This opioid is discouraged due to large histamine release, toxic metabolite that may cause seizures, and can be fatal if given with an MAOI.

This opioid is discouraged due to large histamine release, toxic metabolite that may cause seizures, and can be fatal if given with an MAOI.

• A. Demerol (Meperidine)
• B. Morphine sulfate
• C. Fentanyl
• D. Hydromorphone

Answer: (A)

Meperidine stands out because of a dangerous combination of properties: it produces a toxic metabolite, normeperidine, that can accumulate and provoke CNS excitation and seizures, especially in patients with kidney impairment or when given repeatedly. It also has a notable histamine-releasing effect, which can cause hypotension and pruritus. Most importantly for safety, combining it with a monoamine oxidase inhibitor can lead to a potentially fatal reaction, including severe agitation, hyperthermia, and seizures. Other opioids like morphine, fentanyl, and hydromorphone do not have the same combination of a neurotoxic metabolite and dangerous MAOI interaction, making this opioid the one to avoid.

Meperidine stands out because of a dangerous combination of properties: it produces a toxic metabolite, normeperidine, that can accumulate and provoke CNS excitation and seizures, especially in patients with kidney impairment or when given repeatedly. It also has a notable histamine-releasing effect, which can cause hypotension and pruritus. Most importantly for safety, combining it with a monoamine oxidase inhibitor can lead to a potentially fatal reaction, including severe agitation, hyperthermia, and seizures. Other opioids like morphine, fentanyl, and hydromorphone do not have the same combination of a neurotoxic metabolite and dangerous MAOI interaction, making this opioid the one to avoid.