Abstract:
ADVERSE EVENT:Repeated and prolonged episodes of central apnoea and hypoxia after receiving intravenous morphine for analgesia and ketamine for sedation. DRUG IMPLICATED:Intravenous morphine sulfate. THE PATIENT:Previously healthy 12-year-old male with no history of sleep apnoea who presented with distal tibia and fibula fracture. EVIDENCE THAT LINKS DRUG TO EVENT:Pharmacogenomic testing revealed that the patient was homozygous for the T allele at the rs887829 SNP in UGT1A1, an enzyme involved in the metabolism of morphine. This polymorphism is a loss-of-function variant, leading to impaired metabolism of morphine. MECHANISM:Morphine is metabolized by UDP-glucuronosyltransferase (UGT)-2B7 and UGT1A1 to form its major metabolites morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). Our patient was a poor metabolizer through UGT1A1, likely leading to increased respiratory depression as morphine has greater respiratory depressant effects compared to its metabolites. IMPLICATIONS:When appropriate, physicians should enquire about prior receipt of opioids, in both the patient and family, to be better prepared for potential adverse reactions. In the patient with excessive sedation or respiratory depression to standard doses of morphine, genetic testing may be warranted, especially if there is a family or past history that supports a metabolic defect in morphine metabolism and/or excretion.
journal_name
Br J Clin Pharmacoljournal_title
British journal of clinical pharmacologyauthors
Toce MS,Kim H,Chung S,Krauss BSdoi
10.1111/bcp.13779subject
Has Abstractpub_date
2019-01-01 00:00:00pages
258-262issue
1eissn
0306-5251issn
1365-2125journal_volume
85pub_type
杂志文章abstract::1. A questionnaire examining the use of, and knowledge about over-the-counter (OTC) drugs was administered verbally to representatives from 200 urban and 200 rural households. Self-medication was common in both groups but there were more drugs present in rural (336 items) than urban homes (231 items) with the differen...
journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
doi:10.1111/j.1365-2125.1989.tb03435.x
更新日期:1989-06-01 00:00:00
abstract::Model-based prediction on clinical doses for cannabinoids therapy is beneficial in the clinical setting, especially for seriously ill patients with both altered pharmacokinetics and pharmacodynamic responses. The objective of this article is to review the currently available PK and/or PD models of Δ9-tetrahydrocannabi...
journal_title:British journal of clinical pharmacology
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章
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更新日期:1983-01-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章,多中心研究
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更新日期:2009-01-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
doi:10.1111/j.1365-2125.1985.tb02770.x
更新日期:1985-01-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
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更新日期:1996-03-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1991-02-01 00:00:00
abstract::The prevalence of putative poor metaboliser (PM) phenotypes of proguanil oxidation in Caucasian populations is 3-10%. The PM frequency in Oriental populations is unknown. In this study the plasma metabolic ratios of proguanil and dapsone to their principal metabolites cycloguanil and monoacetyldapsone were determined ...
journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
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abstract:AIM:This study aims to investigate the clinical and demographic factors influencing gentamicin pharmacokinetics in a large cohort of unselected premature and term newborns and to evaluate optimal regimens in this population. METHODS:All gentamicin concentration data, along with clinical and demographic characteristics...
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
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更新日期:2012-07-01 00:00:00
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pub_type: 杂志文章
doi:10.1111/j.1365-2125.1993.tb00412.x
更新日期:1993-12-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1989-01-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
doi:10.1111/bcp.12130
更新日期:2013-12-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
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更新日期:2020-10-28 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1995-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:1979-10-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章
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更新日期:1981-01-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 临床试验,杂志文章
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更新日期:1997-04-01 00:00:00
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journal_title:British journal of clinical pharmacology
pub_type: 杂志文章,评审
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更新日期:2003-11-01 00:00:00