An 82-year-old man is admitted to the hospital after a new diagnosis of multiple myeloma. Treatment is initiated with bortezomib, lenalidomide, and dexamethasone. Intravenous morphine is administered at regular intervals for control of bone pain. Two days later his creatinine increases from 1.0 to 2.3 mg/dL. He is noted to be lethargic with respirations of 8/min (normal 12). Naloxone is administered and he becomes more alert with increased respirations. Which of the following may explain his response to morphine?

Question

An 82-year-old man is admitted to the hospital after a new diagnosis of multiple myeloma. Treatment is initiated with bortezomib, lenalidomide, and dexamethasone. Intravenous morphine is administered at regular intervals for control of bone pain. Two days later his creatinine increases from 1.0 to 2.3 mg/dL. He is noted to be lethargic with respirations of 8/min (normal >12). Naloxone is administered and he becomes more alert with increased respirations. Which of the following may explain his response to morphine?

Quizplus · Accepted Answer

The patient's renal function has declined, leading to the accumulation of morphine metabolites, which are primarily excreted by the kidneys. This accumulation can enhance the effects of morphine, causing respiratory depression and lethargy.

An 82-Year-Old Man Is Admitted to the Hospital After a New