Question:
An elderly man with end-stage metastatic lung carcinoma on palliative care is receiving morphine for severe pain. Despite escalating doses, he continues to experience significant pain relief with mild drowsiness but develops a respiratory rate of 8/min and oxygen saturation of 88%. What factor should now determine the maximum permissible dose of morphine in this patient?
An elderly man with end-stage metastatic lung carcinoma on palliative care is receiving morphine for severe pain. Despite escalating doses, he continues to experience significant pain relief with mild drowsiness but develops a respiratory rate of 8/min and oxygen saturation of 88%. What factor should now determine the maximum permissible dose of morphine in this patient?
Show Hint
In palliative care, the "Principle of Double Effect" is often discussed, where giving high doses of opioids to relieve pain is ethically permissible even if it foreseeably hastens death via respiratory depression. However, clinically, one must balance symptom control against causing immediate hypoxic demise.
Updated On: Sep 3, 2026
- Degree of pain relief
- Patient’s tolerance and comfort
- Risk of respiratory depression
- Frequency of dosing and tablet strength
Show Solution
Verified By Collegedunia
The Correct Option is C
Solution and Explanation
Concept:
The management of severe pain in terminal or palliative care relies heavily on strong opioids like morphine.
The guiding principle in palliative pain management is to titrate the opioid dose upward until the patient achieves adequate pain relief or until intolerable/dangerous side effects manifest.
Explanation:
• Opioids act on mu-receptors in the central nervous system, providing both powerful analgesia and suppression of the brainstem respiratory centers.
• While opioid tolerance rapidly develops to side effects like sedation and nausea, tolerance to respiratory depression develops more slowly and less reliably.
• There is theoretically no absolute "ceiling dose" for pure opioid agonists like morphine; the dose can be continually escalated to match the severity of the pain.
• However, the absolute limiting factor for further dose escalation is the onset of life-threatening respiratory depression.
• In this scenario, the patient has developed a respiratory rate of 8 breaths per minute and hypoxia (oxygen saturation 88%). This is clinical evidence of significant, dangerous respiratory depression.
• At this point, even if the patient desires more pain relief (Option A) or comfort (Option B), further escalating the morphine dose poses an immediate risk of fatal respiratory arrest.
• Therefore, the limiting threshold determining the maximum safe dose has been reached due to the unacceptable risk of respiratory failure.
Final answer:
The risk of life-threatening respiratory depression is the definitive factor that limits the maximum permissible dose of opioids.
The management of severe pain in terminal or palliative care relies heavily on strong opioids like morphine.
The guiding principle in palliative pain management is to titrate the opioid dose upward until the patient achieves adequate pain relief or until intolerable/dangerous side effects manifest.
Explanation:
• Opioids act on mu-receptors in the central nervous system, providing both powerful analgesia and suppression of the brainstem respiratory centers.
• While opioid tolerance rapidly develops to side effects like sedation and nausea, tolerance to respiratory depression develops more slowly and less reliably.
• There is theoretically no absolute "ceiling dose" for pure opioid agonists like morphine; the dose can be continually escalated to match the severity of the pain.
• However, the absolute limiting factor for further dose escalation is the onset of life-threatening respiratory depression.
• In this scenario, the patient has developed a respiratory rate of 8 breaths per minute and hypoxia (oxygen saturation 88%). This is clinical evidence of significant, dangerous respiratory depression.
• At this point, even if the patient desires more pain relief (Option A) or comfort (Option B), further escalating the morphine dose poses an immediate risk of fatal respiratory arrest.
• Therefore, the limiting threshold determining the maximum safe dose has been reached due to the unacceptable risk of respiratory failure.
Final answer:
The risk of life-threatening respiratory depression is the definitive factor that limits the maximum permissible dose of opioids.
Was this answer helpful?
0
0
Top NEET SS Medical Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- A 32-year-old male recovering from dengue fever initially showed clinical improvement but now presents with recurrence of high-grade fever, fatigue, and pancytopenia on day 10 of illness. He is hemodynamically stable with no bleeding manifestations. Which of the following investigations should be performed first to evaluate the cause of relapse and cytopenia?
- A 48-year-old man with chronic hepatitis C infection is being evaluated for risk factors associated with progression of liver disease. He has a 20-year history of infection, drinks alcohol occasionally, and has a high serum HCV RNA viral load. Which of the following factors is not associated with an increased risk of progression of liver disease in chronic HCV infection?
- A 28-year-old veterinary worker who previously received a full 3-dose pre-exposure rabies vaccination series is bitten by a stray dog while handling an animal in the clinic. The wound is cleaned immediately. What is the most appropriate post-exposure management?
- A 42-year-old patient undergoing chemotherapy for acute myeloid leukemia develops neutropenia (ANC $<$ 500) and is treated with broad-spectrum antibiotics. After initial recovery of neutrophil counts (ANC = 1500), he again develops high-grade fever and right upper quadrant abdominal pain. Imaging shows multiple small hypodense lesions in the liver and spleen. What is the most likely diagnosis?
View More Questions
Top NEET SS Clinical Pharmacology Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- what is the most common cause of reactive arthritis in a patient with diarrhea and dysuria?
- A 17-year-old girl presents with short stature, delayed puberty, and primary amenorrhea. She also has poor vision due to bilateral optic atrophy. On examination, her visual acuity is reduced. What is the most probable diagnosis?
- Which of the following is a well-known side effect of Oxcarbazepine therapy?
- In anaphylaxis, bronchoconstriction is primarily mediated by which of the following inflammatory mediators?
Top NEET SS Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- A 32-year-old male recovering from dengue fever initially showed clinical improvement but now presents with recurrence of high-grade fever, fatigue, and pancytopenia on day 10 of illness. He is hemodynamically stable with no bleeding manifestations. Which of the following investigations should be performed first to evaluate the cause of relapse and cytopenia?
- A 48-year-old man with chronic hepatitis C infection is being evaluated for risk factors associated with progression of liver disease. He has a 20-year history of infection, drinks alcohol occasionally, and has a high serum HCV RNA viral load. Which of the following factors is not associated with an increased risk of progression of liver disease in chronic HCV infection?
- A 28-year-old veterinary worker who previously received a full 3-dose pre-exposure rabies vaccination series is bitten by a stray dog while handling an animal in the clinic. The wound is cleaned immediately. What is the most appropriate post-exposure management?
- A 42-year-old patient undergoing chemotherapy for acute myeloid leukemia develops neutropenia (ANC $<$ 500) and is treated with broad-spectrum antibiotics. After initial recovery of neutrophil counts (ANC = 1500), he again develops high-grade fever and right upper quadrant abdominal pain. Imaging shows multiple small hypodense lesions in the liver and spleen. What is the most likely diagnosis?
View More Questions