opioids

1. Dr.Arul Amuthan
MMMC, Mainpal
Opioids

2. Analgesics:
 Opioids – (narcotics) only analgesic activity
 NSAIDS – (analgesic + anti-inflammatory +
antipyretic) eg: paracetamol

3. Examples of commonly used opioids:
 Morphine
 Codeine
 Pethidine
 Tramadol
 Methadone
 Fentanyl
 Pentazocine

4. Actions, uses and adverse effects of Morphine:
Pharmacological
action (CNS)
Adverse effects Therapeutic uses
• Causes analgesic
• Sedation,drowsines
• Euphoria
• Depress the
temperature
regulating center,
cough center, and
respiratory center.
• Drowsiness,
confusion.
• Respiratory
depression &
death.
• newborn if
administered
to mother.
• Painful condition
– MI, fractures,
burn, bullet
wound.
• Renal colic pain
• Postoperative
pain.
• For conscious
sedation
• Dry cough

5. Pharmacological action Adverse effects uses
CNS:
o Constricts pupil to
cause miosis.
o Stimulate vomiting.
o Stimulate vagal center
o Causes dependence
 Nausea, vomiting
 Physical and psychological
dependence
 withdrawal syndromes
such as abnormal behavior,
irritability, body shakes,
sweat, insomnia

6. Pharmacological action Adverse
effects
uses
CVS:
 Causes vasodilation
 Fall in blood pressure
Hypotension
GIT:
 Rise urethral sphincter tone,
 cause urinary retention,
 Constipation
• Difficulty in
micturition
• Constipation Diarrhea
Biliary tract:
 Increase tone of sphincter of
oddi,
 increase intrabiliary pressure.

7. Pharmacological action Adverse effects uses
Bronchus:
 Release histamine and
cause bronchospasm
Itching, skin rash

8. Actions, uses and adverse effects of Morphine:
Pharmacological
action (CNS)
Adverse effects Therapeutic uses
• Causes analgesic
• Sedation,drowsines
• Euphoria
• Depress the
temperature
regulating center,
cough center, and
respiratory center.
• Drowsiness,
confusion.
• Respiratory
depression &
death.
• newborn if
administered
to mother.
• Painful condition
– MI, fractures,
burn, bullet
wound.
• Renal colic pain
• Postoperative
pain.
• For conscious
sedation
• Dry cough

9. Pharmacological action Adverse effects uses
CNS:
o Constricts pupil to
cause miosis.
o Stimulate vomiting.
o Stimulate vagal center
o Causes dependence
 Nausea, vomiting
 Physical and psychological
dependence
 withdrawal syndromes
such as abnormal behavior,
irritability, body shakes,
sweat, insomnia

10. Pharmacological action Adverse
effects
uses
CVS:
 Causes vasodilation
 Fall in blood pressure
Hypotension
GIT:
 Rise urethral sphincter tone,
 cause urinary retention,
 Constipation
• Difficulty in
micturition
• Constipation Diarrhea
Biliary tract:
 Increase tone of sphincter of
oddi,
 increase intrabiliary pressure.

11. Pharmacological action Adverse effects uses
Bronchus:
 Release histamine and
cause bronchospasm
Itching, skin rash
Contraindications to opioids:
1. Bronchial asthma – histamine release aggravates asthma
2. COPD such as emphysema, chronic bronchitis
3. Hypotensive states.

12. 4. Infant - more chance for respiratory depression
5. Old people – worsen urinary retention
6. Undiagnosed acute abdominal pain - interfere with
diagnosis by masking pain & worsen biliary pain.
7. Head injury – causes vomiting and miosis.
These interfere with assessment of prognosis.
Morphine increase the intracranial tension.

13. Treatment for opioid poisoning:
1.Gastric lavage with potassium permanganate.
2. Antidote is naloxone - reverses the respiratory depression.
3. Maintain airway, breathing.