Sample NBDE Part II Question

Directions: Read the following question and select the best answer from the choices below.

Which of the following analgesics are most likely to cause seizures in an individual with renal insufficiency?

  1. Acetaminophen
  2. Ibuprofen
  3. Meperidine
  4. Morphine
  5. Propoxyphene


Answer & Explanation:

The answer is C.

Individuals with renal dysfunction are at a particularly high risk for developing toxicity secondary to the accumulation of compounds normally excreted through the kidneys. Meperidine is a narcotic analgesic used in the treatment of moderate to severe pain. In renally compromised individuals, its hepatic metabolite (normeperidine), which is normally excreted through the kidneys, can accumulate resulting in the development of myoclonic seizures. Although dosage adjustments of the other analgesics have to be made in patients with renal dysfunction, they are not associated with the development of seizures in patients.

Acetaminophen (choice A) is a non-narcotic analgesic indicated for the treatment of mild to moderate pain. It is commonly found in many narcotic analgesic combination products.

Ibuprofen (choice B) is a non-steroidal antinflammatory drug (NSAID) used in the treatment of mild to moderate pain caused by inflammation. The use of NSAID's in renally compromised individuals is not recommended since they can decrease renal blood flow.

Morphine (choice D) is a narcotic analgesic used in the treatment of moderate to severe pain. Morphine can accumulate in renal failure patients; however, the resulting toxicity is typically respiratory depression and sedation.

Propoxyphene (choice E) is mild narcotic analgesic used in the treatment of mild to moderate pain. It can also accumulate in renal failure patients resulting in sedation and respiratory depression.