Toxicology: tramadol overdose: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Toxicology: tramadol overdose

Sample item

A young man who took a large quantity of tramadol has a generalised seizure, after which he is drowsy with slow breathing. Which statement about his management is correct?

AFlumazenil is the antidote of choiceBPhenytoin is the drug of choice for the seizuresCNaloxone reverses the respiratory depression but may not stop the seizures and can precipitate themDNaloxone reliably stops tramadol seizures

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Naloxone reverses the respiratory depression but may not stop the seizures and can precipitate them

Tramadol is an opioid and also a serotonin and noradrenaline reuptake inhibitor, and its seizures are not mediated through opioid receptors. Naloxone treats the respiratory depression but may lower the seizure threshold. Benzodiazepines are used for seizures.

Option by option

A. Flumazenil is the antidote of choice
Flumazenil antagonises benzodiazepines and may itself provoke seizures.
B. Phenytoin is the drug of choice for the seizures
Phenytoin is not effective for toxin-induced seizures and benzodiazepines are preferred.
C. Naloxone reverses the respiratory depression but may not stop the seizures and can precipitate them (correct)
Correct. Naloxone corrects the opioid effect but does not treat, and may provoke, tramadol seizures.
D. Naloxone reliably stops tramadol seizures
The seizures are not opioid-receptor mediated, so naloxone does not reliably stop them.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Naloxone reverses the respiratory depression but may not stop the seizures and can precipitate them. Tramadol is an opioid and also a serotonin and noradrenaline reuptake inhibitor, and its seizures are not mediated through opioid receptors.

Why is "Flumazenil is the antidote of choice" not the answer?

Flumazenil antagonises benzodiazepines and may itself provoke seizures.

Why is "Phenytoin is the drug of choice for the seizures" not the answer?

Phenytoin is not effective for toxin-induced seizures and benzodiazepines are preferred.

Why is "Naloxone reliably stops tramadol seizures" not the answer?

The seizures are not opioid-receptor mediated, so naloxone does not reliably stop them.

What concept does this question test?

It tests Toxicology: tramadol overdose in Forensic Medicine. Naloxone treats the respiratory depression but may lower the seizure threshold. Benzodiazepines are used for seizures.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: tramadol overdose?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.