NBME 20 Naloxone (NBME Answers)

NBME 20 Answers

nbme20/Block 4/Question#41 (reveal difficulty score)
A 56-year-old man with a 20-year history of ...
Naloxone 🔍 / 📺 / 🌳 / 📖
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+9 upvote downvote
submitted by ∗waterloo(126)

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if you look at the answer choices, they are all pain suppressors except for naloxone.

Naloxone is an opoid antagonist so blocking mu receptors would lead to increase in mediators that induce pain.

I don't think you need to know any experimental data, or really anything before the last two sentences. He is given something that reduces pain (opioid agonist), and if you give him naloxone you would be reducing the effect of his opoid agonist.

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+2 upvote downvote
submitted by ∗usmleuser007(464)

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https://www.ncbi.nlm.nih.gov/pubmed/301658

Relief of intractable pain was produced in six human patients by stimulation of electrodes permanently implanted in the periventricular and periaqueductal gray matter. The level of stimulation sufficient to induce pain relief seems not to alter the acute pain threshold. Indiscriminate repetitive stimulation produced tolerance to both stimulation-produced pain relief and the analgesic action of narcotic medication; this process could be reversed by abstinence from stimulation. Stimulation-produced relief of pain was reversed by naloxone in five out of six patients. These results suggest that satisfactory alleviation of persistent pain in humans may be obtained by electronic stimulation.

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usmleuser007 These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2

xxabi I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +24

xxabi Also its the only one that's an opioid antagonist from the list! +2

redvelvet they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4

champagnesupernova3 Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2

champagnesupernova3 Enkephalins* not encephalitis +

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submitted by ∗neovanilla(57)

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The crux of the question is asking, if the patient feels decreased pain (which is driven by opioid molecules; that's why opioids are administered as painkillers), then how do you stop the inhibition? An opioid antagonist (naloxone is the only one that is an antagonist)

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neovanilla wrong answers: b-endorphin - an endorphin and ACTH hormone (similar to ACTH, POMC) that can bind to the µ-opioid receptor Enkephalin - a neurotransmitter involved in the indirect basal ganglia pathway (along with GABA); it can also bind to delta-opioid receptors Morphine - an opioid agonist (used for pain relief) Oxycodone - Another opioid agonist (~same potency as morphine) +4

kevin enkephalin, endorphin, dynorphin are the bodies endogenous opioids +1

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