Nitroglycerin morphine

Transdermal patches are applied to the skin. The drug is mixed with the adhesive for the patch, and so it lies next to the skin. The skin can readily absorb many chemicals and so can absorb drugs such as nitroglycerin (for heart disease), morphine derivatives (for constant, severe pain), estrogen (for hormone replacement therapy), or nicotine (for easing symptoms that result when a patient stops smoking). 

Patients have an exaggerated preload dependence. Blood pressure may decrease in response to diuretics, nitroglycerin, morphine, and/or positive end expiratory pressure (PEEP)... 

MI usually develops after rupture or erosion of an atherosclerotic plaque within a coronary blood vessel. At this site, the clotting cascade is activated and the resultant thrombus occludes the lumen. In all patients under suspicion of MI, immediate therapy has to be initiated by the emergency physician. To relieve the patient from severe pain and anxiety, morphine and a benzodiazepine need to be given. Antiplatelet drugs and heparin are necessary for preventing further formation of thrombi. Nitroglycerin can be used to reduce cardiac load. When blood pressure and heart rate have stabilized, a p-blocker can be administered to lower cardiac 02 consumption and the risk of arrhythmias. Infusion of lidocaine is required to counter the threat of arrhythmias. The chance of survival of the MI patient depends on the interval between the onset of infarction and the start of therapy. 

Lauretti GR, Lima IC, Reis MP, Prado WA, Pereira NL. Oral ketamine and transdermal nitroglycerin as analgesic adjuvants to oral morphine therapy for cancer pain management. Anesthesiology 1999 90(6) 1528-33. 

Coronary thrombosis History, ECG, enzymes Thrombolytics, oxygen, nitroglycerin, heparin, aspirin, morphine... 

Low-molecular-weight heparins Measles, mumps, and rubella vaccine Meclofenamate Mesalamine MethyIdopa Minoxidil Morphine Nalidixic acid Naphazoline Naproxen Nitroglycerin Octreotide Oxacillin... 

BILIARY TRACT After the subcutaneous injection of 10 mg morphine sulfate, the sphincter of Oddi constricts, and the pressure in the common bile duct may rise more than tenfold within 15 minutes this effect may persist for 2 hours or more. Fluid pressure also may increase in the gallbladder, producing symptoms that vary from epigastric distress to typical biliary cohc. All opioids can cause biliary spasm. Atropine only partially prevents morphine-induced biliary spasm, but opioid antagonists prevent or relieve it. Nitroglycerin (0.6-1.2 mg) administered sublingually also decreases the elevated intrabiliary pressure. 

Noninterfering alfentanil, aprotinin, atropine, bupivacaine, chlorpromazine, dalteparin, dexamethasone, diazepam, dopamine, droperidol, etomidate, fentanyl, furosemide, gallamine, haloperidol, midazolam, morphine, neostigmine, nitroglycerin, nitroprusside, oxytocin, pancuronium, pentobarbital, phenylephrine, phenytoin, pipecuronium, piperacillin, promethazine, propofol, ranitidine, succinylcholine, sufentanil, terbutaline, thiopental, vecuronium, verapamil... 

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