A patient in the last days of life has severe renal failure and needs a strong opioid. Which approach is most appropriate?
Answer and explanation
Correct answer: A. An opioid not dependent on renal excretion, such as alfentanil or fentanyl, with specialist advice
- Step 1: Morphine and its active metabolites accumulate when the kidneys fail. Step 2. Opioids with hepatic metabolism and inactive metabolites are preferred, with specialist palliative input. Answer: An opioid not dependent on renal excretion, such as alfentanil or fentanyl, with specialist advice. Why not the others: Morphine can cause toxicity from metabolite accumulation. Withholding opioids leaves pain untreated. Codeine is a weak opioid with active metabolites that also accumulate.
Practise more Cancer and palliative care.
Free questions with an explanation for every one, and full timed UKMLA Applied Knowledge Test (MSRA-style single best answer) mock tests.
More Cancer and palliative care questions
- At what ages are women invited for routine NHS breast screening in England?
- A patient with high-grade lymphoma starts chemotherapy and soon has potassium 6.5 mmol/L, phosphate 2.8 mmol/L, calcium 1.7 mmol/L and a ris…
- A man with known lung cancer has progressive facial swelling, dilated neck veins and stridor. What is the appropriate management?
- Which prescribing principle applies when a patient starts regular strong opioids for cancer pain?
- A patient with cancer pain is stable on modified-release morphine 60 mg twice daily but has episodes of breakthrough pain between doses. Wha…
- Which medication is recommended as a first-line option for neuropathic pain in non-specialist settings according to NICE?