long presentation

1. Opium poppies are white flowers that thrive in the dry, warm climate of southern Asia. This field was grown for pharmaceutical purposes. OPIOIDS DR CHANDRA SEKHAR BEHERA PG 2ND YEAR ANAESTHESIOLOGY The Magic within The Flower of Joy Monday, November 16, 2009 1 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

2. OPIUM Monday, November 16, 2009 2 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

3. HISTORY Monday, November 16, 2009 3 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

4. HISTORY Monday, November 16, 2009 4 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

5. HISTORY Monday, November 16, 2009 5 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

6. HISTORY Monday, November 16, 2009 6 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

7. INTRODUCTION Monday, November 16, 2009 7 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

8. CLASSIFICATIONS Monday, November 16, 2009 8 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

9. ENDOGENOUS OPIOIDS Monday, November 16, 2009 9 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

10. ENDORPHINS

11. ENKEPHALLINS Monday, November 16, 2009 11 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

12. STRUCTURE ACTIVITY Monday, November 16, 2009 12 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

13. Structure - T Monday, November 16, 2009 13 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

14. MORPHINE Monday, November 16, 2009 14 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

15. Schematic of Presynaptic Opiate action Monday, November 16, 2009 15 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

16. RECEPTORS Monday, November 16, 2009 16 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

17. RECEPTORS Monday, November 16, 2009 17 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

18. OPIOID RECEPTORS Monday, November 16, 2009 18 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

19. RECEPTOR ACTIVITY Monday, November 16, 2009 19 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

20. TERMINOLOGY Monday, November 16, 2009 20 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

21. CLASSIFICATION Monday, November 16, 2009 21 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

22. PARTIAL AGONISTS Monday, November 16, 2009 22 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

23. PARTIAL AGONISTS Monday, November 16, 2009 23 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

24. AGONISTS Monday, November 16, 2009 24 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

25. ANTAGONISTS Monday, November 16, 2009 25 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

26. AGONISTS - ANTAGONISTS Monday, November 16, 2009 26 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

27. ANALGESIA Monday, November 16, 2009 27 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

28. ANALGESIA Monday, November 16, 2009 28 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

29. AGE EFFECTS Monday, November 16, 2009 29 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

30. PHARMACODYNAMICS Monday, November 16, 2009 30 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

31. CNS Monday, November 16, 2009 31 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

32. CNS Monday, November 16, 2009 32 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

33. CNS Monday, November 16, 2009 33 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

34. CNS Monday, November 16, 2009 34 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

35. OTHER CNS EFFECTS Monday, November 16, 2009 35 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

36. MUSCLE RIGIDITY Monday, November 16, 2009 36 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

37. CEREBRAL BLOOD FLOW Monday, November 16, 2009 37 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

38. CEREBRAL BLOOD FLOW Monday, November 16, 2009 38 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

39. CVS Monday, November 16, 2009 39 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

40. CVS EFFECTS Monday, November 16, 2009 40 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

41. CVS EFFECTS Monday, November 16, 2009 41 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

42. CVS:BRADYCARDIA Monday, November 16, 2009 42 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

43. RESPIRATORY Monday, November 16, 2009 43 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

44. RESPIRATORY Monday, November 16, 2009 44 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

45. RESPIRATORY Monday, November 16, 2009 45 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

46. FACTORS INCREASING RESPIRATORY DEPRESSION Monday, November 16, 2009 46 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

47. GIT Monday, November 16, 2009 47 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

48. GUT Monday, November 16, 2009 48 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

49. NEUROENDOCRINE Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 49

50. Monday, November 16, 2009 50 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

51. TOLERANCE TO OPIOIDS Monday, November 16, 2009 51 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

52. PHARMACOKINETICS Monday, November 16, 2009 52 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

53. IMPORTENCE OF KINETICS IN OPIOIDS Monday, November 16, 2009 53 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

54. IDEAL KINETICS FOR OPIOID INFUSION Monday, November 16, 2009 54 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

55. PHARMACOKINETIC PROPERTIES OF OPIOIDS Monday, November 16, 2009 55 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

56. MORPHINE Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 56

57. MORPHINE Poor lipid solubility and vd-3-5l/kg Conversion of phamacologicaly active metabolite m6g Slow onset and prolong duration Pka-8.0 , % unionised at pH-7.4-23 %plasma protein binding-35 Clearance-15-30ml/min/kg Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 57

58. INDICATIONS 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 severe chronic pain, e.g., cancer pain from kidney stones (renal colic, ureterolithiasis) severe back pain Morphine can also be used: 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 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). Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 58

59. CONTRADICTIONS The following conditions are relative contraindications for morphine: acute respiratory depression renal failure (due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide) chemical toxicity (potentially lethal in low tolerance subjects) raised intracranial pressure, including head injury (risk of worsening respiratory depression) Biliary colic. Although it has previously been thought that morphine was contraindicated in acute pancreatitis, a review of the literature shows no evidence for this. Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 59

60. CODEINE Monday, November 16, 2009 60 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

61. HEROIN Monday, November 16, 2009 61 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

62. HYDROMORPHONE Monday, November 16, 2009 62 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

63. OXYMORPHONE Monday, November 16, 2009 63 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

64. OXYCODEINE Monday, November 16, 2009 64 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

65. HYDROCODONE AND DIHYDROCODEINE Monday, November 16, 2009 65 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

66. PARTIAL AGONIST-BUPRENORPHINE Monday, November 16, 2009 66 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

67. SYNTHETIC COMPOUND Monday, November 16, 2009 67 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

68. MEPERIDINE Monday, November 16, 2009 68 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

69. FENTANYL Monday, November 16, 2009 69 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

70. USES Extensivly used for anaesthesia and analgesia in both operating room and ICUsettings Used with benzodiazepines and midazolam in endoscopic procedure,cardiac catheterisation, oral surgeries Widely used as tansdermal patches to alleviate pain like in cancer Fentanyl given in intrathecaly as spinal anaesthesia and epiduraly as epidural anaesthsia and anagesia Monday, November 16, 2009 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE 70

71. SULFENTANIL Monday, November 16, 2009 71 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

72. ALFENTNIL Monday, November 16, 2009 72 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

73. REMIFENTANIL Monday, November 16, 2009 73 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

74. METHADONE Monday, November 16, 2009 74 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

75. LAAM Monday, November 16, 2009 75 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

76. TRAMADOL Monday, November 16, 2009 76 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

77. ANTAGONISTS Monday, November 16, 2009 77 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

78. SIGNS OF OVERDOSE Monday, November 16, 2009 78 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

79. NALOXONE

80. NALTREXONE Monday, November 16, 2009 80 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

81. NALMEFENE Monday, November 16, 2009 81 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

82. MIXED AGONIST ANTAGONIST Monday, November 16, 2009 82 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

83. NALORPHIN AND CYCLOZOCINE Monday, November 16, 2009 83 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

84. PENTAZOCINE Monday, November 16, 2009 84 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

85. BUTORPHANOL Monday, November 16, 2009 85 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

86. NALBUPHINE Monday, November 16, 2009 86 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

87. DEPENDENCE AND ADDICTION Monday, November 16, 2009 87 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

88. WITHDRAWAL Monday, November 16, 2009 88 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

89. WITHDRAWAL

90. OPIOID ANAESTHESIA Monday, November 16, 2009 90 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

91. OPIOID ANAESTHESIA Monday, November 16, 2009 91 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

92. ANAESTHESIA

93. ANAESTHETIC TECNIQUES USING OPIOIDS Monday, November 16, 2009 93 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

94. PCA Monday, November 16, 2009 94 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

95. PCA Monday, November 16, 2009 95 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

96. PCA Monday, November 16, 2009 96 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

97. OPIOID PATHWAY Monday, November 16, 2009 97 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE

98. Monday, November 16, 2009 98 DEPT OF ANAESTHESIA MKCG MEDICAL COLLEGE