Tue16November0750PM 3

An 83-year-old lady with known end stage breast carcinoma and acute kidney injury (GFR 38 ml/min) presents with uncontrolled pain, despite being on paracetamol and codeine.

Which of the following drugs would you add to best manage her symptoms?

(Please select 1 option)

Alfentanil This is the correct answer

Morphine

Oxycodone Incorrect answer selected

Fentanyl patch

Buprenorphine

Explanation

Alfentanil is a potent short acting opioid. It is metabolised via P450 enzyme and CYP3A4 in the liver. It is the preferred drug in renal impairment.

All of the other drugs listed here accumulate in renal failure and so would be contraindicated or used with caution.

It is worth noting that alfentanil may cause respiratory depression as an adverse effect or in overdose; this would need to be managed using naloxone (opioid reversal) and advanced airway techniques. Flumazenil should be kept at hand in cases of respiratory depression secondary to benzodiazepine use.

Answer Statistics

1

10%

2

5%

3

40%

4

32%

5

14%

Times answered: 266