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Comparative Opioid  Pharmacology
Disclosure ,[object Object],[object Object]
Classical Opioid Pharmacology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classical Opioid Pharmacology ,[object Object],[object Object]
Classical Opioid Pharmacology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pure    agonists ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Morphine The prototypical opioid
Morphine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Simulation of Morphine Time Course Dahan et al. Anesthesiology. 2004 Nov;101(5):1201-9.
Fentanyl The ever morphing molecule
Fentanyl ,[object Object],[object Object],[object Object]
How we think of fentanyl: (small part of the market)
Fentanyl morph 1: Duragesic
Fentanyl morph 2: Actiq
Fentanyl morph 3: E-trans fentanyl Viscusi et al, JAMA 2004 291:1333
Fentanyl morph 4: Inhaled liposomal fentanyl Hung et al, Anesthesiology 1995 83:277-84
Fentanyl morph 5: Inhaled fentanyl aerosol Mather et al, Br J Clin Pharmacol 1998 46:37
Fentanyl morph 6: Effervescent Fentanyl (OraVescent) Pather et al, http://www.drugdeliverytech.com/cgi-bin/articles.cgi?idArticle=5
Sufentanil Newly morphing molecule
Sufentanil ,[object Object],[object Object],[object Object],[object Object]
Sufentanil morph 1: Implantable sufentanil delivery http://www.drugdeliverytech.com/cgi-bin/articles.cgi?idArticle=115
Meperidine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hydromorphone A better morphine
Hydromorphone ,[object Object],[object Object],[object Object],[object Object],[object Object]
Alfentanil ,[object Object],[object Object],[object Object],[object Object]
Remifentanil ,[object Object],[object Object],[object Object],[object Object],[object Object]
Methadone The Under-Utilized Opioid
Methadone ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fundamental PK/PD Parameters
Comparative Opioid PK
Comparative Opioid PK
Comparative Onset of  Opioid Drug Effect
Context Sensitive Half Time
50% Effect Site Decrement Time
20% Effect Site Decrement Time
Rise to Steady State
Relative Potency
50   g fentanyl at 10 minutes
50   g/hour fentanyl at 2 hours
  Opioid Receptor
Evidence of    opioid subtypes ,[object Object],[object Object],[object Object],[object Object],[object Object],Gavril Pasternak, Life Sciences 2001:68, 2213
Naloxonazine ,[object Object],[object Object],[object Object],[object Object],Gavril Pasternak, Life Sciences 2001:68, 2213
Morphine-6-glucuronide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gavril Pasternak, Life Sciences 2001:68, 2213
MOR-1 gene splice variants (gene=OPRM) Gavril Pasternak, http://www.mskcc.org/mskcc/html/11384.cfm
Antisense lowers  morphine  analgesia (no effect on m6g) Gavril Pasternak, Life Sciences 2001:68, 2213
Antisense lowers  m6g  analgesia (no effect on morphine) Gavril Pasternak, Life Sciences 2001:68, 2213
Morphine-6-glucuronide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 1  selective agonists? ,[object Object],[object Object],[object Object],[object Object]
“ Power corrupts, PowerPoint corrupts absolutely” dr shabeel pn

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