severe overdoses requiring naloxone
Symptoms: Tachypnea, Rales, Hypoxia, Pulmonary infiltrates
Pathophysiology
Alveolar injury from hypoxia or histamine release
Capillary leak and neurogenic injury
Management
Oxygen supplementation, Ventilatory support
Avoid diuretics and additional naloxone
Slide 8: Diagnosis of Opioid Intoxication
Diagnostic Triad
Respiratory rate <12 breaths/min, Miosis, Evidence of opioid use
Physical Examination
Inspect for drug paraphernalia, Injection marks, Fentanyl patches
Auscultate for pulmonary edema, Palpate for compartment syndrome
Differential Diagnosis
Clonidine overdose, Organophosphates, Sedative-hypnotics, Carbon monoxide
Slide 9: Opioid Screening and Testing
Urine Opioid Screens
Detect morphine, codeine, heroin, hydromorphone
Limitations: False positives from certain medications
Specific Immunoassays
Detect oxycodone, fentanyl, methadone specifically
Confirmation Testing
Gas chromatography/mass spectroscopy required for positive screens
Slide 10: Medications Causing False Positives on Opioid Screens
False-Positive Urine Opioid Screen
Poppy seeds, Rifampin, Quinine, Dextromethorphan
False-Positive Urine Methadone Screen
Chlorpromazine, Clomipramine, Doxylamine, Quetiapine
Clinical Implications
Importance of thorough patient history and confirmatory testing
Slide 11: Treatment of Opioid Intoxication - Initial Steps
Airway Management
Ensure airway protection and adequate ventilation
Use bag-valve mask as needed
Ventilatory Support
Supplemental oxygen, Possible intubation for severe cases
Immediate Pharmacological Intervention
Administration of Naloxone based on clinical presentation
Slide 12: Naloxone Administration Guidelines
Routes of Administration
Intravenous (IV), Intramuscular (IM), Subcutaneous (SC)
Intranasal, Nebulized
Dosing Strategies
Opioid-Dependent Patients: Start with 0.04 mg IV
Opioid-Naive Patients: Start with 0.4 mg IV
Apneic/Cyanotic Patients: Start with 2 mg IV
Duration and Re-dosing
Onset: 1-2 minutes (IV)
Duration: 20-90 minutes, may require repeated doses
Slide 13: Continuous Naloxone Infusions
Indications
Long-acting opioids, Sustained-release preparations, Transdermal patches
Dosing Calculations
Determine "wake-up dose" and administer two-thirds per hour by IV infusion
Monitoring and Adjustments
Adjust for respiratory depression or withdrawal symptoms
Admission to a monitored unit recommended
Slide 14: Opioid Antagonists Overview
Naloxone
Pure competitive antagonist at all opioid receptors
Reverses respiratory depression, sedation, miosis, analgesia
Other Antagonists
Naltrexone: Oral, extended-release for abstinence maintenance
Nalmefene: Not available in the U.S., used in Europe
Safety and Side Effects
Minimal adverse effects in opioid-naive patients
Withdrawal symptoms in opioid-dependent individuals
Slide 15: Management of Opioid Withdrawal Symptoms
Gradual Naloxone Dosing
Mitigate acute withdrawal by incremental dosing
Supportive Care
Address anxiety, nausea, vomiting, muscle cramps
Behavioral Health Considerations
Essential for patients with opioid use disorder
Integration into treatment and follow-up plans
Slide 16: Disposition and Follow-Up After Opioid Intoxication
Observation Periods
Heroin Intoxication: Safe discharge 1 hour post-naloxone if stable
Other Opioids: 4-6 hours observation after last naloxone dose
Long-acting Opioids: Minimum 8 hours observation
Hospital Admission Criteria
Moderate to severe symptoms, Polysubstance overdose
Need for continued naloxone administration
Follow-Up Care
Behavioral health evaluation for suicidal intent or opioid use disorder
Slide 17: Summary and Key Takeaways
Comprehensive Understanding
Opioid pharmacology, clinical features, and management strategies
Critical Interventions
Timely airway management, appropriate naloxone dosing
Holistic Patient Care
Importance of follow-up, behavioral health integration
Slide 18: References
Key Literature and Guidelines
Tintinalli's Emergency Medicine: A Comprehensive Study Guide
Relevant Clinical Studies and Reviews
Additional Resources
CDC Opioid Overdose Guidelines
Local Protocols and Treatment Pathways
Slide 19: Questions and Discussion
Open Floor for Audience Questions
Case Studies and Clinical Scenarios
Feedback and Experience Sharing