Questions and Answers
What is a common adverse effect of morphine?
What is the specific antidote for morphine poisoning?
What is a major limitation in the use of morphine?
What is a characteristic of withdrawal symptoms in dependent subjects?
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What is a serious toxicity manifestation of acute morphine poisoning?
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What should be done to remove unabsorbed morphine in acute poisoning?
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What happens to blood pressure in hypovolaemic patients who walk about after morphine administration?
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What is a complication that may occur at terminal stages of acute morphine poisoning?
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Which of the following physical manifestations is NOT typically associated with morphine withdrawal?
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Morphine is contraindicated in patients with head injury due to its potential to:
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Which of these is a potential complication of morphine use in patients with bronchial asthma?
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Which of the following is NOT a risk factor for increased sensitivity to morphine?
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What is the primary aim of treatment for morphine addiction?
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Which of the following groups is particularly susceptible to the respiratory depressant effects of morphine?
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What is the most important consideration when administering morphine to a patient with respiratory insufficiency?
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Which of the following drugs can potentiate the effects of morphine?
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What possible effect does Tramadol have compared to morphine in terms of respiratory depression?
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Which opioid is indicated for prompt administration during myocardial infarction to alleviate apprehension?
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What common side effect is experienced with codeine usage?
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What aspect of morphine or pethidine is important for balanced anaesthesia?
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How does the analgesic effect of codeine compare to that of aspirin?
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What is a notable difference in side effects between Tramadol and morphine?
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Which opioid is less potent and cannot relieve severe pain effectively?
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Which of the following best describes the duration of effects for Tramadol?
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Study Notes
Morphine - Adverse Effects
- Common adverse effects include sedation, lethargy, and mental clouding.
- Occasional vomiting occurs in patients lying down; constipation is prevalent.
- Respiratory depression and blurring of vision can be serious complications.
- Urinary retention is particularly concerning in elderly males.
- Blood pressure may decrease, especially in patients with low blood volume or while moving.
- Allergic reactions may manifest as urticaria, itching, or swelling of lips.
Acute Morphine Poisoning
- In non-tolerant adults, 50 mg intramuscularly can lead to significant toxicity.
- Symptoms include stupor/coma, shallow breathing, cyanosis, pinpoint pupils, and potential convulsions.
- Pulmonary edema may occur in terminal stages; death typically results from respiratory failure.
- Treatment involves respiratory support, intravenous fluids, vasoconstrictors, and gastric lavage with potassium permanganate.
- Naloxone (0.4–0.8 mg IV) is the specific antidote, administered every 2–3 minutes until respiration restores.
Morphine - Tolerance and Dependence
- Morphine and related opioids can lead to high degrees of tolerance and abuse potential.
- Psychological and physical dependence is pronounced; medically supervised use rarely leads to abuse.
- Withdrawal symptoms include anxiety, sweating, tremors, abdominal pain, and rapid weight loss.
- Treatment includes the gradual withdrawal of morphine, potentially substituting with long-acting methadone, though relapse risk is high.
Precautions, Contraindications, and Interactions
- Caution is necessary in infants and elderly, who are more susceptible to respiratory depression.
- Risk factors include respiratory insufficiency, head trauma, hypotensive states, and urinary retention in elderly males.
- Patients with hypothyroidism and liver/kidney diseases may exhibit increased sensitivity to morphine.
- Unstable personalities may be prone to addiction.
- Concomitant use with phenothiazines and tricyclic antidepressants can enhance morphine's effects.
Morphine - Dosing
- Typical adult oral dose ranges from 10 to 50 mg; injectable doses are 10-15 mg (IM/SQ) or 2-6 mg IV.
- Pediatric dosage is approximately 0.1-0.2 mg/kg for IM/SQ administration.
Codeine
- A naturally occurring derivative of morphine, often used as a less potent analgesic (1/10th the potency of morphine).
- Comparable analgesic effects to aspirin; effective cough suppressant at subanalgesic doses.
- Well absorbed orally, with an action duration of approximately 4-6 hours.
- Side effects are generally mild, with constipation as a notable adverse effect.
Tramadol
- A centrally acting analgesic with a dual mechanism of action, including opioid pathways.
- Comprehensive oral bioavailability; effects last between 4-6 hours with a half-life of 3-5 hours.
- Causes fewer gastrointestinal and respiratory side effects compared to morphine.
- Common side effects include dizziness, nausea, and mild hemodynamic effects.
- The usual dosing range is 50-100 mg orally, IM, or via slow IV infusion, with pediatric dosing of 1-2 mg/kg.
Opioids - Clinical Uses
- Primarily indicated for severe pain management, especially in traumatic, visceral, and burn pain scenarios.
- Limited use in dentistry as they mainly provide symptomatic relief without addressing underlying issues.
- Morphine and pethidine are utilized in preanaesthetic settings for select patients.
- Key components of balanced anaesthesia and surgical analgesia include opioids like fentanyl, morphine, or pethidine.
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Description
Test your knowledge on the pharmacological effects and toxicity of morphine, including its adverse effects, antidotes, and withdrawal symptoms.
