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NBME 22 Answers

nbme22/Block 1/Question#5 (29.2 difficulty score)
A 10-month-old girl is brought to the ...

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submitted by d_holles(198),
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ihsT nuisqteo encosdfu em bc I uhthotg ldmoireepa ulocd ont orcss teh BBB dna hfrteeoer ldouc nto ecsau asrryrtpeoi soidpeersn p-o(iiodum onsmgia at eht mbitsenra sutsrle in rstSrepyr/CaoNi porinse,esd .)1 utB .dx@xr si certcro ni ntnoig htta ↓ RR dan NSC rnsepdosie in the tP dsulho llac fro na -ioudipmo otngsiatan artreh atnh coenahtbhl ii(mcholimtenc)o ot ttrea icnt.aiosntpo

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nwinkelmann This explains a case in an infant. "Respiratory depression and coma after overdosage have been shown to be reversible by injection of naloxone [6]. Owing to its structural similarity to opioid, loperamide toxicity can be reversed by using Nalaxone which is a specific opioid antagonist acts competitively at opioid receptors. Naloxone hydrochloride is usually given intravenously for a rapid onset of action which occurs within 2 minutes." +3  
yb_26  FA 2019: "Loperamide has poor CNS penetration" - so it still penetrates => can cause respiratory depression +4  
whoissaad  Also maybe because the blood brain barrier in a baby is not developed as well as in an adult. +4  

submitted by pingra(4),

I looked at it this way:

A ten month girl receiving adult doses of a mu agonist (which has POOR CNS penetration not zero) could probably have some adverse effects

I then read that the kid has a decreased RR (10/min) and marked abdominal dissension (prob due to the fact that opioids slow peristalsis; sketchy pharm also says opioids can lead to biliary colic)

Figured naloxone would reverse these symptoms

submitted by syoung07(38),

Loperamide is a Mu opioid agonist that can be used to tx diarrhea. It doesn't cross the BBB so theres no chance of addiction but you can still see the effects of opioid overdose I believe. So tx opioid overdose with naloxone.

submitted by dr.xx(157),
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olramN oasryprtrei erta orf a 10 htomn dol t;g& 05 htsarbe per uimtn.e

xaNoolne oduslh be vegni ni eht eernescp of ysrroeitrap droiesnpse adn yam eerqriu edreatpe osdn.ig