A patient prescribed an opioid analgesic has severe chronic obstructive pulmonary disease (COPD). This medication would be contraindicated in which of the following conditions?

A patient prescribed an opioid analgesic has severe chronic obstructive pulmonary disease (COPD). This medication would be contraindicated in which of the following conditions?

• A. Renal insufficiency
• B. Severe chronic obstructive pulmonary disease
• C. Liver disease
• D. Diabetes mellitus

Answer: (B)

Opioid analgesics slow breathing by acting on the brainstem, reducing the respiratory rate and the drive to breathe. In severe COPD, the patient already has limited ventilatory reserve and impaired gas exchange. Adding a drug that further depresses respiration can precipitate dangerous hypoventilation, hypoxemia, and CO2 build-up, making this combination contraindicated. The other conditions may require dose adjustments because liver or kidney function affects metabolism and clearance, but they do not inherently pose the same acute risk to breathing. Diabetes mellitus does not directly impact respiratory drive or COPD physiology.

Opioid analgesics slow breathing by acting on the brainstem, reducing the respiratory rate and the drive to breathe. In severe COPD, the patient already has limited ventilatory reserve and impaired gas exchange. Adding a drug that further depresses respiration can precipitate dangerous hypoventilation, hypoxemia, and CO2 build-up, making this combination contraindicated. The other conditions may require dose adjustments because liver or kidney function affects metabolism and clearance, but they do not inherently pose the same acute risk to breathing. Diabetes mellitus does not directly impact respiratory drive or COPD physiology.