TYK403

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

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

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