A breastfeeding mother of a 6-month-old infant calls the clinic. Her child just had an outpatient tonsillectom…

Question

A breastfeeding mother of a 6-month-old infant calls the clinic. Her child just had an outpatient tonsillectomy and the surgeon prescribed codeine with acetaminophen elixir for the child and codeine for the mother. Which response by the nurse is most appropriate?

Accepted Answer

Option 3: Both prescriptions are unsafe; codeine has an FDA boxed warning against use in children under 12 years, after tonsillectomy/adenoidectomy in those under 18, and in breastfeeding because some people are ultra-rapid metabolizers (CYP2D6) and produce high morphine levels that can cause infant respiratory arrest; please contact the surgeon for an alternative such as acetaminophen and ibuprofen, or hydrocodone or oxycodone if an opioid is required.

Codeine is a prodrug converted to morphine by the CYP2D6 enzyme. The amount produced varies dramatically by genotype: poor metabolizers get little analgesia, while ultra-rapid metabolizers convert codeine into very high morphine levels rapidly, with risk of life-threatening or fatal respiratory depression. The FDA has issued strict boxed warnings: (1) contraindicated in any child under 12 years for any indication; (2) contraindicated in any child under 18 years for postoperative pain after tonsillectomy or adenoidectomy because deaths have been reported even with usual doses; (3) contraindicated in breastfeeding women because morphine passes into breast milk and has caused infant deaths from respiratory arrest; (4) caution in adolescents 12 to 17 with obesity, sleep apnea, or severe lung disease because of overlapping respiratory risk; (5) tramadol carries an essentially identical pediatric and breastfeeding warning. Safer alternatives in these populations: acetaminophen, ibuprofen (over 6 months), or non-codeine opioids such as hydrocodone or oxycodone for short-term severe pain when needed. Halving doses, refusing only one of the two prescriptions, or accepting the prescription as written are unsafe. The nurse contacts the prescriber to communicate the boxed warning and request a change.

Answer

Option 1: Halve the dose of both prescriptions and proceed.

Answer

Option 2: Refuse to fill the mother prescription only and have the child take it as ordered.

Answer

Option 4: It is safe; codeine is the mildest opioid and works well for both children and breastfeeding mothers.

A breastfeeding mother of a 6-month-old infant calls the clinic. Her child just had an outpatient tonsillectomy and the surgeon prescribed codeine with acetaminophen elixir for the child and codeine for the mother. Which response by the nurse is most appropriate?

In-depth explanation

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A breastfeeding mother of a 6-month-old infant calls the clinic. Her child just had an outpatient tonsillectomy and the surgeon prescribed codeine with acetaminophen elixir for the child and codeine for the mother. Which response by the nurse is most appropriate?

In-depth explanation

Master the NCLEX-RN with MyMerci