Opioids pancreatitis

Long -term sequelae of chronic pancreatitis include dietary malabsorption, impaired glucose tolerance, cholangitis, and potential addiction to opioid analgesics. 

Pain management is an important component of therapy and is similar to that of acute pancreatitis. Non-opioid analgesics are preferred, but the severe and persistent nature of the pain often requires opioid therapy. Patients can require chronic doses of opioid analgesics, with a resulting risk of addiction. Pain can also be managed by removing the stimulus of exacerbation if identified.31,38... 

Make a plan for analgesia, in conjunction with a pain management service if possible, to control and prevent pain. Recommend an analgesic with ease of dosing and minimal side effects, realizing that patients with chronic pancreatitis may require large doses of opioids. 

Analgesics are given to reduce abdominal pain. In the past, parenteral meperidine (50 to 100 mg) every 3 to 4 hours was usually used because it causes less spasm of the sphincter of Oddi than other opioids. Meperidine is used less frequently today because it is not as effective as other opioids and is contraindicated in renal failure. Parenteral morphine is sometimes used, but it is thought to cause spasm of the sphincter of Oddi, increases in serum amylase and, rarely, pancreatitis. Hydromorphone may also be... 

E. Krondahl, H. von Euler-Chelpin, A. Orzechowski, G. Ekstrom, H. Lennernas, Investigation of the in-vitro Metabolism of Three Opioid Tetrapeptides by Pancreatic and Intestinal Enzymes ,./. Pharm. Pharmacol. 2000, 52, 785 - 795. 

Digestive system g agonists decrease secretion of stomach acid, reduce gastric motility, and prolong gastric emptying. Pancreatic, biliary, and intestinal secretions are reduced. Intestinal transit is also slowed. Peristaltic movements are reduced, but tone is increased, sometimes causing spasm. As a result, constipation is a frequent problem with opioid use. Bile duct pressure is also increased by opioids. 

Administer opioids with caution to patients in circulatory shock, because vasodilation produced by the drug may further reduce cardiac output and blood pressure. Pancreatitis/Biliary tract disease Use opioids with caution in patients with biliary tract disease, including acute pancreatitis and in those about to undergo surgery of the biliary tract. 

The opioids contract biliary smooth muscle, which can result in biliary colic. The sphincter of Oddi may constrict, resulting in reflux of biliary and pancreatic secretions and elevated plasma amylase and lipase levels. 

Analgesic efficacy and clinical use Pethidine (Clark et al.,1995 Latta et al., 2002) is used for the treatment of moderate to severe pain including labor pain. It is also used as preoperative medication and as an adjunct to anesthesia. Due to its anti-muscarinic properties, it has a weaker muscle stimulant activity than other opioids and does not increase biliary pressure, which makes it suitable for the treatment of pain associated with pancreatitis or biliary colic. 

To provide adequate analgesia. Opioids are generally satisfactory their potential disadvantage of contracting the sphincter of Oddi (and retarding the flow of pancreatic secretion) appears to be outweighed by their... 

Niemann T, Madsen LG, Larsen S, Thorsgaard N. Opioid treatment of painful chronic pancreatitis. Int J Pancreatol 2000 27(3) 235-40. 

Islet tissue contains a variety of peptides which are stored in pancreatic neurons, nerve fibres and secretory cells and which may, when released, also modulate insulin secretion. Among these are VIP, PHI, GRP, NPY, galanin, CCK, calcitonine-gene-related peptide (CGRP), substance P and opioid... 

Enkephalins and endorphins have been found to stimulate insulin release (Ipp etal., 1978 Hermansen, 1983. Verspohl etal., 1986a). In this connection it was also demonstrated that opioid -receptors do not play a role in pancreatic islets but that the insulinotropic effect of low concentrations of Met-enkephalin is mediated via S-receptors (Verspohl et al., 1986a). 

The conorfamides, isolated from Conus spurius, belong to the RFamide neuropeptide family and may act as an agonist of the FMRF-amide-gated ion channels. In invertebrates, this peptide family has many diverse functions, whereas in the mammalian system they moderate opioid function in the CNS, modulate epithelial Na" " channels, have important cardiovascular effects, and stimulate pancreatic somatostatin secretion. ... 

Morphine sulfate, an opioid, to a client diagnosed with pancreatitis. 

Which intervention should be implemented when discharging a client diagnosed with chronic pancreatitis who has been receiving high doses of meperidine (Demerol), an opioid, for the past 4 weeks ... 

Somatic pain responds well to NSAIDs and narcotics. Visceral pain, deep and poorly localized, caused by irritation of the serous or distension or ischemic tissue (for example pain associated with nephrolithiasis or pancreatitis) responds better to narcotics. In some cases, however, the narcotics themselves can exacerbate the problem (for example in case of bile duct obstruction). Neuropathic pain is characterized by excruciating burning pain, and is frequently associated with hypersensitivity. It maybe more responsive to anticonvulsants and antidepressants than to opioids. 

The first patient was a 20-year-old man who presented with nausea, vomiting and severe epigastric pain. He was initially diagnosed with pancreatitis because of a mildly elevated serum amylase level and history of heavy alcohol use. He was using marijuana daily for 2 years. With the use of intravenous (IV) opioids and fluids his symptoms did not improve even after his laboratory values normalised. He insisted on taking several showers... 

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