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Narcotics
Drugs derived from opium or opium like
compounds, with potent analgesic effects
associated with significant alteration of mood
and behavior, and with the potential for
dependence and tolerance following repeated
administration.
Nociceptive
Pain
Pain arising from tissue
damage
Type Of
Pain
Neuropatic
Pain Other Pain
Pain arising from neurogical
Pain arising from damage dysfunction, not damage
to the damage –reporting like fibromyalgia
system itself, the
nervous system
A dark brown, resinous material obtained
from poppy (Papaver somniferum) Capsules.
Morphine 9-14%
Codein 0,5-2%
Thebaine 0,2-1%
Papaverin 0,8-1%
Noscapin 3-10%
Narcine 0,2-0,4%
Friedrich Wilhelm Serturner
A German Pharmacist
Isolated Morphine in 1803 and named it
after the Greek god of Dreams
“MORPHEUS”
Strong Analgesic
Visceral pain is relieved better than
somatic pain
Degree of analgesia increases with
dose
Nociceptive pain is better relieved
than Neuretic pain
Two components – spinal and supraspinal
Inhibits release of excitatory transmitters
from primary afferents – at Substantia
gelatinosa of dorsal horn
Exerted through Interneurones – geting of
pain
At supraspinal level in cortex, meidbrain and
medulla - alter processing and interpretation
and send inhibitory impulses through
descending pathway
Sedation
Drowsiness and indifference to surroundings
Inability to concentrate and extravagant
imagination – colorful day dream
Apparent excitement
Mood Effect
In Normal persons calming effect, mental
clouding, feeling of detachment, lack of
initiative etc. - unpleasant in absence of
pain
Sometimes DYSHORIA
But in persons with pain & addicts sense
of wellbeing, pleasurable floating feelings
– kick EUPHORIA
Depression
Respiratory centre depression – Both rate and
depth of respiration are diminished
- Dangerous in Head injury and asthmatics
Cough Centre – Depressed
Temperature regulating centre – depressed
Vasomotor centre – high doses cause fall in
BP
Stimulation
CTZ – sensitize CTZ to vestibular and other
impulses
Edinger Westphal Nucleus – miosis
Vagal centre – Bradycardia
Hippocampal cells – convulsions (inhibition of
GABA release)
Neuro-endocrine
GnRH and CRH are inhibited – FSH, LH and
ACTH levels are lowered – only short term –
tolerance develops
Decrease in levels of Sex hormone and
corticosteroids, but no infertility
Increases ADH release – oliguria
Cardiovascular
Vasodilatation – histamine release,
depression of vasomotor centre and directly
on blood vessels decreasing the tone
Cardiac work reduction due to consistent
vasodilatation
GIT
Due to direct action on intestine reducing
propulsive movement, spasm of sphincters,
decrease in all GIT secretions
Smooth Muscle
Billiary Tract: Billiary colic – closure of sph.
Of Oddi
Bladder: Urinary urgency but difficulty
Bronchi - Bronchospasm
Respiratory Depression: Infant and Old
Vomiting
Sedation, Mental Clouding – sometimes dysphoria
Hypotensive effect
Rise in Intracranial Pressure
Apnoea: Newborn
Urinary retention
Idiosyncrasy and allergy
Acute Morphine Poisoning: occurs if >50 mg (Lethal
dose –250 mg), Gastric lavage with KMNO4, Specific
antidote: Naloxone: 0.4 to 0.8 mg IV repeatedly in 2-
3 minutes till respiration picks up
Tolerance and dependence
Long Bone Fracture
Myocardial Infarction
Terminal stages of cancer
Burn patients
Postoperative patients
Visceral pains – pulmonary embolism,
pleurisy, acute pericarditis
Biliary colic and renal colic
Obstetric analgesia
Segmental analgesia
Preanaesthetic Medication
Balanced anaesthesia and surgical analgesia
Acute Left ventricular failure – Cardiac
Asthma
Cough – not used but Codeine is used
Diarrhoea – colostomy - Loperamide,
Diphenoxylate
Two Extremes of Age
Bronchial asthma
Respiratory insufficiency – empysema
Head Injury
Shock – Hypotension
Undiagnosed acute abdomen
Renal Failure, Liver diseases and
hypothyrodism
Unstable personalities