Mary Lynn McPherson
speaker
498 appearances
2 recordings
1 series
first heard Oct 2018
last heard Dec 2021
Mary Lynn McPherson’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
But all the opiates are handled by the liver.
I think you have a little more flexibility in making better choices when the person has renal impairment because
Methadone, we believe its main metabolite is largely pharmacologically inactive.
Although there's a hint of data now that perhaps that metabolite may be the culpable agent with QTC prolongation, but for intents and purposes, let's say it's they're pharmacologically inactive, as is as are the metabolites of fentanyl.
So those would be better choices of people with significant renal impairment.
Oh all of them.
Absolutely.
So all the opiates are handled by the liver.
The most problematic in my mind is gonna be the methadone because it could take you two weeks to get to steady state with an incompetent liver.
Yeah.
I'll tell you my I think the naughtyest kittens are clearly morphine, but I think hydromorphone is almost just as bad.
And I know prescribers think that hydromorphone is such a clean drug, but both morphine and hydromorphone are metabolized to a three glucuronide metabolite.
And that's the bad boy that accumulates and can cause opiate induced hyperalgesia.
By the liver.
the liver.
And then but they're far it's a pharmacologically active metabolite that relies on renal excretion.
So if you have bad kidneys, that sucker's gonna accumulate and can cause hyperalgesia.
muscle twitching, seizures, coma, even death.
Not a good look.
I think uh the best are gonna be the fentanyl and the methadone and frankly the rest, the hydrocodone and the oxycodone, are in the middle.
Showing 241–260 of 498 · page 13 of 25
← Previous
Next →