a. Findings. Classic triad of opioid intoxication is mental status depression, respiratory depression, and pinpoint pupils. Bradycardia, hypotension (rare), hypothermia, hyporeflexia, and needle marks may be present.
b. Agents. Morphine, heroin, designer fentanyls, oxycodone, hydromorphone, and propoxyphene are commonly associated with this toxidrome. Meperidine, pentazocine, and dextromethorphan may cause CNS and respiratory depression but are often associated with dilated pupils. Central a2-receptor agonists (eg, clonidine, guanabenz, guanfacine, and imidazoline derivatives) act on the locus ceruleus of the CNS and cause many of the same symptoms in the overdose setting.
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