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Morphine renal impairment — GPhC CRA MCQ

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EasyRenal and Hepatic ImpairmentMorphine renal impairmentGPhC CRA

A palliative care nurse asks about an opioid for a patient with severe pain and eGFR 18 mL/min/1.73 m². The patient has developed drowsiness on oral morphine. What is the most appropriate alternative?

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Correct answer: B — Seek specialist advice about a renal-safer opioid

Morphine metabolites can accumulate in significant renal impairment and contribute to toxicity such as sedation. Specialist palliative care advice is appropriate when changing opioids in severe renal impairment. Codeine and pethidine also have important limitations in renal impairment. Ibuprofen may worsen renal function and is not appropriate for severe uncontrolled cancer pain without assessment.

Reference: BNF