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Opioid choice in renal impairment — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentOpioid choice in renal impairmentGPhC CRA

A frail 86-year-old man with eGFR 18 mL/min/1.73 m2 is prescribed codeine 30 mg four times daily for severe back pain. His daughter reports increasing drowsiness after two doses. What is the most appropriate alternative?

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Correct answer: E — Arrange urgent opioid and analgesic review

Codeine and morphine-related metabolites can accumulate in severe renal impairment, increasing sedation and toxicity. New drowsiness after starting opioids is a safety concern. The prescriber should review analgesic choice, dose and the cause of severe pain urgently.

Reference: https://www.pharmacyregulation.org/students-and-trainees/pharmacist-education-and-training/registration-assessment