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Opioid toxicity — DipIMC MCQ

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ModerateMedical EmergenciesOpioid toxicityDipIMC

A 64-year-old woman is found with pinpoint pupils, shallow respirations at 6/min and oxygen saturations of 82%. A family member reports recent morphine dose escalation for cancer pain. What is the most appropriate drug/dose?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Naloxone titrated to restore adequate ventilation while supporting breathing

Opioid toxicity causing respiratory depression should be treated with airway support, ventilation and titrated naloxone. The goal is adequate ventilation, not necessarily full arousal with severe pain or withdrawal. Flumazenil is a benzodiazepine antagonist and can be hazardous in mixed overdose. The pearl is that oxygenation and ventilation are the immediate lifesaving interventions.

Reference: JRCALC Guidelines 2025; TOXBASE principles