Name: Codeine (Coding computer)MOA: Codeine is a pro-drug that is converted to the active metabolite, morphine by CYP2D6Morphine agonizes the mu opioid receptor in the cough center in the brainstem, which reduces the release of excitatory peptides that trigger cough (Green plus, CYP2D6 = morphine, brain with green brain stem)Clinical: Antitussive and analgesic with abuse liability (Cough and Oww in conversation bubble, radio song I want it all and I want it now)ADME: Prodrug metabolized by CYP2D6 to active metabolite. Ultrarapid metabolizers à toxicity, poor metabolizers à lack of efficacy. Dose reduction required in renal failure (Sticker on radio with kidney = arrow down)AE: Constipation, sedation. Black box warning for addiction risk, respiratory depression in ultra-rapid metabolizers, interaction with CYPs, Neonatal opioid withdrawal risk, and concomitant use of CNS depressants (like benzodiazepines (eg, Valium)) (Constipated colon mouse cord, ZZzzs on screen, black box with addiction and resp-depress on top of computer)Contraindications: pediatric patients less than 12, acute/severe bronchial asthma in an unmonitored setting, GI obstruction, concurrent use of MAOIs (within the last 14 days)Notes: Overdose S/S: CNS depression and coma, severe chest and stomach pain, respiratory depression, panic, fear of death

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