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Opioid toxicity — GPhC CRA MCQ

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ModerateCNS TherapeuticsOpioid toxicityGPhC CRA

A 46-year-old man prescribed morphine modified-release 30mg twice daily for cancer pain is also receiving immediate-release morphine for breakthrough pain. His wife reports he is increasingly drowsy, has pinpoint pupils and used six breakthrough doses yesterday after a dose increase. What would you advise the patient?

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Correct answer: B — Seek urgent clinical review before further opioid doses are escalated

Increasing drowsiness and pinpoint pupils after opioid dose escalation suggest opioid toxicity or excessive opioid exposure. Frequent breakthrough use also indicates that the pain regimen requires clinical review rather than ad hoc escalation. Modified-release morphine must not be crushed because this can cause dose dumping. The patient should receive urgent advice from the prescriber, specialist nurse or out-of-hours service depending on severity.

Reference: BNF; NICE CKS Palliative care pain