A young man is found drowsy with respiratory rate of 6 per minute, pinpoint pupils unreactive to light, and cyanosis. Needle tracks are seen over both forearms. After securing the airway, the immediate drug of choice is:
- A Flumazenil
- B Naltrexone
- C Naloxone ✓
- D Physostigmine
Correct answer: C. Naloxone
Explanation
Coma, respiratory depression and pinpoint pupils form the classic opioid overdose triad, and needle tracks suggest injection drug use. Naloxone, a pure competitive mu receptor antagonist, is the immediate antidote because it reverses respiratory depression within minutes. Flumazenil reverses benzodiazepines, naltrexone is a long-acting antagonist used for relapse prevention and not for acute resuscitation, and physostigmine treats anticholinergic toxicity.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
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Written and medically reviewed by the StethoPrep medical team.