Morphine injection

Kalivas PW, Duffy P. (1987). Sensitization to repeated morphine injection in the rat possible involvement of AlO dopamine neurons. J Pharmacol Exp Ther. 241(1) 204-12. 

Goldberg SR, Spealman RD, KeUeher RT (1979) Enhancement of drug-seeking behavior by environmental stimuU associated with cocaine or morphine injections. Neuropharmacology 18 1015-1017... 

In retrospect, the reason for this is not all that obscure. Most of the soldiers were in hypo-volaemic shock with low blood pressure, low blood volume, and as part of the shock syndrome, systemic circulation was minimal with intense vasoconstriction - hence the poor therapeutic effect. The repeated doses of morphine were usually given intramuscularly into the buttock or thigh but their clearance into the systemic circulation was minimal until resuscitation occurred and the peripheral circulation was restored. Blood flow to the muscle increased and all the morphine injected became available - all at once. This was the reason for the morphine overdoses and the occasional death. Thereafter it has become standard practice to give morphine in emergency directly into the veins and not into poorly perfused muscles. 

Medico-technical instruments such as infusion pumps can be used in PCA (patient-controlled analgesia, Fig. 1) to provide patient-orientated and therapy as required, e.g. with morphine injection solutions. Depending on the patients perception of pain, they may add small doses of analgesics to the basic infusion by means of an electrically controlled infusion pump. The physician specifies the basic dose, which is infused independent of patient demands, the boluses that can be demanded, an hourly maximum dose and a refractory time that cannot be reduced between two doses. The infusion may be given intravenously, subcutaneously, epidurally or intraspinally. 

Morphine has a clear-cut place in medicine. For cancer, after surgeries, in childbirth, and even for chronic, daily headaches that resist all other treatments, morphine is effective in relieving symptoms. It is still the most widely prescribed drug for severe pain. Typical doses of morphine injected into muscle are 5-20 mg every four hours. Oral doses must be higher, between 8 and 20 mg. 

Kalso, E. (1983). Effects of intrathecal morphine, injected with bupivacaine, on pain after orthopaedic surgery. Br.J. Anaesth. 55, 415-422. 

A physician named Dr. Gustav Wilhelm Schiibbe allegedly killed 21,000 persons single-handedly, with morphine injections. 110,000 to 140,000 victims were allegedly killed in this way at the German Annihilation Institute in Kyiv.50,51... 

In morphine-dependent rhesus monkeys, MC-CAM substituted for morphine in withdrawn animals at a dose of 0.8 mg/kg but in non-withdrawn animals the same dose of MC-CAM produced signs of withdrawal slowly over a 3-day period these signs were incompletely suppressed by regular morphine injections [35]. 

All morphine-injected animals observed 1 h post injection all (+ )-7-OH-A6-THC-DMH-injected animals observed 2 h post injection refer to test methods given in the original article. 

Kieffer (1999) amply demonstrated that almost all the major pharmacologic activities, as studied with mu receptor knockout mice, after having been treated with morphine injection usually take place by interactions with mu receptors. Such observed activities are decreased gastric motility, emesis, tolerance, analgesia, respiratoiy depression and withdrawl symptoms. 

Case morphine injection fatal medication errors... 

Figure 26.1 illustrates the sensitivity of these measures in analyzing the effect of systemic (IP) administration of morphine sulfate (30 mg/kg) on the cortical EEC. It will be noted that the skewness measure changes abruptly only immediately after the morphine injection, when the EEG was dominated by the appearance of spindles. However, the index of kurtosis characterizes the entire extent of the drug effect from onset to its return to baseline. 

A 54-year-old hypertensive and diabetic man presented witii intractable neuropathic pain despite intrathecal morphine injection. His medical history included hypertension and diabetes mellitus which he has had for 30 years with complications including pol5meuropathy with bladder dysfunction and erectile dysfunction. Good erectile function had been achieved in the past 5 years on testosterone treatment. He has had intrathecal administration of morphine for 9 years. Despite dose escalation, considerable pain relief had not been achieved. A trial of Ziconotide was stopped because it did not provide any pain relief but ratiier caused severe side effects. A combination of morphine and clonidine was delivered by a programmable pump. Considerable pain relief was achieved in 2 weeks at a clonidine dose of 0.04 mg per day. However, he developed erectile dysfunction and relative hypotension immediately he commenced clonidine because of which he opted to stop clonidine and revert back to morphine monotherapy. Thereafter, erectile dysfunction disappeared and BP reverted back to habitual high levels... 

In mice 8-azaguanine, an inhibitor of protein s thesis, antagonized the development of tolerance30 31, Morphine injections inhibited the incorporation of C leucine into brain proteins. This effect of morphine could be blocked by keeping the rats at an ambient temperatwe of 30° and by the simultaneous injection of nalorphine32. The relationship of morphine s action to protein synthesis or nucleic acids is still not clear. 

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