Morphine
It is the most important pharmacologically active constituent of opium, the resin copied from the dried juice of the opium poppy. It was first established into clinical practice more than 200 years ago. It is the prototype opioid drug, whose analgesic and rewarding effects are mediated by activating opioid receptors which are found mainly within the central nervous system (CNS). Morphine continues the strong opioid of choice for moderate to severe cancer pain and it is on the World Health Organization’s important drugs list.
Cancer patients are usually unwilling to be managed with morphine as they fear its adverse effect and the risk of addiction or they have it as solely a comfort for the dying rather than a legitimate analgesic.
Pharmacology
The chemical structure of morphine is that a phenanthrene alkaloid, containing of five condensed rings which are structurally rigid. It is a weak base with a PK 7.9 and with PH 76% of its molecules is ionized and it is relatively water soluble and poorly lipid soluble. It is a available for management use because of the hydrochloride, sulphate and tartrate salts in large different formulations. Cancer patients prefer to take morphine orally than any other route of administration because of analgesic given regularly to prevent recurrence of pain usually for months or even years.
Pharmacodynamics
Morphine creates its effects by being an agonist at opioid receptors, located basically in the spinal cord and brain. It is a pure opioid agonist with primary affinity for the mu subclass of receptor, a member of the G- protein coupled receptor (GPCR) super family, while also some affinity for the kappa and delta subclasses. The most crucial responses mediated by activation of opioi...
... middle of paper ...
...the full effect of any dose alteration can be assessed at this time.
Modified release (MR) morphine preparation has a slower onset of action and a later peak effect than NR formulations. There are twice-daily preparations with an onset of action of 1-2h, reaching peak drug levels at 4h. The once daily MR preparations have slower onset and reach peak levels at 8.5h.
The most widely recognized side effects are sedation, respiratory depression and constipation as well as nausea and vomiting, while there are others common such as hpogonadism, immunosupression and tolerance as well as physical and psychological dependence. They can be reduced all these adverse effects of morphine by five possible approaches which are reducing the dose, changing the route and using opioid-spring adjuvant drugs as well as opioid rotation and symptomatic management of the side effect.
In medical school/pharmacology school, medical professionals are taught to treat severe pain with opioids. However, opioids should be prescribed with the possibility of future dependency in mind. Physicians often struggle with whether they should prescribe opioids or seek alternative methodologies. This ethical impasse has led may medical professionals to prescribe opioids out of sympathy, without regard for the possibility of addiction (Clarke). As previously stated, a way to address this is use alternative methods so that physicians will become more acquainted to not not treating pain by means of opioid
... side effects such as analgesia, alteration in mood and drowsiness can occur. Fentanyl depresses the respiratory centres and the cough reflexes in addition to restricting the pupils. Analgesic blood concentration of fentanyl can cause nausea and vomiting due to stimulation of the chemoreceptor trigger zone.5
In my opinion cancer patients can alternative pain management and higher dose of pain medicine so that they can have some comfort during their stage of dying.
Management of pain is very important when it comes to palliative care patients, considering that 55-95% of this patient population requires analgesia for pain relief (Creedon & O’Regan, 2010, p. [ 257]). But what is considered pain management? And why does pain continue to be inadequately treated? According to the article on chronic non-cancer pain in older people: evidence for prescribing, in the past few decades significant improvements have been made to the management of pain in palliative care. However, it is universally acknowledged that pain on a global scale remains inadequately treated because of cultural, attitudinal, educational, legal, and systemic reasons (Creedon & O’Regan, 2010, p. ...
Almost one hundred years ago, prescription drugs like morphine were available at almost any general store. Women carried bottles of very addictive potent opiate based pain killers in their purse. Many individuals like Edgar Allen Poe died from such addictions. Since that time through various federal, state and local laws, drugs like morphine are now prescription drugs; however, this has not stopped the addiction to opiate based pain killers. Today’s society combats an ever increasing number of very deadly addictive drugs from designer drugs to narcotics to the less potent but equally destructive alcohol and marijuana. With all of these new and old drugs going in and out of vogue with addicts, it appears that the increase of misuse and abuse is founded greater in the prescription opiate based painkillers.
Where did this drug come from and what makes it different from any other drug that is on the market? Heroin's origins go back long before Christ was a bleep on the radar. It goes back to 1200 B.C. Or the Bronze Age. At that time how ever heroin would be known as its chemically altered state of the poppy seeds. Even at that time however the ancient peoples of that time knew that if the poppy seeds juice were collected and dried. the extract that was left behind could make a effective painkiller. This would later be named opium. There were small incidents of it appearing in Europe, for instance it was used by the gladiators in the Roman Colosseum. But as a whole it would take more then a millennium for opium to travel from the Middle East to the Europe. This only occurred do to crusades. In just a few hundred after that is went from a rarely used painkiller to a liquid that was said to cure all aliments and would even lead to the most humiliating defeat China Empire. In the 1803 opium became dwarfed by its new brother morphine which is named in honor of the Greek god Morpheus who is the god of dreams. Morphine is an extract of opium and is ruffly 10 times the strength of its counter part. After Morphine creation it was put to used almost at once to assist battle field victims. This was a mistake however, because this refined does of opium is also 10 times more addicting then it was in its original form. Hundreds of thousands of soldiers would retur...
If the drug is being used primarily to treat severe pain not responsive to other analgesics, in a painful terminal condition, (such as advanced widespread cancer), it may ...
Opioids work by attaching to specific proteins called opioid receptors which are located on nerve cells in the body. When the drug attaches to the receptors it reduces the perception of pain, but it can also cause drowsiness, altered mental status, and nausea. Misuse and addiction to opioids are very common. According to the CDC 1,000 people annually are seen in the Emergency Department for treatment regarding misuse of prescribed opioids. Addiction occurs in older adults aged forty years and older more frequently than adults aged twenty to
Patients are scared of what the disease will do to them and how they will feel. Advocates say that the name physician assisted suicide is misleading, in part because people associated suicide with being a horrid thing. Psychological factors are a major reason, mainly including depression, feeling like a burden, fearing loss of control or dignity, or being dependent. Many patients do not want palliative care because they feel they will be mistreated, harmed, or just not cared for by their caretaker. If this is the case, it can make things worse because it can cause more suffering through secondary illness 's and other complications due to neglect.(Lachman 3) The patient can develop bedsores and atrophy if not properly moved, they can lose the ability to feed themselves and use the facility. Patients that are utilizing PAS often remain in the care of family and hospice during the time of their death, but before then most utilize a limited amount of palliative care to help control their pain. (Lachman 4) Depending on what the patient is utilizing to aid in their dying the body itself may often help with pain management. If the patient is utilizing the VSED, the body will produce a strong Opiate, which is known to have an anesthetic effect on the body, reducing the pain and thirst felt. Chewing in ice and mouth washes often help with the feeling of thirst, and artificial saliva help when patients choose terminal dehydration. (Pickert
Opiates are a class of drugs that are used for chronic pain. Opioids are substances that are used to relieve pain by binding opiate receptors throughout the body, and in the brain. These areas in the brain control pain and also emotions, producing a feeling of excitement or happiness. As the brain gets used to these feelings, and the body builds a tolerance to the opioids, there is a need for more opioids and then the possibility of addiction. There are different forms of opioids manufactured such as Morphine, Oxycodone, Buprenorphine, Hydrocodone, and Methadone.
Morphine is a highly addictive opiate psychoactive painkiller. It is often used before or after surgery to alleviate severe pain. Morphine acts by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. The drug was originally derived from the poppy seed plant before it was chemically enhanced and manufactured. Starting off, the drug was used to cure alcoholism and certain types of addictions.
Effective treatment of cancer pain is essential for ensuring the best outcomes for cancer patients, in terms of physical, psychological and social aspects. Although there are no NICE guidelines for management of cancer pain, WHO guidance should be used to inform clinical practice. Careful assessment is a critical element of the process to ensure that patients are offered the treatment which is likely to offer the best outcomes, yet without providing a greater than necessary risk of complications such as tolerance and addiction to opioids. The main outcome that this paper highlights is that “Pain is what the patient says it is and exists when he says it does” (McCaffery 1983
The change which is outlined in this paper relates to how early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management. PICO format question will be used , along with a supportive body of evidence regarding the fact that early onset into a hospice program is helpful with providing end of life pain control. Hospice programs available, and options associated with them will be discussed as well as common concerns associated with early admission to hospice. The methods used for payment of hospice, and how one qualifies for entrance into a hospice program will be explored. A literature search will be performed and its results detailed within the body of this paper. Recent publications on the subject matter and associated issues such as moral and ethical questions as well as the change question will be discussed. Planning, implementing and evaluation of the change proposed will be explored within this paper.
Cancer patients often wonder if going through treatments like chemotherapy and radiation are worth the risk of the side effects, in addition to the cancerous side effects. They feel that they can’t enjoy or relax in what a short amount of time they have left because they are bedridden from the nausea and pain that treatments put them through. Patients tell their loved ones to just let them die so long as they don’t have to go through any more pain. Those who are too old, are unable to recover from the effects, or are just too far in the grips of cancer, should refuse the more harsh treatments like chemo and radiation. On the positive side, refusing treatments after a certain point can save their families from the stress and cost of hospital bills. If caught early enough, patients can opt for safer and easier routes to getting rid of cancer like surgery or by doing a stem cell transplant.
Potent pain medication contains the aspects of utilizing medications such as morphine or demerol, how the medications are dispensed, and t...