Opioid --> are important drugs used in the pain management.
Employ appropriate pharmacological choice by knowing the pharmacology of the drugs --> both pharmaco dynamic and pharmaco kinetics.
Provide optimal effect and minimize side effects
Non adrenergic non cholinergic transmission(nanc)Merlin Binu
Neurotransmitters other than Acetyl choline and NorAdrenaline of parasympathetic and sympathetic nervous system play important role in synaptic junction transmission. That neurotransmitters are called NANC.
Non adrenergic non cholinergic transmission(nanc)Merlin Binu
Neurotransmitters other than Acetyl choline and NorAdrenaline of parasympathetic and sympathetic nervous system play important role in synaptic junction transmission. That neurotransmitters are called NANC.
An overview of muscarinic receptor agonists and antagonists. This presentation was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology class and accompanies Goodman & Gilman's (12e) chapter 9.
An overview of muscarinic receptor agonists and antagonists. This presentation was delivered to 2nd year pharmacy students enrolled in a pharmacology & toxicology class and accompanies Goodman & Gilman's (12e) chapter 9.
Some of the factors that increase the risk of overdose are: Injecting rather than smoking drug, mixing drugs (especially heroin, benzos, alcohol, methadone, etc. which are respiratory depressants), using alone, the variable purity of street drugs, using in unfamiliar surroundings, using with unfamiliar people increase the risks of overdose. Some of the risky times are those in which we have lost tolerance, we are at the beginning / ending substitute medication and we are in difficult life events.
Some of the external signs of overdose is a person unconscious, that cannot be woken, cyanosis (blue tinge to lips, tip of nose, eye bags, finger tips or nails), not breathing at all or taking slow/shallow or infrequent breaths and pin point pupils.
opioid analgesics with detailed description of introduction, mechanism of action, adverse effect, uses and contraindication along with examples for under graduates.
Opioid analgesics are the important group of medications used in pain management. The present seminar has been prepared by referring to standard textbooks of pharmacology and presented point wise for easy understanding.
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
The term “opiate” refers only to substances with morphine-like activity that are structurally related to morphine. Opioids are sometimes referred to as “narcotic analgesics” and opioid receptor antagonists as “narcotic antagonists”
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
Solution of inadequate postoperative pain relief lies in developing Acute Pain Service.
APS has been shown to reduced morbidity and
mortality, increased out put and out come of
postoperative pain patients
Increased stisfaction of the patients
Shorten LOS in ICU and Hopital low cost
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
History taking
Adequate time
Listen carefully
Empathetic
Trust building
Do not intervere
Pschosocioeconomic & spiritual codition
- quantity: VAS
- quality: nociceptive
- mode of onset and location
- duration & chronicity
- provocating & relieving factors
- special character
- timing of pain
- relation with posture
- associated complaints
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Clossing
By 3 step ladder WHO cancer pain management, 90 % of cancer pain can be relief.
Since cancer patients cannot be cured, our main task is to let them die free of pain with Iman
Ideal pain clinic
Promoting multidisciplinary team approach
Coordinating all specialist effort
Measuring the outcome of treatment offered
Promoting palliative model rather than curative models of pain treatments
Identifying complications of IPM and promoting safe and base-evidence intervention
PiCCO tidak hanya memberikan informasi tentang curah jantung (CO) tapi bisa memberi pengukuran untuk menilai preload, kontraktilitas, afterload, dan air paru ekstravaskular (ELWI)
Role of the thalamus in propofol-induced unconsciousness relates primarily to the functional connections of nonspecific nuclei to the cortex (i.e., mediating multimodal integration of information)
The Anesthetized Brain is less Vulnerable to ischemic injury than the awake brain.
EEG changes suggestive of severe ischemia are present.
Basic Methode Brain Protection are “ Corner Stone “
CPP, CBF, CBV maintained in “Normal Range”, MAP may increased up to 10 – 20 %.
Anesthetics Drugs may have Brain Protectection effect.
Volatile anesthetics do provide some Transient Protection (< 1,5 MAC)
Barbiturates, although long considered to be the gold standard.
Hypothermic methode are controversial, Hyperthermia should be avoided.
Insulin is Administered if glucose values exceed 180 mg/dl.
Close monitoring of BSL to ensure that Hypoglycemia does not develop
Anesthesiologists should concern about the risk of POCD by making prevention and attentive to the potential risk factors.
It should be remembered that research in animal models which represent the specific characteristics of POCD in human remains unclear.
With many factors still unknown, there is still a chance for sinchronized preclinical and clinical research on POCD.
a better understanding of sleep and coma may lead to new approaches to general anesthesia based on new ways to alter consciousness,29,97,98 provide analgesia,99,100 induce amnesia, and provide muscle relaxation.66
More from Department of Anesthesiology, Faculty of Medicine Hasanuddin University (20)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
dr. Ike - update on opioid pharmacology
1. Curriculum Vitae
Nama : Dr. Ike Sri Redjeki, dr., SpAnKIC,KMN,M.Kes
Jabatan : Kepala Departemen Anestesiologi & Terapi Intensif Fakultas
Kedokteran Universitas Padjadjaran Bandung
Ketua Program Studi Pendidikan Konsultan Intensive Care (KIC)
Fakultas Kedokteran Universitas Padjadjaran Bandung
Alamat : Departemen Anestesiologi & Terapi Intensif Fakultas Kedokteran
Universitas Padjadjaran/RS. Hasan Sadikin
Jalan Pasteur no. 38 Bandung 40161
Telp : 022-2038285/0811230514
Fax : 022-2038306
E-mail : ikesriredjeki@yahoo.co.id
2. Update on Opioid Pharmacology
Ike Sri Redjeki
Department of Anesthesiology and Intensive Care Unit
Hasan Sadikin Hospital/Medical Faculty of Padjadjaran University
BANDUNG
3. Introduction
Opioid
• The most effective analgesics are the opioid
analgesics
• The opioids interact with opioid receptors in
the nervous system
• These receptors are the sites of action for the
endorphins, compounds that already exist in the
body also site of action for the external
opioid drugs
• Pharmakokinetics of this specific drugs also
influence its efficacy
4. Ascending fast -
Ascending slow –
Descending
*Opioid Receptor
↓
Site of action of
Endorphine and
other mediator
Opioid
*
*
*
*
*
*
5. FSC MO P MID DI
C
SC Spinal Cord
MO Medulla (oblongata)
P Pons
C Cerebellum
MID Midbrain (Mesencephalon)
DI Diencephalon (Thalamus + Hypothalamus)
F
NRPG
RVM
Forebrain (Cerebral Cortex + Deep nuclei, e.g. amygdala)
nucleus reticularis paragigantocellularis
Rostral Ventral Medulla
PAGRVM
NRPG
Amygdala
Thalamus
Hypothalamus
Nociceptive
Input
6. Example of physiological control of
descending inhibition
Stress produced analgesia (SPA)
• Many accounts of people ignoring injuries when
stressed, e.g. during sports contests, in battle
• Animal studies show at least partly due to activation
of PAG/RVM system
• Possible role for amygdala, hypothalamus, some
cortical regions (insula) that are also involved in
other aspects of stress responses (hormonal,
cardiovascular)
• Note that PAG/RVM system is also part of
cardiovascular control system for stress responses
7. Enkephalins are
derived from pro-
enkephalin
relatively selective δ
ligands
Endorphins are derived from
pro-opiomelanocortin
(also the precursor for ACTH
and MSH)
bind to the µ receptor
Dynorphins are derived from
pro-dynorphins and are
highly selective at the µ receptor
Presynaptic
Postsynaptic
Opioid
Nociceptins (nociceptin/orphaninFQ
[N/OFQ]) (orphanin),
have potent hyperalgesic effects
Little affinity for the µ, d, κ receptors,
(“opioid-receptor-like”)
Nociceptin antagonists may be
antidepressants and analgesics
Kappa receptor
only analgesia and
sedation no other
side effect
8. The ORL-1 receptor
• the ORL-1 receptor or the “orphan” receptor
was very recently discovered
• The natural opioid peptide that is a ligand for
this receptor is nociceptin which is also
called orphanin
• The ORL-1 receptor is associated with many
different biological effects such as memory
processes, cardiovascular function, and renal
function
• It is thought to have effects on dopamine
levels and is associated with neurotransmitter
release during anxiety
10. Opioid Receptor placed by opioid
Secondary
ascending
neuron
Primary
afferent
nociceptor
terminal
Ca2+ Ca2+
K+ K+
Neurotransmitter
glutamate
opioid
receptor
opioid
receptor
Opioid
Opioid
x x
Noxious stimulus
ATP cAMPX
11. Classification based on degree of affinity and
efficacy at various receptor
• Opioid Agonist
• Opioid Partial Agonist ( high affinity but low
efficacy at the μ receptor)
• Opioid Agonist / Antagonist ( poor μ opioid
receptor efficacy or μ opioid receptor
antagonist and have κ agonist )
• Opioid Antagonist
12. Analgesic effects at opioid receptors.
in the brainstem and medial
thalamus
in the limbic and other diencephalic
areas, brain stem, and spinal cord
13. Future of Opioid Analgesics
• The future of Opioid Analgesics seems to be
linked to the study of the Kappa Receptor
– The kappa receptor induces analgesia without
the dangerous and unwanted side effects that
the mu and delta receptors are associated with
– However there are not any selectively strong
agonists to this receptor as of now
• As similar as endogenous morphine non toxic
metabolite
14. Chemical Structure of Opioid
Morphine
Phenolic
hydroxyl group
Alcohol
hydroxyl group
> Nausea and
hallucination
Nitrogen Atom
Changes to the methyl
group will decrease
analgesia and creating
antagonists ( nalorphine )
15. Prototype of
opioid
Pentazocine
High incidence of
dysporia
Fentanyl,
Meperidine
Hihgest affinity for
the mu receptor
Include
propoxyphene
and metadone
Tramadol does not fit in the
standard opioid classes
unique analgesic , an atypical
opioid 4-phenyl – piperidine
analogue of codein
Has partial μ agonist, in
addition to central GABA
catecholamine and
serotonergic activity
16. Pharmacology of opioid
Side effect of opioid
Drug interaction
Morphine ( prototype μ receptor, phenanthrene deriative )
• After oral administration only 40 – 50% reaches the
CNS within 30 minute other extended release 90
min
• Poor penetration poor lipid solubility
• Respiratory acidosis increase brain concentration of
morphine caused by increase in CBF
• Elimination half life 120 min
• Drug inhibit morphine degradation : tamoxifen,
diclofenac, naloxone, carbamazepin, tryciclic and
heterocyclic antidepressants, benzodiazepine
Side Effect :
• Decrease sympathetic nervous system
tone
• Decreased intestinal motility
• Spasm of biliary smooth muscle and
sphincter Oddi spasm
• Induce nausea and vomiting direct
stimulation of CTZ in the floor of 4th
ventricle
• Skin sign urticaria ( histamine release)
17. Pharmacology of opioid
Side effect of opioid
Drug interaction
Codein
• Weak affinity to μ receptor
• Potency 50% of morphine
• Half life 2.5 – 3 hours
• Analgesic activity occurs from metabolism of codein
to morphine
• Inhibitor metabolit : celecoxib, cimetidine, cocaine
• Inducers : dexamethasone, rifampin
• Doses > 65 mg not well tolerated
• Low dose paradoxically more emetic than higher
dose competing effect in CTZ
Side effect :
A very rare but serious side effect
in nursing infants whose mothers are
taking codeine,
and are apparent ultra-rapid metabolizers
of codeine,
resulting in rapid and higher levels of
morphine in
the breast milk, and the subsequent
potentially
fatal neonate respiratory depression
18. Pharmacology of opioid
Side effect of opioid
Drug interaction
Meperidine
• Relatively weak opioid μ agonist only 10% of morphine
• Have a significant anticholinergic and local anesthetic
properties
• Half life 3 hours half life the metabolite
normeperidine 15 – 30 hour
• Must not be given with MAO inhibitor may produce
severe respiratory depression, hyperpyrexia, CNS
excitation, delirium, and seizures
• side effect : anxiety, tremors, multifocal myoclonus,
seizures especially in patients with renal disease,
following repeated administration
19. Pharmacology of opioid
Side effect of opioid
Drug interaction
Fentanyl
• Strong opioid agonist
• Available in parenteral, transdermal, transbuccal
preparation
• Synthetic piperidine opioid agonist
• 80x more potent than morphine
• Highly lipophylic
• Binds strongly to plasma protetin
• Transdermal formulation a lag time 6 – 12
hour to onset of action, reach 3 – 6 days steady
state
20. Notes about the Fentanyl patch
• Takes 12 hours for onset of analgesia
• Need adequate subcutaneous tissue for
absorption
• Takes 24 hours to reach maximum effect
• Change patch every 72 hours
• Dosage change after six days on patch
• Suitable for stable pain only
21. Pharmacology of opioid
Side effect of opioid
Drug interaction
Tramadol
• Unique analgesic
• An atypical opioid, has a higher affinity to μ receptor
than the parent compound
• Max doses 400 mg/day
• Toxic dose cause CNS excitation
• Oral tramadol absorbed rapidly analgesic potency
the same with codein
22. Addiction
• A single exposure to morphine could induce
tolerance and dependence
• Recent study shows that prolonged ventral
tegmental area (VTA), dopamine neuron
activities (DA) and opiate receptor
desensitization followed single morphine
exposure
• Cause the development of dependence and
tolerance cause acute analgesic tolerance
and acute addiction of morphine
23. Withdrawal Sign
( after Physiological Dependence )
Acute Action
• Analgesia
• Respiratory Depression
• Euphoria
• Relaxation and sleep
• Tranquilization
• Decreased blood pressure
• Constipation
• Pupillary constriction
• Hypothermia
• Drying of secretions
• Reduced sex drive
• Flushed and warm skin
Withdrawl Sign
• Pain and irritability
• Hyperventilation
• Dysphoria and depression
• Restlessness and insomnia
• Fearfulness and hostility
• Increased blood pressure
• Diarrhea
• Pupillary dilation
• Hyperthermia
• Lacrimation, runny nose
• Spontaneous ejaculation
• Chilliness and “gooseflesh”
24. Potential problem in Opioid Therapy
• Opioid induced hyperalgesia : hyperalgesia syndrome
occur following effective opioid administration the
phenomenon of pharmacological tolerance or may be
mediated through mechanism :
– Central glutamatergic mechanism
– Increase in the synthesis of excitatory neuropeptides such
as dynorphine
– Descending facilitatory mechanism arising in the medula
• Medication overuse headache
30. Conclusions
• Opioid are important drugs used in the
pain management
• Employ appropriate pharmacological choice
by knowing the pharmacology of the drugs
both pharmaco dynamic and pharmaco
kinetics
• Provide optimal effect and minimize side
effects