Paper I
2025 August (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

A drug addict is found in a state of stupor with flaccidity of muscles, shallow breathing, fall in BP and pinpoint pupils. A diagnosis of Morphine overdose is made.

  • (a) How do you treat a case of Morphine poisoning 3 mark(s)
  • (b) What are the contraindications of Morphine 3 mark(s)
Q26 marksEssays

Answer

a) Treatment of morphine poisoning

  • Maintain airway, breathing, circulation — assisted ventilation/oxygen for respiratory depression, this is the immediate life-threatening priority
  • Naloxone (specific opioid antagonist) — IV, titrated to reverse respiratory depression without precipitating severe withdrawal; repeated dosing or infusion often needed since naloxone’s duration is shorter than morphine’s
  • Gastric lavage/activated charcoal if oral ingestion and presentation is early
  • Supportive care — IV fluids for hypotension, continuous monitoring (morphine’s duration may outlast a single naloxone dose, risking re-sedation)

b) Contraindications of morphine

  • Head injury/raised intracranial pressure — CO₂ retention from respiratory depression further raises ICP, and miosis masks the pupillary sign of deterioration
  • Bronchial asthma — histamine-mediated bronchospasm
  • Severe hepatic impairment — reduced first-pass metabolism, risk of toxicity
  • Labour and near-term pregnancy — neonatal respiratory depression
  • Concurrent MAO inhibitors — risk of a serotonin-syndrome-like reaction

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