MOHAMMAD AIZAT KAMAL BIN MD SHAMUDDIN C111 11 827

MORPHINE
INDICATION:
Morphine still is the drug of choice for the treatment of severe acute or chronic pain as in surgery, trauma, acute pulmonary edema, fractures, cancer pain, and severe neuralgia. Morphine is also frequently injected to prepare for surgery and it can also be given during the operation for the suppression of nociceptive stimuli. For long-term treatment of terminally ill, pain ridden patients, oral preparations are usually better suited. For this, regular administration of individually adjusted doses is decisive. Morphine can be combined with other (non-opioid) analgesics or psychotropic drugs. For subjects with refractory pain, the epidural (or intrathecal) injection or infusion of morphine can be considered. This treatment is frequently efficacious but it is associated with considerable risks. It should therefore only be performed by specially trained staff.

CONTRAINDICATION:
Morphine is contraindicated in patients with a known hypersensitivity to the drug. Because of morphine's stimulating effect on the spinal cord, morphine should not be used in convulsive states, such as those occurring in status epilepticus, tetanus and strychnine poisoning. Morphine is also contraindicated in the following conditions: heart failure secondary to chronic lung disease; cardiac arrhythmias; brain tumor; acute alcoholism; delirium tremens; idiosyncracy to the drug. Narcotic analgesics, including morphine, are contraindicated in premature infants or during labor when delivery of a premature infant is anticipated .

SPECIAL PRECAUTION :
Before using morphine, You should not take this medicine if you have ever had an allergic reaction to morphine or other narcotic medicines, or if you have: 1.Severe asthma or breathing problems; 2. Blockage in your stomach or intestines; or 3. Bowel obstruction called paralytic ileus.

Do not use morphine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue Morphine also is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated. FDA pregnancy category C. It is not known whether morphine will harm an unborn baby. Morphine may cause breathing problems, behavior changes, or life-threatening addiction and withdrawal symptoms in your newborn if you use the medication during pregnancyt.Morphine can pass into breast milk and may harm a nursing baby.

PHARMACODYNAMIC :
Morphine is a narcotic pain management agent indicated for the relief of pain in patients who require opioid analgesics for more than a few days. Morphine interacts predominantly with the opioid mu-receptor. These mu-binding sites are discretely distributed in the human brain, with high densities in the posterior amygdala, hypothalamus, thalamus, nucleus caudatus, putamen, and certain cortical areas. They are also found on the terminal axons of primary afferents within laminae I and II (substantia gelatinosa) of the spinal cord and in the spinal nucleus of the trigeminal nerve. In clinical settings, morphine exerts its principal pharmacological effect on the central nervous system and gastrointestinal tract. Its primary actions of therapeutic value are analgesia and sedation. Morphine appears to increase the patient's tolerance for pain and to decrease discomfort, although the presence of the pain itself may still be recognized. In addition to analgesia, alterations in mood, euphoria and dysphoria, and drowsiness commonly occur. Opioids also produce respiratory depression by direct action on brain stem respiratory centers.

DOSAGE :
Short-acting oral dose (capsules, oral solution, syrup, or tablets): For severe, chronic pain in Adults: initially 10 to 30 milligrams (mg) every four hours. For injection dosage form: For pain in Adults: 5 to 20 mg (usually 10 mg), injected IM or SC every four hours as needed. It can also be given as 4 to 10 mg, injected slowly as IV. Children: 0.1 to 0.2 mg per kg of body weight, up to a maximum of 15 mg, injected SC every four hours as needed. It can also be administered as 0.05 to 0.1 mg per kg of body weight, injected slowly as IV.

SIDE EFFECT
Morphine is most commonly used as a means of providing pain relief. However, the side effects of morphine vary somewhat and while some of the adverse effects seen with initial therapy are

short-term, others may be long-term, especially when the drug is used over longer durations of time. Some common side effects associated with morphine use include: 1.Gastrointestinal side effects - These include nausea, vomiting, abdominal cramps and constipation. Opioid receptors for morphine are present in the gastrointestinal tract and their activation may lead to a slowing of gut movement, leading to constipation. Long-term use leads to severe constipation. In addition, morphine stimulates the vomiting centre of the brain causing nausea and vomiting. Morphine and codeine cause more nausea than other opioids. There may be drying of the mouth as well. 2.Sedation - Named after Morpheus, the Greek god of dreams, morphine is one of the most powerful sedative opioids. People taking morphine are therefore advised to refrain from driving and operating heavy machinery to avoid accidents. 3.Skin changes - Morphine may lead to the release of histamine in the skin leading to warmth, flushing and urticaria or allergic eruptions across the skin. Skin may appear cool and clammy and a severe chill called hypothermia may develop. 4.Shrunken pupils - Morphine may cause the pupils to constrict and appear pin-pointed in size. 5.Respiratory depression - The breathing mechanism can become suppressed in response to low blood oxygen. In healthy individuals, as blood oxygen falls and blood carbon dioxide rises, the drive for breathing increases. However, morphine suppresses this drive in the brain, potentially causing this very dangerous side effect. Respiratory depression is more common with higher doses. 6.Initial doses lead to euphoria but at higher doses unpleasant symptoms such as hallucinations, delirium, dizziness and confusion manifest. There may be some amount of headache and memory loss. 7.One of the prominent side effects of morphine use is the development of physical or psychological dependence on the drug and withdrawal symptoms when the drug is stopped. Morphine is a highly addictive substance and some of the withdrawal symptoms include pain, loss of sleep, nausea, vomiting, diarrhea, goose bumps, hot and cold flashes and intense craving. 8.Development of tolerance - Tolerance describes when a person needs to take a drug in higher doses to achieve the same degree of e.g. euphoria or pain relief as before. Developing a tolerance in this way often means addicts use higher doses of the drug.Transmission of diseases such as HIV/AIDS and hepatitis B and C among drug abusers who use needles to inject the drug.