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

Appeared in: INI-CET EXAM -2026

Explanation

The clinical triad of central nervous system depression (causing hypotension), respiratory depression, and miosis (pinpoint pupils) is the hallmark presentation of opioid toxicity.
Naloxone is a pure, competitive opioid antagonist specifically used to reverse the effects of an opioid overdose.
It acts rapidly to displace opioids from their receptors, thereby restoring adequate ventilation and reversing sedation.
According to the American Heart Association, naloxone is the drug of choice for reversing opioid-induced respiratory depression in an emergency setting.

Why Other Options Were Wrong

Option B: Flumazenil is the antidote for benzodiazepine overdose (e.g., diazepam, lorazepam).
Option C: Naltrexone is also an opioid antagonist, but it is long-acting and primarily used for the management of opioid and alcohol dependence to prevent relapse.
Option D: Atropine is an anticholinergic agent used to treat symptomatic bradycardia and organophosphate poisoning.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Opioid Toxicity as background academic context rather than a clinical decision trigger.
In any suspected overdose, the nurse's first priority is to assess and manage the ABCs: Airway, Breathing, and Circulation. Respiratory support should be initiated immediately if needed.
Rapid administration of naloxone is critical in a suspected opioid overdose to prevent respiratory arrest and hypoxic brain injury.
Nurses must continue to monitor the patient closely after giving naloxone. Naloxone has a shorter half-life (60-90 minutes) than many opioids. The patient may become re-sedated and experience recurrent respiratory depression, requiring repeated doses.

How to Approach the Question

First, analyze the clinical signs presented in the question: hypotension, respiratory depression, and pinpoint pupils.
Recognize that this combination of three specific signs forms a classic clinical triad.
Recall the common toxidromes (poisoning syndromes) and match the triad to the correct one. This triad is pathognomonic for opioid toxicity.
Once the toxidrome is identified, recall the specific antidote for that class of substance.
Select Naloxone as the specific and most appropriate antidote for acute opioid overdose from the given options.

Concept Tested & Keywords

Concept Tested: Management of Opioid Toxicity
Stem keywords: hypotension, respiratory depression, pinpoint pupils, child, antidote
Lead-in keywords: most appropriate
Clinical cues: The combination of hypotension, respiratory depression, and pinpoint pupils forms a classic triad pointing to opioid overdose.

Question ID

Qoulm389MlrHqN-J974vMY

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 1 p. 170-172

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 4584-4586

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 728-730

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