Morfine

Morphine is one in the medicine widely used powerful narcotic analgeticum (painkiller). pharmacist Friedrich Sertürner isolated in 1804 thealkaloïde morphine (C17H19NO3) as the active ingredient of opium.

The name of morphine comes from God Morpheus from the Greek mythology.

Although morphine in principle can be made completely synthetically, is where the raw material is extracted from morphine (the crude opium) still by the papaverplant delivered.

It has been in clinical practice often oppose the use of morphine and morfinederivaten because she addictive and there would be tolerancewould occur. The therapeutic use of opiates (bv. in the context of a pain treatment) generally does not lead to major problems. Apart from that, however, it may give rise to physical dependence, which means that sudden withdrawal, the patient may develop withdrawal symptoms. An opiate should therefore always be gradually phased. of habituation – the phenomenon that are needed increasingly higher doses in the course of time – is indeed for some effects of the drug. As pain noticeable increases, then there is a reason for that has to be sorted out.

Indications to prescribe morphine are acute severe pain (post-operative, myocardial infarction) en bij cardiac asthma.

Morphine is also widely used for chronic severe pain, such as in the terminal stage of a disease. Furthermore, morphine is used as premedication before anesthesia, and if analgeticum during the operation.

For acute pain relief is morphine parenterally applied (subcutaan, intramuscularly, intraveneus en epiduraal). As a maintenance dose is in the form of suppositories and used as a drink.

A diagnostic side are the small pupils.miosis

Fentanyl is a morfinomimeticum, a substance having an action analogous to that of morphine. However, it works many times stronger than morphine (by weight ca. 80 meal). It is mainly used in medicine as a potent painkiller during operations, whose effects persist reasonably short and the operation if necessary can be quickly eliminated by the administration of the antagonist nalorphine.

Fentanyl and related compounds, of course, subject to the provisions of the Opium Act to the full extent.

In the chronic pain is used in the form of patches from which it is released slowly and gradually, and is absorbed through the skin. such patches (often incorrectly as ‘morfinepleisters‘ designated) need only to the 3 days to be replaced. A disadvantage is that it takes after sticking a few hours work for these patches and the effect after removing the patch continues for several hours.

There are a number of synthesized fentanyl analogs which partly have a different effect profile:

Alfentanil (Rapifen), one ultrashort (5-10 min.) working opioid analgeticum;
Sufentanil
(Sufenta), a very strong acting drug (10-15 x stronger than fentanyl)

Remifentanil
(Ultiva), currently the shortest acting opioid,

Carfentanil
, a highly potent agent, which is used in the veterinary medicine to stun with large animals; 10 mg is sufficient for an adult elephant. It works ca. 10.000 x as strong as morphine.

In addition to the above-mentioned fentanyl derivatives in the operating room, there are by anesthesiologen any other opioids en opiates used, aspethidine, piritramide, methadone en morfineanalogen,es.

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