Morphine
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Morphine

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jawad_amc@yahoo.com

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Morphine Morphine Presentation Transcript

  • MORPHINE JAWAD AHMAD 06-066 27th of MAY,Y2K9 WEDNESDAY
    • Morphine (INN) (pronounced /ˈmɔrfiːn/) is a highly potent opiate analgesic drug, is the principal active agent in opium, and is considered to be the prototypical opioid. Like other opioids, e.g. oxycodone, hydromorphone , and diacetylmorphine (heroin), morphine acts directly on the central nervous system (CNS) to relieve pain. Morphine has a high potential for addiction; tolerance and both physical and psychological dependence develop rapidly.
    INTRODUCTION
  • STRUCTURE Morphine is a benzylisoquinoline alkaloid with two additional ring closures.
    • Systematic (IUPAC) name (5α,6α)-7,8-didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol
    • Identifiers
    • CAS number 57-27-264-31-3 (neutral sulfate),52-26-6 (hydrochloride)
    • ATC code N02AA01
    • PubChem 5288826
    • DrugBank APRD00215
    • ChemSpider 4450907
    • Chemical data
    • Formula C17H19NO3
    • Mol. mass 285.34
    • Pharmacokinetic data
    • Bioavailability ~25% (oral); 100% (IV);
    • Protein binding 30–40%
    • Metabolism Hepatic 90%
    • Half life 2–3 h
    • Excretion Renal 90%, biliary 10%
    • Therapeutic considerations
    • Pregnancy cat.
    • C(AU) C(US)
    • Legal status
    • Controlled (S8)(AU) Schedule I(CA) Class A(UK) Schedule II(US)
    • Routes Smoked/inhaled, insufflated, Oral, SC, IM,
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  • SOURCE
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  • REGIONAL DISTRIBUTION
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    • 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
    • in the relief of severe chronic pain, e.g.,
    • cancer
    • pain from kidney stones (renal colic, ureterolithiasis)
    • severe back pain
    INDICATIONS
    • 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
    • in nebulized form, for treatment of dyspnea, although the evidence for efficacy is slim. Evidence is better for other routes.
    • 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).
    INDICATIONS
  • Effects on Human Performance
    • Most reviews conclude that opioids produce minimal impairment of human performance on tests of sensory, motor, or attentional abilities. However, recent studies have been able to show some impairments caused by morphine, which is not surprising given that morphine is a central nervous system depressant. Morphine has resulted in impaired functioning on critical flicker frequency (a measure of overall CNS arousal) and impaired performance on the Maddox Wing test (a measure of deviation of the visual axes of the eyes). Few studies have investigated the effects of morphine on motor abilities; a high dose of morphine can impair finger tapping and the ability to maintain a low constant level of isometric force (ie. fine motor control is impaired), though no studies have shown a correlation between morphine and gross motor abilities
  • Effects on Human Performance
    • In terms of cognitive abilities, one study has shown that morphine may have a negative impact on anterograde and retrograde memory, but these effects are minimal and are transient. Overall, it seems that acute doses of opioids in non-tolerant subjects produce minor effects in some sensory and motor abilities, and perhaps also in attention and cognition. It is likely that the effects of morphine will be more pronounced in opioid-naive subjects than chronic opioid users
  • Effects on Human Performance
    • In chronic opioid users, such as those on Chronic Opioid Analgesic Therapy (COAT) for managing severe, chronic pain, behavioural testing has shown normal functioning on perception, cognition, coordination and behaviour in most cases. One recent study[38] analysed COAT patients in order to determine whether they were able to safely operate a motor vehicle. The findings from this study suggest that stable opioid use does not significantly impair abilities inherent in driving (this includes physical, cognitive and perceptual skills). COAT patients showed rapid completion of tasks which require speed of responding for successful performance (eg. Rey Complex Figure Test) but made more errors than controls. COAT patients showed no deficits in visual-spatial perception and organization (as shown in the WAIS-R Block Design Test) but did show impaired immediate and short-term visual memory (as shown on the Rey Complex Figure Test – Recall).
  • Effects on Human Performance
    • These patients showed no impairments in higher order cognitive abilities (ie. Planning). COAT patients appeared to have difficulty following instructions and showed a propensity towards impulsive behaviour, yet this did not reach statistical significance. Importantly, this study reveals that COAT patients have no domain-specific deficits, which supports the notion that chronic opioid use has minor effects on psychomotor, cognitive, or neuropsychological functioning.
  • EFFECTS OF MORPHINE
    • IT ACTS ON CNS CAUSING FIRST A STIMULATION AND LATER A DEPRESSION FOLLOWED BY NARCOSIS.
    • THE EFFECTS CAN BE DESCRIBED IN 3 STAGES.
    • EXCITEMENT
    • STUPOR
    • NARCOSIS
  • EXCITMENT
    • THIS STAGE IS ABSENT IF THE DOSE TAKEN IS LARGE.
    • IN ADULTS,THERE IS A SENSE OF WELL BEING OF BRIEF DURATION,LAUGHTER,HALLUCINATION, AND RAPID HEART RATE OCCUR.
    • IN CHILDREN,CONVULSIONS MAY OCCUR.
  • STUPOR
    • IT IS CHARACTERISED BY
    • HEADACHE
    • WEARINESS
    • GIDDINESS
    • A SENSE OF WEIGHT IN THE LIMBS
    • DIMINISHED SENSIBILITY
    • STRONG TENDENCY TO SLEEP
    • PUPILS CONTRACTED,FACE AND LIPS CYANOSED,ITCHING SENSATION FELT ALL OVER THE SKIN
    • THE PULSE AND RESPIRATION ARE ALMOST NORMAL
  • NARCOSIS
    • DEEP COMA
    • MUSCLES RELAXED
    • REFLEXES ABOLISHED
    • PUPILS CONTRACTED TO PIN POINT AND NO RESPONSE TO LIGHT
    • BP FALLS,PULSE RAPID AND FEEBLE
    • BREATHING SLOW,GRADUALLY DIMINISHING IN RATE
    • SKIN IS COLD WITH PERSPIRATION
    • HYPOTHERMIA
    • IN FATAL TERMINATION,THERE IS
    • MARKED CYANOSIS
    • FROTH ESCAPE FROM MOUTH
    • BREATHING IS SIGHING AND IRREGULAR (chyne stokes type)
    • BREATHING RATE IS 2-4 PER MINUTE
    • PULSE IS IMPERSCEPTIBLE
    • PUPILS DILATE TERMINALLY, WHEN ASPHYXIA ENSUES, BUT DO NOT REACT TO LIGHT
    • COMA DEEPENES AND DEATH REASULTS FROM ASPHYXIA DUE TO RESPIRATORY PARALYSIS
    • THE BREATH MAY SMELL OF OPIUM THROUGHOUT THE ILLNESS
  • FATAL DOSE
    • IN PERSON NOT ADDICTED TO OPIUM, 200mg OF MORPHINE, OR ITS EQUIVALENT OF OPIUM 2gm IS FATAL
    • 10ml OF OPIUM IS REGARDED AS DANGEROUS DOSE
    • THE FATAL DOSE OF TINCTURE OF OPIUM IN CHILDREN IS 2-3 DROPS
  • FATAL PERIOD
    • THE USUAL FATAL PERIOD IS ABOUT 9-12 HOURS
  • ABUSES
    • The euphoria, comprehensive alleviation of distress and therefore all aspects of suffering, promotion of sociability and empathy, "body high", and anxiolysis provided by narcotic drugs including the opioids can cause the use of high doses in the absence of pain for a protracted period, which can impart a morbid craving for the drug in the user. Being the prototype of the entire opioid class of drugs means that morphine has properties that may lend it to misuse. Morphine addiction is the model upon which the current perception of addiction is based.
  • ABUSES
    • Animal and human studies and clinical experience back up the contention that morphine is one of the most euphoric of drugs, and via all but the IV route heroin and morphine cannot be distinguished according to studies. Chemical changes to the morphine molecule yield other powerful euphorigenics such as dihydromorphine, hydromorphone (Dilaudid®, Hydal®) and oxymorphone (Numorphan®, Opana®) as well as the latter three's methylated equivalents dihydrocodeine, hydrocodone and oxycodone respectively; in addition to heroin, there are dipropanoylmorphine, diacetyldihydromorphine and other members of the 3,6 morphine diester category like nicomorphine and other similar semi-synthetic opiates like desomorphine, hydromorphinol &c. used clinically in many countries of the world but in many cases also produced illicitly in rare instances
  • ABUSES
    • Misuse of morphine generally entails taking more than prescribed or outside of medical supervision, injecting oral formulations, mixing it with unapproved potentiators such as alcohol, cocaine, and the like, and/or defeating the extended-release mechanism by chewing the tablets or turning into a powder for snorting or preparing injectables. The latter method can be every bit as time-consuming and involved as traditional methods of smoking opium. This and the fact that the liver destroys a large percentage of the drug on the first pass impacts the demand side of the equation for clandestine re-sellers, as many customers are not needle users and may have been disappointed with ingesting the drug orally. As morphine is generally as hard or harder to divert than oxycodone in a lot of cases, morphine in any form is uncommon on the street, although ampoules and phials of morphine injection, pure pharmaceutical morphine powder, and soluble multi-purpose tablets are very popular where available
  • ABUSES
    • Morphine is also available in a paste which is used in the production of heroin which can be smoked by itself or turned to a soluble salt and injected; the same goes for the penultimate products of the Kompot (Polish Heroin) and black tar processes. Poppy straw as well as opium can yield morphine of purity levels ranging from poppy tea to near-pharmaceutical grade morphine by itself or with all of the more than 50 other alkaloids. It also is the active narcotic ingredient in opium and all of its forms, derivatives, and analogues as well as forming from breakdown of heroin and otherwise being present in many batches of illicit heroin as the result of imcomplete acetylation.
  • ABUSES
    • Slang terms for morphine include M, Big M, Vitamin M, Miss Emma, morph, morpho, Murphy, cube, cube juice, White Nurse, Red Cross, mojo, hocus, 13, Number 13, mofo, unkie, happy powder, joy powder, first line, Aunt Emma, coby, em, emsel, morf, dope, glad stuff, goody, God's Medicine, God's Own Medicine, hard stuff, morfa, morphia, morphy, mud, sister, Sister Morphine, stuff, white stuff, white merchandise and others. MS-Contin and its equivalents in other countries are known as misties, blockbusters, and the 100 mg tablets as greys.
  • RELATED TERMS
    • DRUG ADDICTION
    • HEROIN
    • GLUE SNIFFING
  •  
  • 1. JAWAD AHMAD 2. ABSTRACT BATCH 3. MIRPUR POLICE STATION SPECIAL THANKS TO 4. ADMINISTRATOR KALA DHAKA.OGHI
  • THANKYOU