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Morphine

Morphia


Presentation

  • The study population comprised patients presenting with NSTE ACS at 443 hospitals across the United States from January 2001 through June 2003 (n 57,039).[ncbi.nlm.nih.gov]
  • One possible solution to this problem is to confirm the presence of unique drug metabolites that cannot be present through contamination, such as phase II glucuronide conjugates.[ncbi.nlm.nih.gov]
  • A discussion of a patient's perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented.[ncbi.nlm.nih.gov]
  • This case report presents a unique case of morphine-induced transient reversible cardiogenic shock. A 44-year-old woman with a history of hypertension, diabetes, and asthma presented with a 3-day history of epigastric pain.[ncbi.nlm.nih.gov]
  • We report a case of a 57-year-old male patient with intrathecal morphine pump failure who presented with psychosis as part of a clinical presentation of opioid withdrawal.[ncbi.nlm.nih.gov]
Intravenous Administration
  • Voiding occurred within 20 min after intravenous administration of methylnaltrexone (0.15 mg/kg body weight). A relapse of urinary retention 24 h later responded well to a second dose of methylnaltrexone.[ncbi.nlm.nih.gov]
  • The abrupt release of accumulated paracetamol at the end of morphine-mediated gastrointestinal inhibition following oral but not intravenous administration of paracetamol suggests that intravenous paracetamol provides a better option for the management[ncbi.nlm.nih.gov]
  • Bednarski, Pharmacokinetics, pharmacodynamics, and analgesic effects of morphine after rectal, intramuscular, and intravenous administration in dogs, American Journal of Veterinary Research, 10.2460/ajvr.2000.61.24, 61, 1, (24-28), (2000).[doi.org]
  • Lack of analgesic activity of morphine-6-glucuronide after short-term intravenous administration in healthy volunteers. Anesthesiology 1997;87:1348–58. [ISI] [Medline] Motamed C, Mazoit X, Ghanouchi K, et al.[web.archive.org]
  • "Driving Miss Emma" is intravenous administration of morphine.[en.wikipedia.org]
Hypothermia
  • Awareness of hypothermia postoperatively with associated morphine administration through subarachnoid block must be ruled out in cases of progressing hypothermia.[ncbi.nlm.nih.gov]
  • To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine.[ncbi.nlm.nih.gov]
  • The neonate had normal findings in cranial MRI that was performed after elective cessation of induced hypothermia.[ncbi.nlm.nih.gov]
  • BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable.[ncbi.nlm.nih.gov]
Congestive Heart Failure
  • It also has a calming effect that protects the system against exhaustion in traumatic shock, internal hemorrhage, congestive heart failure, and debilitated conditions (as certain forms of typhoid fever).[britannica.com]
  • The effect of intravenous morphine in patients with mitral valvular disease and congestive heart failure. Acta Medica Scandinavica 1-2(1):69-74, 1973 Jul-Aug Vismara LA. Leaman DM. Zelis R.[bestbets.org]
Dyspnea
  • BACKGROUND: Dyspnea is highly prevalent in patients with idiopathic interstitial pneumonias (IIPs).[ncbi.nlm.nih.gov]
  • Clinically significant improvements in the patient's dyspnea, measured using a modified Borg score, were observed with subsequent doses. His dyspnea remained well controlled until his death two days later.[ncbi.nlm.nih.gov]
  • Case 1 is a 63-year-old female with terminal lung cancer complaining of a severe dry cough with dyspnea and sleeplessness.[ncbi.nlm.nih.gov]
  • She was administered nebulized fentanyl for symptomatic relief of dyspnea with good effect and she did not experience any allergic response.[ncbi.nlm.nih.gov]
  • This is the first report to review the use of morphine for the treatment of dyspnea in nonverbal children with severe impairment of the central nervous system.[ncbi.nlm.nih.gov]
Bradypnea
  • CONCLUSION: Of 1915 patients, 5 women (0.26%) developed bradypnea associated with 0.15 mg intrathecal morphine. The incidence of severe bradypnea requiring naloxone was 1/1915 (0.052%).[ncbi.nlm.nih.gov]
  • […] which is often the source of published reports, may not always record the reasons for interventions, and second, that respiratory depression may be reported as sedation or bradypnoea and episodes of nonsymptomatic severe hypoxemia (without sedation or bradypnea[doi.org]
Nausea
  • Abstract Nausea and vomiting are probably the most unpleasant side effects that occur when morphine used.[ncbi.nlm.nih.gov]
  • Similarly, gabapentin was associated with a reduction in the incidence of chronic pain and the incidence of nausea.[ncbi.nlm.nih.gov]
  • Preliminary data indicate that M6G is associated less than morphine with nausea and vomiting, causing 50% and 75% less nausea in postoperative and experimental settings, respectively.[ncbi.nlm.nih.gov]
  • Morphine-6-glucuronide (M6G) appears to show equivalent analgesia to morphine but to have a superior side-effect profile in terms of reduced liability to induce nausea and vomiting and respiratory depression.[ncbi.nlm.nih.gov]
Vomiting
  • Abstract Nausea and vomiting are probably the most unpleasant side effects that occur when morphine used.[ncbi.nlm.nih.gov]
  • Morphine-6-glucuronide (M6G) appears to show equivalent analgesia to morphine but to have a superior side-effect profile in terms of reduced liability to induce nausea and vomiting and respiratory depression.[ncbi.nlm.nih.gov]
  • Thirty minutes after admission to the post-anesthesia recovery unit the patient developed vomiting and diaphoresis being treated with 0.4 mg of naloxone followed by continuous infusion of 0.2 mg x (-1) until the symptoms had subsided.[ncbi.nlm.nih.gov]
  • There was no significant difference between severity or incidence of IVPCA morphine-induced nausea and vomiting and genotype (11 SNPs).[ncbi.nlm.nih.gov]
  • Preliminary data indicate that M6G is associated less than morphine with nausea and vomiting, causing 50% and 75% less nausea in postoperative and experimental settings, respectively.[ncbi.nlm.nih.gov]
Constipation
  • L- but not D-arginine, given intraperitoneally, reversed the constipation induced by both morphine and its quaternary analogue. L-arginine was ineffective when given i.c.v. and did not reverse atropine-induced constipation.[ncbi.nlm.nih.gov]
  • This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation. Keep all medicine out of the reach of children. Never share your medicine with anyone.[web.archive.org]
  • Cost: 25 monthly Side effects: nausea, excessive daytime sleepiness (somnolence), frequent vertigo with nausea, constipation 0 helpful marks[patientslikeme.com]
  • Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, has been studied in adults for the treatment of opioid-induced constipation in advanced illness.[ncbi.nlm.nih.gov]
  • It directly acts on the central nervous system to relieve pain, but also cause secondary complications, such as addiction, respiratory depression and constipation due to its activities on peripheral tissues.[ncbi.nlm.nih.gov]
Miosis
  • Route Parenteral, oral Effects Blocks pain signals to brain and spinal cord Uses Relieves severe acute and chronic pain; facilitates induction of anesthesia Clinical Euphoria, respiratory depression, drowsiness, N&V, GI motility, risk of addiction, miosis[medical-dictionary.thefreedictionary.com]
  • Pharmacodynamics: Morphine produces its major effects on the CNS primarily through m-receptors, and also at k- and d-receptors. m 1-receptors are involved in pain modulation, analgesia, respiratory depression, miosis, euphoria, and decreased gastrointestinal[web.archive.org]
  • The most common side effects of morphine are nausea/vomiting, constipation, sedation, hypotension (low blood pressure), dizziness, euphoria, sweating, miosis (or myosis: excessive constriction of the pupils), and flushing.[everydayhealth.com]
  • Activation of the KOR is associated with spinal analgesia, miosis (pinpoint pupils), and psychotomimetic effects. The DOR is thought to play a role in analgesia.[en.wikipedia.org]
Night Blindness
  • (Whitman, 1895) The sickness form submitted by physicians to the Surgeon General from mid- 1 862 to the end of the war listed 152 categories of disease, including "serpent bite," "apoplexy," "insanity," "night blindness," "poisoning," "inebriation," "[druglibrary.org]
Pruritus
  • OBJECTIVE: The mechanism through which neuroaxial morphine causes pruritus has not been elucidated clearly and thoroughly.[ncbi.nlm.nih.gov]
  • EREM provides a longer duration of analgesia after posterior spinal fusion for scoliosis and may be associated with less opioid-induced pruritus.[ncbi.nlm.nih.gov]
  • More patients in the ITM group developed pruritus requiring treatment during the first 24 hours. There were no differences between the groups in other outcomes (e.g. nausea/vomiting, change in pulmonary or kidney functions).[ncbi.nlm.nih.gov]
  • Epidural opioids provide significant postoperative analgesia; however, their use is often limited by side effects such as nausea and pruritus, or they require the addition of epidural local anesthetics with possible side effects of motor block and hypotension[ncbi.nlm.nih.gov]
  • WHAT IS KNOWN AND OBJECTIVE: Pruritus is one of the most common adverse effects associated with neuraxial morphine. Ondansetron has been used to deal with the problem of neuraxial morphine-induced pruritus (NMIP).[ncbi.nlm.nih.gov]
Euphoric Mood
  • The most common adverse effects are constipation, dizziness, sedation, nausea, vomiting, sweating, dysphoria and euphoric mood.[www2.mallinckrodt.com]
Confusion
  • As he had obtained high morphine doses in the context of palliative therapy and a confusion of his supplemental magnesium tablets with a diuretic by the care retirement home was suspected by the relatives, a comprehensive postmortem examination was performed[ncbi.nlm.nih.gov]
  • A 57-year-old woman presented to the emergency department with complaints of increasing visual hallucinations, restlessness, photophobia, dizziness, neck stiffness, occipital headache, confusion, sweating, tachycardia, and nausea over the previous week[ncbi.nlm.nih.gov]
  • Older adults may be more sensitive to the side effects of this drug, especially confusion, dizziness , drowsiness, and slow/shallow breathing. During pregnancy , this medication should be used only when clearly needed. It may harm an unborn baby.[webmd.com]
  • There is a lot of confusion regarding what an opiate is and what an opioid is. They are two different drugs that essentially accomplish the same thing.[opium.com]
  • Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as agitation, hallucinations , confusion), difficulty urinating, vision changes, slow/fast heartbeat, severe stomach / abdominal pain , signs of your[webmd.com]
Stupor
  • [print friendly page] Narcotics The term "narcotic," derived from the Greek word for stupor, originally referred to a variety of substances that dulled the senses and relieved pain. Today, the term is used in a number of ways.[web.archive.org]
  • Some use the word to characterize any drug which produces stupor, insensibility or sleep; many apply it only to derivatives of the opium plant ('opiates'); others consider the term equivalent to addiction-producing; and in legal matters, 'narcotics' may[druglibrary.org]

Workup

Hypercapnia
  • Use with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or in patients with preexisting respiratory depression.[www2.mallinckrodt.com]
  • […] injury, hypothyroidism or untreated myxedema, intracranial hypertension, brain tumor, toxic psychosis, urethral stricture, urinary tract surgery, seizures, acute alcoholism, delirium tremens, shock, cor pulmonale, chronic pulmonary disease, emphysema, hypercapnia[reference.medscape.com]
  • […] circulatory shock. 192 Warnings/Precautions Warnings Respiratory Depression The major toxicity associated with morphine. 169 170 171 172 192 Occurs most frequently in geriatric and debilitated patients, and those with conditions accompanied by hypoxia or hypercapnia[web.archive.org]

Treatment

  • Our report demonstrates that ropivacaine is successful treatment for cancer pain in this case. It will supply us a novel navigation in cancer pain treatments. Meanwhile, this finding still needs additional study for confirmation.[ncbi.nlm.nih.gov]
  • The average duration of treatment decreased by 7 days in the protocol 2 group compared with the protocol 1 group (18.3 vs 25.4 days).[ncbi.nlm.nih.gov]
  • Treatment Hysterectomy / Postoperative 1 3 Completed Treatment Malignancies 2 3 Completed Treatment Moderate to Severe Postoperative Pain 1 3 Completed Treatment Neoplasms 1 3 Completed Treatment Newborn Infants / Pain NOS 1 3 Completed Treatment Opioids[drugbank.ca]
  • Mor treated cells showed significant down-regulation of the examined genes, while in "Mor   EMF" treatments the genes were not significantly changed.[ncbi.nlm.nih.gov]
  • No adverse outcomes in the newborns related to treatment were observed in either group.[ncbi.nlm.nih.gov]

Prognosis

  • A large number of previously untreatable patients gained access to treatment and improved their prognosis.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of his pain was unclear. During this time, his pulmonary status had slowly deteriorated due to chronic infection with P. aeruginosa and MRSA.[ncbi.nlm.nih.gov]
  • Physicians should consider emergent evaluation for myocardial depression in patients who are receiving opioids and present with persistent hypotension or pulmonary edema without other known etiology.[ncbi.nlm.nih.gov]
  • Dose-Response Relationship, Drug Ganglia, Spinal/drug effects Ganglia, Spinal/metabolism Humans Hyperalgesia/therapy* Inflammation/chemically induced Inflammation/complications Male Mice Mice, Inbred C57BL Morphine/therapeutic use* Pain/drug therapy Pain/etiology[ncbi.nlm.nih.gov]
  • Acute postoperative pain: incidence, severity, and the etiology of inadequate treatment. Anesthesiol Clin North Am. 1989; 7:1-15. 132. Shannon M, Berde CB. Pharmacologic management of pain in children and adolescents.[web.archive.org]

Epidemiology

  • From an epidemiological viewpoint, this case of oral morphine sulfate abuse in an adolescent with no previous history suggests the emergence of a new trend of morphine sulfate consumption.[ncbi.nlm.nih.gov]
  • Kinesiology and Physical Education, McGill University, Montréal, QC, Canada. 2 Jewish General Hospital and Mount Sinai Hospital Montréal, Montréal, QC, Canada. 3 Dept of Medicine, Respiratory Division, McGill University, Montréal, QC, Canada. 4 Respiratory Epidemiology[ncbi.nlm.nih.gov]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Community Epidemiology Working Group, National Institute on Drug Abuse. Epidemiological trends in drug abuse; Proceedings of the Community Epidemiology Working Group, Vol 1;June 2000. Cone E J, Holicky BA, Grant TM, Darwin WD, Goldberger BA.[web.archive.org]
  • Heroin Use by Students, 2004: Monitoring the Future Survey 8th-Graders 10th-Graders 12th-Graders Lifetime *** 1.6% 1.5% 1.5% Annual 1.0 0.9 0.9 30-Day 0.5 0.5 0.5 Community Epidemiology Work Group (CEWG) **** In December 2003, CEWG members reported that[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Under physiological conditions, the function of astrocytes in providing brain metabolic support is compromised under pathophysiological conditions caused by human immunodeficiency virus (HIV) and opioids.[ncbi.nlm.nih.gov]
  • Morphine may induce the development of an acute lung injury in patients, whereas the exact pathophysiologic and pharmacologic mechanisms remain unclear.[ncbi.nlm.nih.gov]
  • INTRODUCTION: Obesity is associated with many pathophysiological changes that may result in altered drug metabolism.[ncbi.nlm.nih.gov]
  • Ballas, Pathophysiology and principles of management of the many faces of the acute vaso‐occlusive crisis in patients with sickle cell disease, European Journal of Haematology, 95, 2, (113-123), (2014).[doi.org]
  • Pharmacotherapy: a pathophysiologic approach. 5th ed. Stamford: Appleton and Lange; 2002:1014-26. 163. Taylor EC, Koo PJS. Pain. In: Young LY, Koda-Kimble MA, eds. Applied therapeutics: the clinical use of drugs. 7th ed.[web.archive.org]

Prevention

  • The aim of this meta-analysis was to evaluate the preventive efficacy of ondansetron on NMIP.[ncbi.nlm.nih.gov]
  • BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable.[ncbi.nlm.nih.gov]
  • Labeling MME on packaging could help prevent prescriber errors.[ncbi.nlm.nih.gov]
  • […] tolerance to the anticonvulsant effect of morphine in a mouse model of clonic seizures induced by pentylenetetrazole, and whether ultra-low doses of the opioid receptor antagonist naltrexone which selectively block G(s) opioid receptors were capable of preventing[ncbi.nlm.nih.gov]
  • In addition, pre-treatment with naloxone prevented the morphine-elicited gene expression alterations.[ncbi.nlm.nih.gov]

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