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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
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==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==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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