Morphine heart failure

Injection - Heart failure secondary to chronic lung disease cardiac arrhythmias brain tumor acute alcoholism delirium tremens idiosyncrasy to the drug increased intracranial or CSF pressure head injuries acute bronchial asthma upper airway obstruction. Because of its stimulating effect on the spinal cord, morphine should not be used in convulsive states (eg, status epilepticus, tetanus, strychnine poisoning) concomitantly with MAOIs or in those who have received such agents within 14 days. 

The relief produced by intravenous morphine in dyspnea from pulmonary edema associated with left ventricular heart failure is remarkable. Proposed mechanisms include reduced anxiety (perception of shortness of breath), and reduced cardiac preload (reduced venous tone) and afterload (decreased peripheral resistance). However, if respiratory depression is a problem, furosemide may be preferred for the treatment of pulmonary edema. On the other hand, morphine can be particularly useful when treating painful myocardial ischemia with pulmonary edema. 

Butorphanol tartrate (stadol) is better suited for the relief of acute than chronic pain. Because of its side effects on the heart, it is less useful than morphine or meperidine in patients with congestive heart failure or myocardial infarction. The usual dose is 1-4 mg of the tartrate given intramuscularly or 0.5-2 mg given intravenously every 3-4 hours. A nasal formulation (STADOLNS) is available and has proven to be effective. 

The major receptor-mediated adverse effect is water intoxication, which can occur with desmopressin or vasopressin. Many drugs, including carbamazepine, chlorpropamide, morphine, tricyclic antidepressants and NSAIDs, can potentiate the antidiuretic effects of these peptides, while lithium, demeclocycline and ethanol can attenuate the antidiuretic response to desmopressin. Desmopressin and vasopressin should be used cautiously when a rapid increase in extracellular water may impose risks (e.g., in angina, hypertension, and heart failure) and should not be used in patients with acute renal failure. Patients receiving desmopressin to maintain hemostasis should be... 

C. Pulmonaiy edema resulting from congestive heart failure. Chemical-induced noncardiogenic pulmonary edema is notan indication for morphine therapy. 

Amantadine may exacerbate central nervous system effects in disorders. Dosages must be adjusted for patients with renal disease or congestive heart failure. Since amantadine interacts with morphine caution is required when these two drugs are administered together. 

Most textbooks in the 1960s suggested that deaths from belladonnoid dmgs were likewise due to central respiratory failure, even though there were insufficient empirical data to confirm this conclusion. To the contrary, a review of lethal studies of BZ in rats indicated that cardiac, rather than respiratory, failure caused death. Unlike morphine, BZ disturbs the heartbeat not the ability to breathe. The ability of the rat (or human) beating heart to mechanically ventilate the lungs, therefore, does not apply to BZ. 

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