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.

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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.

Go to the profile of Christopher M. Bland

Christopher M. Bland

Clinical Associate Professor, University of Georgia College of Pharmacy

2 Comments

Go to the profile of Matthew Stanton
Matthew Stanton 6 months 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.

Matt

Go to the profile of Christopher M. Bland
Christopher M. Bland 3 months 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!