Pharma Exam 2 Opioid Medications: drugs containing – dulls the senses, relieves pain, induces profound sleep; in excess it causes stupor, coma, or convulsions. -Mu, Kappa, and Delta Mu: affinity for morphine. Highest in brain stem, medial thalamus • • • • • Sedation, analgesia Euphoria Resp depression Physical dependence Constipation Kappa: limbic system, brain stem, spinal cord • • • • • Spinal analgesia Sedation Dependence Respiratory depression Psychomimetic effects (anxiety, nightmares, hallucinations) Delta Receptor -analgesia, appears to work better for chronic pain • • Not many adverse effects Not very well understood Morphine: Gold standard for pain medication -Natural occurring opiate Onset: 5 minutes (IV) -60 minutes (spinal) Duration: Varies based on route, form- can be up to 24 hours (spinal) Oral: only 40/50% reaches CNS -immediate release; 30 mins -sustained release; 90 mins -poor lipid solubility, protein binding, rapid metabolism IV: 2-10mg q4hr PRN → 1mg IV=3mg PO Adverse effects: • • Nausea (7-70%) chemoreceptor stimulation Itching (up to 80%)- releases histamine → common reaction, very rare to actually have an allergy • Resp depression, constipation Hydromorphone: very potent! 1 mg =11mg of morphine preferred over morphine in renal failure • • • Nausea (9-28%) Respiratory depression Constipation IV to Oral; 1.5 mg IV converts to 7.5 mg oral onset: Oral-30 mins, IV-15 mins Duration: Oral- 3-6, IV; 4-5 ...
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