What should be approached with caution in patients receiving meperidine?

In the context of moderate sedation and the use of meperidine, caution is particularly warranted when considering its interaction with monoamine oxidase inhibitors (MAOIs). Meperidine is an opioid analgesic that can increase the risk of severe side effects when combined with MAOIs due to the potential for serotonin syndrome—a life-threatening condition characterized by increased serotonin levels in the brain.

MAOIs can interfere with the metabolism of certain neurotransmitters, including serotonin, norepinephrine, and dopamine. When meperidine is administered to a patient who is also taking an MAOI, it can lead to excessive accumulation of these neurotransmitters, resulting in symptoms such as hypertension, hyperthermia, confusion, and autonomic dysregulation. Therefore, it is critical to avoid this combination or to exercise extreme caution and consider alternative pain management strategies for patients undergoing sedation.

The other options present considerations with certain medications but do not pose the same level of risk in combination with meperidine as MAOIs do. Therefore, when managing such patients, the interaction with MAOIs is the most significant concern that requires careful attention and a cautious approach.