A 65-year-old woman with stage 4 chronic kidney disease (eGFR 20 mL/min) requires strong opioids for metastatic cancer pain. Which opioid is PREFERRED in significant renal impairment due to hepatic metabolism producing inactive metabolites?

• A Morphine
• B Pethidine
• C Codeine
• D Fentanyl ✓

Explanation

Fentanyl is metabolized in the liver to inactive metabolites and is the preferred opioid in renal impairment. Morphine has active metabolites (morphine-6-glucuronide and morphine-3-glucuronide) that accumulate in renal failure, causing neurotoxicity and prolonged sedation. Pethidine's metabolite normeperidine accumulates and can precipitate seizures. Codeine is a prodrug with unpredictable metabolism and weak analgesia.

Reference: Oxford Textbook of Palliative Medicine, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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