Drugs for Pain Opiods and Headaches-pharm

Subq up to 90 min may persist 4 5 hr tolerance to

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Unformatted text preview: • Mechanism of action---relieve pain by Mechanism mimicking the actions of endogenous opioid peptides peptides Morphine Morphine • Adverse effects---respiratory depression • Infant and elderly particularly sensitive • Onset: – IV 7 min; IM 30 min; subQ up to 90 min, may persist 4-5 hr • Tolerance to respiratory depression can develop • Increased depression with concurrent use of other drugs Increased that have CNS depressant actions (e.g., alcohol, barbiturates, benzodiazepines) you don’t want to give barbiturates, want morphine to someone who has been drinking. morphine • Can compromise patients with impaired pulmonary Can function – Asthma, emphysema, kyphoscoliosis, chronic cor pulmonale, Asthma, bariatric bariatric Morphine Morphine Other Side Effects Other • • • • • • • • • Euphoria Constipation- teach patients to move, eat fiber teach Urinary retention Orthostatic hypotension-lead to fall risk Orthostatic Emesis Cough suppression Bilary colic Sedation Miosis Morphine Morphine Tolerance • Increased doses needed to obtain same response • Develops with analgesia, euphoria, sedation, Develops respiratory depression respiratory • Cross-tolerance to other opioid agonists • No tolerance to miosis or constipation develops Morphine Physical Dependence • Abstinence syndrome with abrupt discontinuation • About 10 hours after last dose: About – Initial reaction (yawning, rhinorrhea, sweating) • Progresses to: – Violent sneezing, weakness, nausea, vomiting, Violent diarrhea, abdominal cramps, bone and muscle pain, muscle spasm, kicking movements pain, • Lasts 7-10 days if untreated • Withdrawal unpleasant, but not lethal Withdrawal Morphine Morphine • Abuse liability---may cause pleasurable --may experiences experiences • Precautions – – – – – – – – Decreased respiratory reserve Pregnancy- drugs cross the placenta PregnancyLabor and delivery Head injury/IICP- you could have loss of consciousness Head and with pain medicine you cant tell if its getting worse CNS depression Infants and elderly IBS- side effect is constipation IBSHypotension Morphine Drug interactions – CNS depressants. Ex: alcohol, benzos – Anticholinergic drugs. Causes dry mouth, Anticholinergic constipation and urinary retention constipation – Hypotensive drugs – Monoamine oxidase inhibitors – Agonist-antagonist opioids – Opioid antagonists – Other interactions Morphine Toxicity 1. Clinical manifestations • Classic triad 1. Coma- unconsciousness 2. Respiratory depression 3. Pinpoint pupils 2. Treatment • • Ventilatory support- should be 12-24 bpm Antagonist – naloxone (Narcan) blocks the action Antagonist of the opioid (reversible agent) of 1. General guidelines • • Monitor full vitals before giving Give on a fixed schedule Morphine • Preparations, dosage, and administration – General guidelines on dosage and General administration administration • Preparations • Dosage and routes of administration – Oral – Intramusc...
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