NAPLEX Question of the Week: Antidotes

Antidotes are a lifesaving, key group of medications that every pharmacist should have knowledge including dosing, administration, and storage. Today's question focuses on the most common reversal agent given in clinical practice.

Like Comment

A 54 yo F with a PMH of diabetes, osteoarthritis, and hypertension presents to the ED from home after being found very unresponsive by husband who brought her in via private vehicle. Home medications include glipizide, metformin, Norco, and Zestoretic. Blood gas is significant for increased pCO2 with a respiratory rate of 5 per minute. The attending wishes to administer naloxone.

Naloxone is available in which of the following dosage forms for opioid reversal? Select all that apply.

A. Inhalation

B. Intranasal

C. Injection

D. Oral solution

E. Sublingual tablet





Answer and Rationale: B and C are the correct answers. The opioid epidemic has had a tremendous impact on morbidity and mortality within the world including the United States. Pharmacists are poised to provide naloxone to at risk patients as nearly every state allows for dispensing without a prescription. Therefore knowledge of naloxone is crucial in order to provide patients and their families with a medication that could save lives. This patient is on Norco which contains hydrocodone which most likely led to the patient's presentation. Naloxone is not commercially available as an inhalation solution making answer A incorrect. Naloxone is not available in an oral solution making D incorrect. Additionally, naloxone is available as a sublingual tablet with buprenorphine for opioid dependence but not as an acute reversal agent. Therefore answer E is incorrect.

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career. 


Go to the profile of Matthew Stanton
almost 2 years ago

Hi Dr. Bland,

I have some questions regarding this question.  Is naloxone available as inhalation? I'm not familiar with that product.  Perhaps I'm confusing dosage form vs route of administration?  For example, the injection can be used as inhalational therapy (off label), but it's a solution dosage form.  Same for the intranasal products which now there is a product available, but we used the solution for intanasal use for many years.  I may have the wrong thought process surrounding this.  Thank you.


Go to the profile of Christopher M. Bland
over 1 year ago

Hi Matthew- Thank you for your question and very sorry for the delay in response as I'm just seeing this. I agree that the inhalation is more of an off-label usage and would not be the most appropriate answer as the exam mainly focuses on "on-label" uses. Therefore I'm going to modify this to just B and C. Thank you for your attention to detail!