INI-CET 2026 — Forensic Medicine

Q: A child presents with hypotension, respiratory depression, and pinpoint pupils. What is the most appropriate antidote?

Naloxone. ***Naloxone*** - This agent is the **opioid receptor antagonist** of choice for reversing acute opioid toxicity, which classically presents with the triad of **respiratory depression**, **CNS depression (coma)**, and **miosis (pinpoint pupils)**. - It has a short half-life, making it suitable for emergency reversal, though patients must be monitored for the recurrence of opioid effects as the antagonist wears off. *Flumazenil* - This is a specific antagonist for **benzodiazepine receptor** toxicity and is used to reverse sedation from benzodiazepines. - It is contraindicated in patients with suspected mixed overdose or chronic benzodiazepine use due to the high risk of precipitating **seizures**. *Naltrexone* - This is an **opioid receptor antagonist**, but it has a much longer duration of action and is primarily used for the long-term maintenance treatment of **opioid dependence** and alcohol use disorder. - It is not suitable for acute emergency management of overdose because it does not provide the rapid-onset reversal needed in life-threatening respiratory depression. *Atropine* - This is a **muscarinic acetylcholine receptor antagonist** used primarily in the treatment of organophosphate poisoning (cholinergic toxicity) or symptomatic bradycardia. - It would worsen the miosis and CNS depression seen in this child and provides no benefit for opioid-induced respiratory depression.

11 Questions — Page 2 of 2

Q11

A child presents with hypotension, respiratory depression, and pinpoint pupils. What is the most appropriate antidote?