Morphine Fentanyl

Severe pain adjunct in anesthesia (fentanyl, morphine) pulmonary edema (morphine only) maintenance in rehabilitation programs (methadone only)... 

According to the FDA reports, painkillers are the most commonly reported cause of adverse reactions. The five drugs causing the most adverse reactions include oxycodone, fentanyl, morphine, acetaminophen, and methadone—all painkillers. The sixth most common cause of adverse reactions, clozapine is an antipsychosis drug. Other drugs reported to the FDA for adverse reactions include estrogens, insulin, paroxetine (the active ingre-... 

Opioids potentiate the analgesic effect of neuraxial local anesthetics, with minimal adverse effects (SEDA-18,141) (SEDA-20, 121) (SEDA-22, 135), as shown in several studies with clonidine, fentanyl, morphine, or pethidine as the systemic or neuraxial analgesic, and bupivacaine, lidocaine, and ropivacaine as the local anesthetic. The benefits have been shown in relief of long-term pain and postoperative pain, in adults and children (SEDA-18, 141) (SEDA-18,146). 

Therapeutic doses of opioids constrict the sphincter of Oddi, and biliary tract pressure rises ten-fold. Patients with biliary colic can have exacerbation of pain after morphine. Likewise, opioids such as fentanyl, morphine, and dextropropoxjrphene can cause bile duct spasm (SEDA-21, 85). 

When an opioid is used as the sole agent by the epidural or intrathecal route, the results are disappointing, because of unwanted adverse effects, such as pruritus, nausea, vomiting, respiratory depression, and effects on the neonate, caused by significant systemic absorption (SEDA-17, 85). Hypotension and changes in fetal heart rate are not uncommon (SEDA-21, 91). Combinations of opioids (alfentanil, fentanyl, morphine, sufentanil) with local anesthetics (for example bupivacaine) have therefore been suggested to yield better results (SEDA-18, 83). 

Lirzin JD, Jacquinot P, Dailland P, Jorrot JC, Jasson J, Talafre ML, Conseiller C. Controlled trial of extradural bupivacaine with fentanyl, morphine or placebo for pain relief in labour. Br J Anaesth 1989 62(6) 641. ... 

Effective in the management of severe postoperative, chronic, or cancer pain. Spinal opioids can be administered by a single bolus injection into the epidural or subarachnoid space or by continuous infusion via an indwelling catheter. Dosage requirement by these routes is significantly less than with IV administration (epidural opioid doses 10-fold lower than IV doses intrathecal opioid doses 100-fold lower than IV doses). Morphine, hydromorphone, fentanyl, and sufentanil are effective when administered intrathecally. The most commonly used local anesthetic in continuous epidural infusions is bupivacaine. Fentanyl, morphine, or hydromorphone is usually combined with bupivacaine for epidural infusions. 

Analgesics Opioids At induction and during operation to control pain Fentanyl, morphine... 

Simultaneous buprenorphine, butorphanol, codeine, ethylmorphine, fentanyl, morphine, nalbuphine... 

A literature review on human medicine identified numerous drugs that were inadvertently injected epidurally, and these included thiopental, methohexital, vecuronium, midazolam with fentanyl, morphine with dextrose, ephedrine, cefazolin, gentamicin, amoxicillin... 

Morphine has certain undesirable side effects. Among these are respiratory depression, nausea, and vomiting, depression of the cough reflex, cardiovascular depression and hypotension, smooth muscle contraction (constipation), and histamine release (93). Morphine s onset of action, duration, and low therapeutic indices have prompted a search for a more effective opiate iv anesthetic. Extreme simplification of the complex morphine molecule has resulted in anilido —piperidines, the fentanyl class of extremely potent opiate iv anesthetics (118,119). 

Alfentanil, codein, dihydromorphine, etor-phine, fentanyl, heroin, hydromorphone, levo-methadone, morphine, oxycodone, pethidine, piritramide, remifentanil, sufentanil, tilidine, tramadol Buprenorphine, pentazocine Naloxone, naltrexone... 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Sufentanil, fentanyl, remifentanil, alfentanil, and morphine sulfate should be administered only by those specifically trained in the use of IV and epidural anesthetics Oxygen, resusdtative, and intubation equipment should be readily available. 

Alkaloids range from the belladonna alkaloids, such as atropine and scopalomine—which are used as poisons, cold remedies, and truth serums —to dextromethorphan, a cough suppressant (anti-tussive). But the most widely known alkaloids are the opiates, such as morphine, heroin, fentanyl, oxycodone, and methadone. These act on... 

Opioids. Reactions to morphine, codeine phosphate, meperidine, fentanyl and its derivatives are uncommon. Because of their direct histamine-releasing properties, especially regarding morphine and codeine, distinction between anaphylaxis and non-immune-mediated histamine release is not always easy. Only 12 cases were recorded in the last 2 years epidemiologic survey in France, 9 of them being related to morphine administration [9]. 

Synthetic agonist Morphine Codeine Fentanyl Pethidine DSTBULET DPDPE U50488H Pentazocine Oxycodone ... 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Epidural analgesia is frequently used for lower extremity procedures and pain (e.g., knee surgery, labor pain, and some abdominal procedures). Intermittent bolus or continuous infusion of preservative-free opioids (morphine, hydromorphone, or fentanyl) and local anesthetics (bupivacaine) may be used for epidural analgesia. Opiates given by this route may cause pruritus that is relieved by naloxone. Adverse effects including respiratory depression, hypotension, and urinary retention may occur. When epidural routes are used in narcotic-dependent patients, systemic analgesics must also be used to prevent withdrawal since the opioid is not absorbed and remains in the epidural space. Doses of opioids used in epidural analgesia are 10 times less than intravenous doses, and intrathecal doses are 10 times less than epidural doses (i.e., 10 mg of IV morphine is equivalent to 1 mg epidural morphine and 0.1 mg of intrathecally administered morphine).45... 

Few studies have explored the efficacy of opioids specifically for OA. The APS recommends against the use of codeine and propoxyphene for OA because of the high incidence of adverse effects and limited analgesic effectiveness. Oxycodone is the most extensively studied of the agents recommended for OA. However, other narcotic analgesics such as morphine, hydromorphone, methadone, and transdermal fentanyl are also effective. 

Severe pain should be treated with an opioid such as morphine, hydromorphone, methadone, or fentanyl. Moderate pain can be treated effectively in most cases with a weak opioid such as codeine or hydrocodone, usually in combination with acetaminophen. Meperidine should be avoided owing to its relatively short analgesic effect and its toxic metabolite, normeperidine. Normeperidine may accumulate with repeated dosing and can lead to central nervous system side effects including seizures. 

Mortazavi, S., Thompson, J., Baghdoyan, H. A. Lydic, R. (1999). Fentanyl and morphine, but not remifentanil, inhibit acetylcholine release in pontine regions modulating arousal. Anesthesiology 90, 1070-7. 

The answer is c. (Hardman, pp 543—544. Katzang, p 2533) Fentanyl is a chemical relative of meperidine that is nearly 100 times more potent than morphine. The duration of action, usually between 30 and 60 min after parenteral administration, is shorter than that of meperidine. Fentanyl citrate is only available for parenteral administration intramuscularly and intravenously. Tran sbuc cal ( lollipop ) and transdermal patches avoid first-pass metabolism of fentanyl. 

The IV or IM administration of parenteral narcotics (meperidine, morphine, fentanyl) is commonly used to treat the pain associated with labor. Compared to epidural analgesia, parenteral opioids are associated with lower rates of oxytocin augmentation, shorter stages of labor, and fewer instrumental deliveries. 

Severe pain should be treated aggressively with an opioid, such as morphine, hydromorphone, fentanyl, and methadone. Moderate pain should... 

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