This interesting ppt is about the Pharmacology of morphine and acute morphine poisoning dealt with illustrative pictures, diagrams to facilitate learning for medical/paramedical students....

8. *
*Most important symptom that brings the
patient to the doctor
*Demands immediate relief

12. *
*Unpleasant subjective sensation
*Warning signal
*Indicates impairment of structural and
functional integrity of body

17. *
*Somatic pain
*Visceral pain
*Referred pain

23. *
*Drug which relieves pain without loss of
consciousness
*Afford symptomatic relief without
affecting the cause

28. *
*OPIOID Morphine type
*NON-OPIOID Aspirin type

29. *
*Classes:
*Opioid.
*Agonist.
*Antagonist.
*Agonist-antagonist.
*Non-opioids.
*Salicylates.
*NSAIDs.
*Adjuncts.

34. DR. V. SATHYANARAYANAN M.B.B.S.,M.D., ACME.,
PROFESSOR OF PHARMACOLOGY,
SRM MCH & RC
*OPIOID ANALGESICS - I

35. *
*Dark brown gummy exudate
*Obtained from poppy capsule ( papaver
somniferum )
*Opos – juice
*In use since 4000 BC
*Opium smoking popular by 18th century
*Used for medicinal and recreational purposes

48. *
*Serturner --- isolated a pure opium alkaloid ( 1801)
*Named it as -------- MORPHINE
*By 19th century ----- pure alkaloids available for
therapeutic use

50. *
*Drugs with morphine-like actions
*Also known as Narcotic analgesics

52. *
*Peptides released in the body in response to
pain
*These Act on the opioid receptors
*ENKEPHALINS - act on delta receptors
*ENDORPHINS – act on mu receptors
*DYNORPHINS - act on kappa receptors

56. Actions at Opioid Receptors
Drugs Mu Kappa
Pure Agonists
-morphine, codeine, meperidine (Demerol®),
fentanyl (Sublimaze®), remifentanil (Ultiva®),
propoxyphene (Darvon®), hydrocodone (Vicodin®),
oxycodone (Percocet®)
Agonist Agonist
Agonist-Antagonist
-nalbuphine (Nubaine®), butorphanol (Stadol®)
Antagonist Agonist
Pure Antagonist
-naloxone (Narcan®)
Antagonist Antagonist

57. *
*PROTOTYPE
*Most important alkaloid of opium
*GOLD STANDARD

60. *

61. *
*Act on opioid receptors ------
*Mu – 1,2
*Kappa – 1, 2, 3
*Delta – 1,2
* all are G-protein coupled receptors
*Open K channels and close voltage gated Ca channels 
reduces neuronal excitability, inhibit the release of pain
neurotransmitters

63. Actions of Opioid Receptors
Response Mu Kappa
Analgesia  
Respiratory
Depression

Sedation  
Euphoria 
Physical Dependence 
 GI motility  

64. *

65. *
ANALGESIA
*Dull aching visceral pain is relieved better
than somatic pain
*Raises pain threshold
*Also alters emotional reaction to pain

69. *
*EUPHORIA - feeling of well being,
* “HIGH ”,
* Colourful daydreams
*SEDATION – drowsiness,
* inability to concentrate
* feeling of detachment and indifference
*HYPNOSIS - sleep

76. *
*Respiratory depression - depresses respiratory
centre - decreases rate, rhythm, tidal volume
*Depresses cough centre
*Nausea, vomiting – stimulation of CTZ
*Pupils – miosis
*Stimulates vagal centre – bradycardia
*Body temperature falls slightly

83. *
HYPOTENSION
BY
*Peripheral vasodilatation
*Inhibition of baroreceptor reflexes
*Higher doses – histamine release, depression
of vasomotor centre

85. *GIT
*Decreased gastric motility  increased gastric
emptying time  decreases absorption of drugs
*Increased oesophageal reflux
*Decreased intestinal motility, secretions
*Increased tone of sphincters, spasm of intestine
*All actions result in MARKED CONSTIPATION

88. *
*Spasm of sphincter of Oddi - increased intrabiliary
pressure  biliary colic
*Increases tone, amplitude of ureter may worsen ureteric
colic
*Increases tone of external sphincter of bladder, inhibits
urinary voiding reflex  URINARY RETENTION
*BRONCHOCONSTRICTION

92. *
*Decrease renal plasma flow  depress
renal function
*Anti-diuretic action

93. *
*Inhibit the release of GRH, CRF  DECREASES
BLOOD LEVELS OF
*FSH
*LH
*ACTH
*Betaendorphins

94. *
*Flushing of face,
*Pruritus
*Complex immuno modulatory properties

98. *
*Analgesia
*Respiratory depression
*Constipation
*Urinary retention
*Cough suppression
*Emesis
*Increased ICP
*Indirect through CO2
retention
*Euphoria/Dysphoria
*Sedation
*Miosis
*Pupil constriction
* Preload & afterload
*Watch for hypotension!

101. *
*Develops On repeated administration for
* sedation,
* analgesia,
* euphoria,
* respiratory depression
*Cross tolerance also seen
*NO TOLERANCE FOR constipation and miosis

103. *
*Drug of addiction
*Produce both PSYCHOLOGICAL and PHYSICAL DEPENDENCE
*Sudden stoppage  cause withdrawal symptoms  known as
COLD TURKEY
*Babies born to addicted mothers  also be DEPENDENT

114. *

115. *
*Orally  absorption slow and incomplete
*Bioavailability 20 – 40%
*SUBCUTANEOUSLY 
* onset of action - 15-20 mins
* peak effect - 1 hour
* duration of action- 3-5 hours
*METABOLISM  By glucuronide conjugation
* EXCRETION  through kidneys
*Undergoes enterohepatic circulation

116. *
*10 – 50 mg oral,
*10 – 15 mg SC/IM injection
*2 – 6 mg IV inj
*2 - 3 mg epidural inj
*10, 30, 40, 100 mg continuous release tablets
*Also given as rectal suppositories, transdermal patches

122. *

123. *
*Sedation, mental clouding
*Nausea, vomiting, dizziness
*Respiratory depression
*Constipation
*Urinary retention
*Hypotension
*Dysphoria
*Allergic reactions  skin rash, pruritus,
rarely anaphylaxis ( after IV injection )
*DRUG DEPENDENCE

133. *
*Given to pregnant mother in labour  cause
APNOEA IN THE NEW BORN
*Reversed by inj. Naloxone in the umbilical cord

136. *

137. *
*Potentiates CNS depressants &
*enhances the effects of
1. alcohol
2. Sedative-hypnotics like diazepam
3. Antipsychotics
4. antidepressants
5. Antihistamines
*With MAO inhibitors  hyperpyrexia, coma, hypertension

142. *
*Extremes of age
*With other CNS depressants

146. *
*HEAD INJURY  increases the intracranial tension
* respiratory depression
* interfere with assessment & prognosis
*UNDIAGNOSED ACUTE ABDOMEN
*HYPOVOLAEMIC SHOCK
*RESPIRATORY INSUFFICIENCY, COPD
*BRONCHIAL ASTHMA

151. *

153. *
AS AN ANALGESIC
*Excellent for severe pain in
Acute MI
Fractures
Burns
Pulmonary embolism
Terminal stages of cancer
Acute pericarditis
Postoperative pain

160. *
* AS AN ANALGESIC
morphine + atropine  Biliary colic
Epidural analgesia
Patient Controlled Analgesia

164. *
* As Pre-anaesthetic medication ( reduce
anxiety, pain, dose of anaesthetic, smoothen
induction )
*Acute left ventricular failure/ Acute
pulmonary edema
*Special anaesthesia
*Relieves anxiety in threatened abortion

169. *
*LETHAL DOSE – 250 MG ( in non-addicts )
*Pin point pupils
*Respiratory depression with shallow breathing
*Hypotension
*Shock
*Cyanosis
*Hypothermia, flaccidity
*Stupor, coma, death

173. *
*Positive pressure respiration
*Maintenance of BP
*Gastric lavage with KMnO4
*Specific antidote  NALOXONE 0.4 – 0.8 MG IV,
repeated every 10 – 15 min

175. *
*Morphine is the prototype of opioid analgesics
*It is Very useful in severe visceral pain, Though it has many
side effects
*It acts on opioid receptors
*Long term use cause tolerance and dependence
*Naloxone is the specific antidote for morphine poisoning
*Respiratory depression and hypotension has to be watched
for during morphine use

180. *