Which of the following opioids should not be used with MAO inhibitors?: (A) Morphine, (B) Pentazocine, (C) Buprenorphine, (D) Pethidine
Answer is D. pethidine Nonselective MAO inhibitors interfere with hydrolysis but not with demethylation of pethidine - norepithidine is produced in excess and excitement occurs. Excitatory effects include trmors, mydriasis, hyperreflexia, delirium, myoclonus, convulsions etc. Ref: KD Tripathi 8th ed.