Opiates analgesia

Cholecystokinin CCKa (CCKj) Human cDNA Anorexia, gastrointestinal disorders, pancreatitis, satiety, diabetes, obesity, nociception, schizophrenia, Parkinson s disease, addiction, cancer Pancreatic enzyme secretion, potentiation of opiate analgesia, gallbladder contraction, gut motility, growth promoting effects on some tumors, dopamine release... 

Lin Y, Morrow TJ, Kiritsy-Roy JA, Terry LC, Casey KL. (1989). Cocaine evidence for supraspinal, dopamine-mediated, non-opiate analgesia. Brain Res. 479(2) 306-12. 

Misra AL, Pontani RB, Vadlamani NL. (1987). Stereospecific potentiation of opiate analgesia by cocaine predominant role of noradrenaline. Pain. 28(1) 12 38. 

Urinary system disorders Initiation of neuraxial opiate analgesia is frequently associated with disturbances of micturition, especially in males with prostatic enlargement. 

Serotonin has an effect on the hypothalamic control of pituitary function (see chapter 5), in central thermoregulation (attributed to the 5-HTj receptor), and in pain perception (probably the S-HTj receptor), where increased serotonergic function potentiates opiate analgesia. The administration of 5-HT reuptake inhibitors like fluoxetine increases the anorectic effect of 5-hydroxytryptamine and induces a selective suppression of nonprotein caloric intake in rats. The involvement of serotonin in endogenous psychiatric depression has been mentioned. 

Santillan, R., Maestre, J.M., Hurle, M.A., Florez, J. Enhancement of opiate analgesia by nimodipine in cancer patients chronically treated with morphine a preliminary report, Pain 1994, 58, 129-132. 

ChrubasikJ, Chrubasik S, Martin E. Patient-controlled spinal opiate analgesia in terminal cancer. Has its time really arrived Drugs. 1992 43 799-804. 

Reduce the senna dosage to 1-2 tablets once daily initially (also check Mrs CR s current bowel habits if diarrhoea then senna should be stopped, ffowever, as Mrs CR will continue to receive opiate analgesia then it is likely that prophylactic laxative therapy will need to be continued, due to opiates causing constipation in almost all patients). Monitor Mrs CR s bowel habits during her inpatient stay in order to ensure the appropriateness of the laxative therapy. 

In seven patients (median age 7 years), limb and jaw muscle pain, starting at days 3-5 of an intravenous infusion of vincristine and requiring opiate analgesia, was the most pronounced adverse effect (68). 

It has been reported that the serious adverse effects of opiate analgesia such as depression of breathing are caused by direct inhibition of rhythm-generating respiratory neurons in the Pre-Boetzinger complex (PBC) of the brainstem. Serotonin 4(a) or 5-HT4(a) receptors are strongly expressed in these neurons and their selective activation protects spontaneous respiratory activity. Rats treated with a 5-HT4 receptor specific agonist overcame the fentanyl-induced respiratory depression, and reestablished stable respiratory rhythm without loss of fentanyl s analgesic effect. 

Herz A. Role of immune processes in peripheral opiate analgesia. Adv Exp Med Biol 1995 373 193-199. Hori T, Oka T, Hosoi M, Aou S. Pain modulatory actions of cytokines and prostaglandin E2 in the brain. Ann... 

Sutton LC, Fleshner M, Mazzeo R, Maiser SF, Watkins LR. A permissive role of corticosterone in an opioid form of stress-induced analgesia—blockade of opiate analgesia is not due to stress-induced hormone-release. Brain Res 1994 663 19-29. 

Early attempts to explain opiate analgesia by involvement of the receptor concept was followed by later demonstration of the existence of opiate receptors in the early 1970s in their characterization by sophisticated binding studies. This led to the realization that opiate receptors show considerable heterogeneity, and that they are not homogenous. They exist as subtypes with different properties and, in some cases, differ in anatomical loci. Initial work by Martin and co-workers (1976) with the spinal dog, utilizing morphine and certain... 

At what level is opiate analgesia primarily mediated ... 

Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother (2004) 38,949-53. 

Gordon NC, Heller PH, Gear RW, Levine JD. Interactions between fluoxetine and opiate analgesia for postoperative dental pain. Pcdn (1994) 58, 85-8. 

Drugs possessing a- and / -adrenoceptor blocking activity (for example, phentolamine, phenoxybenzamine, propranolol and practolol) have also been studied in connection with opiate analgesia. When administered by a peripheral route, the a-adrenoceptor antagonist, tolazoline, antagonised the antinociceptive activity of morphine [175,176], whilst two other a-adrenoceptor antagonists were antinociceptive themselves and also enhanced the activity of morphine... 

Considerable interest has centred recently on the possible transmitter role of histamine [288-290], an amine known to be released both peripherally [291] and centrally [292] by morphine. A central transmitter role for histamine has been considered and so there is interest in its possible involvement in opiate analgesia. Also, it has been demonstrated that some antihistamines (such as mepyramine which is an antagonist of the Hi receptors) antagonise some of the central effects of morphine [293], including antinociceptive activity in rabbits [294]. However, these effects may be due to atropine-like or even anti-5-HT activity. 

Use with disorders of the urinary system initiation of neuraxial opiate analgesia is frequentiy associated with disturbances of micturition, especially in males with prostatic enlargement. Early recognition of difficulty in urination and prompt intervention in cases of minary retention is indicated. 

Ciprofloxacin-induced severe myalgia necessitating emergency care treatment with opiate analgesia and a benzodiazepine occurred within 2 hours of a dose of ciprofloxacin in a patient who was taking it for the third time, having had mild myalgia on the second occasion [47" ]. Creatine kinase activity was not raised and the symptoms disappeared within 24 hours. 

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