A 70-year-old man with metastatic prostatic cancer is brought to the hospital due to worsining fatigue for the past several days. A year ago, the patient was diagnosed with prostatic cancer, which has progressed despite chemotherapy treatment and metastasized to the bone. The patient is receiving palliative care, and her pain has been adequately controlled with a stable dose of oral morphine. Temperature is 36.7 C (98 F), blood pressure is 110/62 mm Hg, pulse is 92/min, and respirations are 8/min. On physical examination, the patient is somnolent and responds to painful stimuli only. The pupils are small and sluggish to react. The lungs are clear to auscultation, and heart sounds are normal. The abdomen is soft and nondistended. Arterial blood gas analysis shows respiratory acidosis. Which of the following medication-related events most likely precipitated her current condition?

Question

A 70-year-old man with metastatic prostatic cancer is brought to the hospital due to worsining fatigue for the past several days. A year ago, the patient was diagnosed with prostatic cancer, which has progressed despite chemotherapy treatment and metastasized to the bone. The patient is receiving palliative care, and her pain has been adequately controlled with a stable dose of oral morphine.  Temperature is 36.7 C (98 F), blood pressure is 110/62 mm Hg, pulse is 92/min, and respirations are 8/min.  On physical examination, the patient is somnolent and responds to painful stimuli only.  The pupils are small and sluggish to react.  The lungs are clear to auscultation, and heart sounds are normal.  The abdomen is soft and nondistended.  Arterial blood gas analysis shows respiratory acidosis.  Which of the following medication-related events most likely precipitated her current condition?

Quizplus · Accepted Answer

Eductional Objective: Morphine generates 2 major metabolites that are metabolically active and renally cleared.  These metabolites can accumulate in the bloodstream of patients with renal dysfunction and lead to opioid toxicity, evidenced by miosis, respiratory depression, and CNS depression.

A 70-Year-Old Man with Metastatic Prostatic Cancer Is Brought to the Hospital