Question

Jerry is a 64-year-old retired autoworker of Greek descent. He has a BMI of 28 and normal liver function .He was admitted to the hospital with pneumonia this morning and had been coughing throughout the night while he was at home. After he gets settled in his room, his nurse brings him a codeine cough suppressant that contains 15 mg of codeine. He has never taken codeine before. When the nurse comes back to check on him, she finds him difficult to rouse. His skin is cold and clammy and his respirations are extremely shallow. His blood pressure is low and his pulse is weak.

She checks his pupils and finds that they are pinpoint.

1. What is going on with Jerry?
2. If Jerry had CYP450 testing, what would you expect to find?
3. After he is feeling better, how would you explain to Jerry and his family what happened?

Answer 1

ANSWER.

* Symptoms of Jerry like cold and clammy skin,shallow respirations,low blood

   pressure,weak pulse and pinpoint pupil indicate Codeine toxicity.

* CYP450 testing used find whether the patient is poor metabolizer of a drug or

   Ultra rapid metabolizer of a drug.

   If the patient is a poor metabolizer or take long time for processing a drug which

   result in patient felt toxicity in lower doses.

If the patient is an ultra rapid metabolizer or fastly processing drugs then that patient

required higher doses of a drug for effective action.

* Nurse can explain to Jerry about what happend to him as

           * Your symptoms are due to codeine toxicity or presence of high amount of unmetabolized

              codeine in the body after ingestion.

           * 15 mg of codeine is a normal minimum dosage for an adult patient but you are a poor

              metabolizer of codeine so even that low dosage leads to codeine toxicity.