A 70-year-old male with mild dementia and history of intravenous drug abuse, currently on methadone, was admitted to the ICU with obstructive nephropathy. Based on the initial workup, it is likely secondary to advanced prostate cancer with metastatic disease to the bones. He has postobstructive renal acute kidney injury and has been admitted for further care. He was placed on his home dose of methadone.
Which of the following is TRUE regarding methadone?
Correct Answer: A
Methadone is a unique opioid medication with a long duration of action that can be useful in the treatment of opioid addiction. It is also used for cancer-related pain and chronic pain conditions. Methadone is a mureceptor agonist and an NMDA receptor antagonist. Similar to other opioids, it undergoes hepatic metabolism by the cytochrome P450 family via N-methylation. It has no active metabolites. Fecal elimination is the primary process through which methadone is excreted. There is a minimal amount of renal elimination. Therefore, there is no need for a dose adjustment for those with renal dysfunction.
Which of the following antibiotics requires dose adjustment in stage 5 CKD patient?
Correct Answer: D
There are multiple antibiotics that have significant nonrenal excretion routes. Antibiotics such as azithromycin, ceftriaxone, clindamycin, doxycycline, linezolid, metronidazole, moxifloxacin, nafcillin, oxacillin, rifampin, and tigecycline do not require dose adjustment in patients with severe renal disease. Cefazolin, on the other hand, requires dose adjustment based on creatinine clearance.
A patient with chronic renal failure and 60 % (body surface area) burns is undergoing a 20-minute dressing change in the ICU.
Which of the following opioids has the most favorable profile?
Correct Answer: B
All of the opioids listed undergo significant renal elimination except for remifentanil. Remifentanil undergoes rapid metabolism in the blood by plasma esterases. Although its metabolite remifentanil acid requires renal elimination, it has not been shown to be clinically significant.
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