Which opioid can cause pupillary dilation rather than miosis in overdose, and may trigger serotonin syndrome when combined with SSRIs?
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Correct answer: Meperidine
Meperidine has atropine-like (antimuscarinic) effects that can counteract opioid-induced miosis. It also inhibits the reuptake of serotonin, which can lead to life-threatening serotonin syndrome if used with other serotonergic drugs.
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