Respiratory depression morphine

The most common side effect of pentazocine is sedation resulting from an interaction with the K-receptor. Also observed are sweating, dizziness, psychotomimetic effects, anxiety, nightmares, and headache. Nausea and vomiting are less frequent than with morphine. Respiratory depression and increased heart rate, body temperature, and blood pressure accompany overdose. Naloxone is effective in reducing the respiratory depression but requires the use of higher doses than for morphine overdose. 

Respiratory depression occurs less often after epidural than intrathecal opioid administration (109,110). It has been suggested that older patients and those with increased intrathoracic or intra-abdominal pressure are particularly at risk and require reduced dosages (133). In a retrospective study, in which over 6000 patients received epidural morphine, 220 epidural pethidine, and 90 intrathecal morphine, respiratory depression requiring naloxone occurred in about 0.33% after epidural morphine and 5.5% after intrathecal morphine (110). Only two of the patients who received epidural morphine had respiratory depression later than 6 hours after the last dose of opioid. Only three of the 22 patients who had respiratory depression after epidural morphine had not received opioids in addition to epidural morphine during or after the operation. Ten were over 70 years old and 10 had thoracic injections. In another study of 2000 women who received 9000 doses of epidural pethidine 50 mg there was only one case of respiratory depression this was due to migration of the catheter into the subarachnoid space (136). 

Tile general pharmacological action of codeine is similar 10 that of morphine, but as indicated above, it does not possess the same analgesic potency. Studies indicate that a dose uf. fO to 120 mg of ctxleinc is considerably less efficient uninterally than 10 mg of morphine, and the usual side effects of morphine—respiratory depression, constipation, nausea, and such—occur. Codeine is less effective orally lhan pareiitemlly, and Houde and Wallenstein stated that a do.se of. 52 mg of codeine is about as effective as 650 mg nf aspirin in relieving terminal cancer pain. Combinations... 

Peak respiratory depression is observed within 1 hour of intramuscular administration, and there is a return toward normal starting in about 2 hours. Like other opioids, meperidine causes pupillary constriction, increases the sensitivity of the labyrinthine apparatus, and has effects on the secretion of pituitary hormones similar to those of morphine. Meperidine sometimes causes CNS excitation, characterized by tremors, muscle twitches, and seizures these effects are due largely to accumulation of a metabolite, normeperidine. As with morphine, respiratory depression is responsible for an accumulation of CO2 which, in turn, leads to cerebrovascular dilation, increased cerebral blood flow, and elevation of cerebrospinal fluid pressure. 

Fentanyi (Sublimaze) More potent than morphine. Respiratory depression less likely. Preoperative medication used in anesthesia. Respiratory depression less likely. Muscle rigidity, mild bradycardia. 

Moren J, Francois T, Blanloeil Y, Pinaud M. The effects of a nonsteroidal antiinflammatory drug (ketoprofen) on morphine respiratory depression a double-blind, randomized study in volunteers. Anesth Analg (1997) 85, 400-5. 

The replacement of the /V-methyl group on the nitrogen atom of the piperidine ring of morphine and analogues by aHyl, isopropyl, or methyl cyclopropyl, an isopropyl isostere, results in compounds which antagonize opioid responses, especially respiratory depression. Naloxone [465-65-6] C22H2 N04 (10... 

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). 

The existence of further alternative transcripts of MOP was postulated by the observation that in knockout mice with disrupted exon 1, heroin but not morphine was still analgesically active. Based on earlier observations that the antagonist naloxazone blocked morphine-induced antinociception but not morphine-induced respiratory depression, a subdivision of the MOP in pi and p2 was proposed. However, no discrete mRNA for each of these MOP subtypes has been found. It is, however, possible that subtypes of MOPs result from heterodimerization with other opioid receptors or by interaction with other proteins. 

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. 

Discuss important preadministration and ongoing nursing assessments you would make when giving a patient naloxone for severe respiratory depression caused by morphine. 

Major gastrointestinal effects include decreased gut motility and changes in secretion of gastric and intestinal fluids. Morphine and most p receptor agonists cause pupillary constriction. Some tolerance to this effect may develop, but addicts with high opioid levels will still have miosis. Respiratory depression is the usual cause of death from opioid overdose. 

Finally, there is little or no clinical evidence that morphine causes psychological dependence or drug-seeking behaviour, tolerance or problematic respiratory depression in patients. These events simply do not occur when opioids are used to control pain. The reason is likely to be that the actions of morphine and the context of its use in a person in pain are neurobiologically quite different from the effects of opioids in street use. These actions of opioids are described in more detail in Chapter 23. 

The relative extent of the unwanted effects caused by selective agonists at the different opioid receptors is of great importance in determining if non-mu opioids will have better spectra of actions as compared to morphine. However, there are good indications that the kappa and delta receptor agonists cause less respiratory depression than mu... 

Morphine Hypotension, respiratory depression BP and RR 5 minutes after each bolus dose... 

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... 

The history of this class of analgesics might have stopped there were it not for the manifold ancillary activities shown by that molecule. Although still one of the most widely used agents for treatment of severe pain, morphine is a drug that must be used with caution. Side effects include respiratory depression, induction of constipation, and sometimes marked sedation. The one property that most severely limits use of this drug is its propensity to induce physical dependence in patients subjected to more than casual exposure. 

Opium and its derivatives have been employed for centuries for the treatment of pain. Morphine was first synthesized in 1805 and has proven to be one of the most effective analgesic agents available [1], Morphine and its analogs are particularly useful because they diminish pain sensation while maintaining consciousness. However, opiates induce severe side-effects including respiratory depression, nausea, bradycardia and constipation and long-term use of opiates can cause addiction [2]. 

A major side-effect of morphine is respiratory depression. Opiates are believed to cause this effect via actions in brainstem nuclei, fi receptor immunoreactivity and mRNA were detected in neurons of the nucleus of the solitary tract, nucleus ambiguous, and parabrachial nucleus. mRNA was detected in the bed nucleus of the stria terminalis which projects to the nucleus of the solitary tract, fi receptor immunoreactivity is found in the nucleus of the solitary tract and dorsal rhizotomy reduced receptor immunoreactivity in the nucleus suggesting a presynaptic localization of the receptor. 

Morphine can cause constipation, spasms of the sphincter of Oddi, urinary retention, and pruritus (secondary to histamine release) (see Table 54-4). In head trauma patients who are not ventilated, morphine-induced respiratory depression can increase intracranial pressure and cloud the neurologic examination results. 

This class produces analgesia and has a ceiling effect on respiratory depression and lower abuse potential than morphine. However, psychotomimetic responses (e.g., hallucinations and dysphoria with pentazocine), a ceiling analgesic effect, and the propensity to initiate withdrawal in opioid-dependent patients have limited their widespread use. 

---