Which of the following medications would be most likely to cause an unintended respiratory arrest in a patient with renal insufficiency?

a) Meperidine

b) Hydromorphone

c) Codeine

d) Fentanyl

e) Remifentanil

Click for Answer

Answer

Answer c. Morphine is partially metabolized into the active metabolite morphine-6-glucuronide. In patients with renal insufficiency or failure, morphine-6-glucuronide may accumulate (based on its renal elimination); this may result in unanticipated respiratory depression or arrest in these patients. Because codeine is a pro-drug whose effect depends on metabolism into morphine, codeine administration may also result in toxic accumulation of morphine-6-glucuronide and should be avoided in these patients. Meperidine is also contraindicated in renal failure patients due to accumulation of normeperidine; however, accumulation of this metabolite causes seizures, not respiratory depression.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

Keywords



<Prev Question --- Next Question>

About Test Your Knowledge