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  • 1. Opium poppies are white flowers that thrive in the dry, warm   climate of southern Asia.   This field was grown for   pharmaceutical purposes.    
    OPIOIDS
    DR CHANDRA SEKHAR BEHERA
    PG 2ND YEAR ANAESTHESIOLOGY
    The Magic within The Flower of Joy
    Monday, November 16, 2009
    1
    DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE
  • 2. OPIUM
    Monday, November 16, 2009
    2
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  • 3. HISTORY
    Monday, November 16, 2009
    3
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  • 4. HISTORY
    Monday, November 16, 2009
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  • 5. HISTORY
    Monday, November 16, 2009
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  • 6. HISTORY
    Monday, November 16, 2009
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  • 7. INTRODUCTION
    Monday, November 16, 2009
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  • 8. CLASSIFICATIONS
    Monday, November 16, 2009
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  • 9. ENDOGENOUS OPIOIDS
    Monday, November 16, 2009
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  • 10. ENDORPHINS
  • 11. ENKEPHALLINS
    Monday, November 16, 2009
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  • 12. STRUCTURE ACTIVITY
    Monday, November 16, 2009
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  • 13. Structure - T
    Monday, November 16, 2009
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  • 14. MORPHINE
    Monday, November 16, 2009
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  • 15. Schematic of Presynaptic Opiate action
    Monday, November 16, 2009
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  • 16. RECEPTORS
    Monday, November 16, 2009
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  • 17. RECEPTORS
    Monday, November 16, 2009
    17
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  • 18. OPIOID RECEPTORS
    Monday, November 16, 2009
    18
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  • 19. RECEPTOR ACTIVITY
    Monday, November 16, 2009
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  • 20. TERMINOLOGY
    Monday, November 16, 2009
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  • 21. CLASSIFICATION
    Monday, November 16, 2009
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  • 22. PARTIAL AGONISTS
    Monday, November 16, 2009
    22
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  • 23. PARTIAL AGONISTS
    Monday, November 16, 2009
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  • 24. AGONISTS
    Monday, November 16, 2009
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  • 25. ANTAGONISTS
    Monday, November 16, 2009
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  • 26. AGONISTS - ANTAGONISTS
    Monday, November 16, 2009
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  • 27. ANALGESIA
    Monday, November 16, 2009
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  • 28. ANALGESIA
    Monday, November 16, 2009
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  • 29. AGE EFFECTS
    Monday, November 16, 2009
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  • 30. PHARMACODYNAMICS
    Monday, November 16, 2009
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  • 31. CNS
    Monday, November 16, 2009
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  • 32. CNS
    Monday, November 16, 2009
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  • 33. CNS
    Monday, November 16, 2009
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  • 34. CNS
    Monday, November 16, 2009
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  • 35. OTHER CNS EFFECTS
    Monday, November 16, 2009
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  • 36. MUSCLE RIGIDITY
    Monday, November 16, 2009
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  • 37. CEREBRAL BLOOD FLOW
    Monday, November 16, 2009
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  • 38. CEREBRAL BLOOD FLOW
    Monday, November 16, 2009
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  • 39. CVS
    Monday, November 16, 2009
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  • 40. CVS EFFECTS
    Monday, November 16, 2009
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  • 41. CVS EFFECTS
    Monday, November 16, 2009
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  • 42. CVS:BRADYCARDIA
    Monday, November 16, 2009
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  • 43. RESPIRATORY
    Monday, November 16, 2009
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  • 44. RESPIRATORY
    Monday, November 16, 2009
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  • 45. RESPIRATORY
    Monday, November 16, 2009
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  • 46. FACTORS INCREASING RESPIRATORY DEPRESSION
    Monday, November 16, 2009
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  • 47. GIT
    Monday, November 16, 2009
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  • 48. GUT
    Monday, November 16, 2009
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  • 49. NEUROENDOCRINE
    Monday, November 16, 2009
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  • 50. Monday, November 16, 2009
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  • 51. TOLERANCE TO OPIOIDS
    Monday, November 16, 2009
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  • 52. PHARMACOKINETICS
    Monday, November 16, 2009
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  • 53. IMPORTENCE OF KINETICS IN OPIOIDS
    Monday, November 16, 2009
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  • 54. IDEAL KINETICS FOR OPIOID INFUSION
    Monday, November 16, 2009
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  • 55. PHARMACOKINETIC PROPERTIES OF OPIOIDS
    Monday, November 16, 2009
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  • 56. MORPHINE
    Monday, November 16, 2009
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  • 57. MORPHINE
    Poor lipid solubility and vd-3-5l/kg
    Conversion of phamacologicaly active metabolite m6g
    Slow onset and prolong duration
    Pka-8.0 ,
    % unionised at pH-7.4-23
    %plasma protein binding-35
    Clearance-15-30ml/min/kg
    Monday, November 16, 2009
    DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE
    57
  • 58. INDICATIONS
    Morphine can be used as an analgesic in hospital settings to relieve:
    pain in myocardial infarction
    pain in sickle cell crisis
    pain associated with surgical conditions, pre- and postoperatively
    pain associated with trauma
    severe chronic pain, e.g., cancer
    pain from kidney stones (renal colic, ureterolithiasis)
    severe back pain
    Morphine can also be used:
    as an adjunct to general anesthesia
    in epidural anesthesia or intrathecal analgesia
    for palliative care (i.e., to alleviate pain without curing the underlying reason for it, usually because the latter is found impossible)
    as an antitussive for severe cough
    as an antidiarrheal in chronic conditions (e.g., for diarrhea associated with AIDS, although loperamide (a non-absorbed opioid acting only on the gut) is the most commonly used opioid for diarrhea).
    Monday, November 16, 2009
    DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE
    58
  • 59. CONTRADICTIONS
    The following conditions are relative contraindications for morphine:
    acute respiratory depression
    renal failure (due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide)
    chemical toxicity (potentially lethal in low tolerance subjects)
    raised intracranial pressure, including head injury (risk of worsening respiratory depression)
    Biliary colic.
    Although it has previously been thought that morphine was contraindicated in acute pancreatitis, a review of the literature shows no evidence for this.
    Monday, November 16, 2009
    DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE
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  • 60. CODEINE
    Monday, November 16, 2009
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  • 61. HEROIN
    Monday, November 16, 2009
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  • 62. HYDROMORPHONE
    Monday, November 16, 2009
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  • 63. OXYMORPHONE
    Monday, November 16, 2009
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  • 64. OXYCODEINE
    Monday, November 16, 2009
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  • 65. HYDROCODONE AND DIHYDROCODEINE
    Monday, November 16, 2009
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  • 66. PARTIAL AGONIST-BUPRENORPHINE
    Monday, November 16, 2009
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  • 67. SYNTHETIC COMPOUND
    Monday, November 16, 2009
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  • 68. MEPERIDINE
    Monday, November 16, 2009
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  • 69. FENTANYL
    Monday, November 16, 2009
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  • 70. USES
    Extensivly used for anaesthesia and analgesia in both operating room and ICUsettings
    Used with benzodiazepines and midazolam in endoscopic procedure,cardiac catheterisation, oral surgeries
    Widely used as tansdermal patches to alleviate pain like in cancer
    Fentanyl given in intrathecaly as spinal anaesthesia and epiduraly as epidural anaesthsia and anagesia
    Monday, November 16, 2009
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  • 71. SULFENTANIL
    Monday, November 16, 2009
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  • 72. ALFENTNIL
    Monday, November 16, 2009
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  • 73. REMIFENTANIL
    Monday, November 16, 2009
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  • 74. METHADONE
    Monday, November 16, 2009
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  • 75. LAAM
    Monday, November 16, 2009
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  • 76. TRAMADOL
    Monday, November 16, 2009
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  • 77. ANTAGONISTS
    Monday, November 16, 2009
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  • 78. SIGNS OF OVERDOSE
    Monday, November 16, 2009
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  • 79. NALOXONE
  • 80. NALTREXONE
    Monday, November 16, 2009
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  • 81. NALMEFENE
    Monday, November 16, 2009
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  • 82. MIXED AGONIST ANTAGONIST
    Monday, November 16, 2009
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  • 83. NALORPHIN AND CYCLOZOCINE
    Monday, November 16, 2009
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  • 84. PENTAZOCINE
    Monday, November 16, 2009
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  • 85. BUTORPHANOL
    Monday, November 16, 2009
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  • 86. NALBUPHINE
    Monday, November 16, 2009
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  • 87. DEPENDENCE AND ADDICTION
    Monday, November 16, 2009
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  • 88. WITHDRAWAL
    Monday, November 16, 2009
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  • 89. WITHDRAWAL
  • 90. OPIOID ANAESTHESIA
    Monday, November 16, 2009
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  • 91. OPIOID ANAESTHESIA
    Monday, November 16, 2009
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  • 92. ANAESTHESIA
  • 93. ANAESTHETIC TECNIQUES USING OPIOIDS
    Monday, November 16, 2009
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  • 94. PCA
    Monday, November 16, 2009
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  • 95. PCA
    Monday, November 16, 2009
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  • 96. PCA
    Monday, November 16, 2009
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  • 97. OPIOID PATHWAY
    Monday, November 16, 2009
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  • 98. Monday, November 16, 2009
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