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Activates endogenous antinociceptive system and thus gives interneuronal transmission of pain impulses at different levels of the central nervous system and alter emotional pain by acting on the higher parts of the brain.
Morphine increases the pain threshold when stimuli of different modality, inhibits conditioned reflexes, has a euphoric and mild sedative effect, increases the tone of the center of the vagus nerve, inhibits the center of vomiting, can stimulate chemoreceptors trigger zone of the vomiting center, depresses the respiratory center, causing constriction of the pupil due to activation the center of the oculomotor nerve, increases the tone of the smooth muscle of the buy testosterone propionate bronchi and sphincters of the internal organs (intestines, biliary tract, urinary bladder), enhances the contractile activity of myo-meters, weakens the intestinal peristalsis, inhibits the secretory activity of glands of the gastrointestinal tract. Several reduced basal metabolic rate and body temperature, it stimulates the secretion of antidiuretic hormone. It causes dilation of peripheral blood vessels and the release of histamine, which can result in reduced blood pressure, skin redness, increased sweating, redness of the eyes of the protein. When administered subcutaneously effect develops in 10-20 minutes and lasts for 3-5 hours.
It is addictive and the drug (opioid) dependence (morphinism).

Indications for use
Morphine is used as an anesthetic in severe pain syndrome traumatic origin, in the preoperative, operative and postoperative periods, myocardial infarction, severe attacks of angina, pain in malignant formations and other conditions involving severe pain.

Contraindications
: Hypersensitivity to opiates.
State, accompanied by respiratory depression or severe depression of the central nervous system. Spasmodic state. Increased intracranial pressure. Head injuries. Acute alcoholic state and alcoholic psychosis. Bronchial asthma. Paralytic ileus. Heart failure due to chronic lung disease. Cardiac arrhythmias. Acute surgical diseases of the abdominal cavity before the diagnosis. Status after surgery on the biliary tract. Do not use morphine during treatment with monoamine oxidase inhibitors (MAOIs), and for an additional 14 days after their cancellation.

Application with caution
Chronic obstructive pulmonary disease, drug dependency (including history), alcoholism, suicidal tendencies, emotional lability, gallstone disease, surgery on the gastrointestinal tract, urinary system, liver or kidney failure, hypothyroidism, heavy inflammatory bowel disease, prostatic hypertrophy, urethral stricture, epileptic syndrome.
Common serious condition of the patient, elderly, children’s age.

Pregnancy and lactation
During pregnancy, childbirth and breastfeeding morphine application only permissible for health reasons (possible development of drug dependence in the fetus and newborn).

Dosing and Administration
Morphine administered subcutaneously. Doses are selected individually depending on the age and condition of the patient. Adults: the usual dose for adults under the skin – to 1 ml of 10 mg / ml. The analgesic effect develops within 10-15 minutes, reaching a maximum after 1-2 hours and lasts for 8 – 12 hours or more Higher doses for adults under the skin: single 0.02 grams daily 0.05 g Babies from birth up to 2 years Subcutaneous 100 – 200 mg / kg (0.1 – 0.2 mg / kg) as necessary every 4-6 hours, so that the total dose does not exceed 15 mg. Children older than 2 years Subcutaneous 100 – 200 mg / kg (0.1 – 0.2 mg / kg) as necessary every 4-6 hours, so that the total dose does not exceed 1.5 mg / kg body weight

Side effect From the digestive system: more often – nausea and vomiting (usually at the beginning of therapy), constipation; less often – dry mouth, anorexia, biliary tract spasm, cholestasis (in the main bile duct), gastralgia, stomach cramps; rarely – gepatotok-sichnost (dark urine, pale stools, hysteria sclera and skin), with severe inflammatory bowel disease – intestinal atony, paralytic buy testosterone propionate ileus, toxic megacolon (constipation, flatulence, nausea, stomach cramps, vomiting). On the side cardiovascular system: more frequent – lowering blood pressure, tachycardia, less often – bradycardia, the frequency is not known – high blood pressure. The respiratory system: more often – depression of the respiratory center, less often – bronchospasm, atelectasis. From the nervous system: more often – dizziness, fainting, drowsiness, unusual tiredness, weakness; less often – headache, tremor, involuntary muscle twitching, discoordination muscle movements, paresthesia, anxiety, depression, confusion (hallucinations, depersonalization), increased intracranial pressure with a probability of subsequent ischemic attacks, insomnia; seldom – a restless sleep, depression of the central nervous system, on the background of large doses – muscle stiffness (especially respiratory), in children – paradoxical excitement, restlessness; the frequency is unknown – cramp, nightmares, sedative or stimulating effect (especially in elderly patients), delirium, decreased ability to concentrate. With the genitourinary system: less often – reduced urine output, spasm of the ureters (difficulty and pain when urinating, frequent urge to urinate), reduced libido, reduced potency; the frequency is unknown – a spasm of the sphincter of the bladder, a violation of the outflow of urine, or aggravation of the condition in prostatic hyperplasia and stenosis of the urethra. Allergic reactions: more often – wheezing, facial flushing, rash, facial skin; less often – skin rash, hives, itching, swelling of the face, swelling of the trachea, laryngeal spasm, fever. Local reactions: redness, swelling, burning sensation at the injection site. The other: more often – sweating, hoarseness; less frequently – a violation of sharpness of vision (including diplopia), miosis, nystagmus, an imaginary feeling of well-being, a sense of discomfort; the frequency is unknown – tinnitus, drug dependence and tolerance, “cancellation” syndrome (muscle pain, diarrhea, tachycardia, mydriasis, pyrexia, rhinitis, sneezing, sweating, yawning, aioreksiya, nausea, vomiting, nervousness, fatigue, irritability, tremors, stomach cramps, fatigue, hypoxia, muscle contraction, headache, increased blood pressure and other autonomic symptoms). repeated use of morphine in techetsie 1-2 weeks (sometimes for 2-3 days may develop addiction (weakening of the analgesic effect) and opioid drug dependence.

 

Overdose
If overdose or poisoning develops stuporous or comatose, hypothermia, lowering blood pressure, there is respiratory depression. A characteristic feature is a pronounced constriction of the pupils (pupils with significant hypoxia may be extended).
First aid for poisoning – Maintenance of adequate pulmonary ventilation Intravenous administration of a specific opioid antagonist naloxone at a dose of 0.4 to 2 mg quickly restores breathing. If no effect within 2-3 minutes of administration of naloxone is repeated. The initial dose of naloxone for children – 0.01 mg / kg. Nalorphine may be used: 5.10 mg intramuscularly or intravenously every 15 minutes to a total dose of 40 mg. It is necessary to consider the possibility of a withdrawal syndrome when administered naloxone and nalorphine patients with addiction to morphine – in such cases the dose should be increased gradually antagonists.

Interaction
Enhances the effect of buy testosterone propionate hypnotics, sedatives, mestnoanesteziruyuschih drugs, drugs for general anesthesia and anxiolytics.
Ethanol, muscle relaxants, and drugs that suppress the central nervous system, enhance deprimiruyuschie effects and respiratory depression.
Buprenorphine (including prior therapy) reduces the effect of other opioid analgesics; during treatment with high doses of agonists of the mu-opioid receptor reduces respiratory depression, and during treatment with low doses of agonists mu or kappa opioid receptor – strengthens; accelerates the emergence of symptoms of “withdrawal” upon discontinuance of the agonists of mu-opioid receptors in the background of drug dependence, with their sudden abolition partially reduces the severity of symptoms. The systematic admission of barbiturates, especially phenobarbital, there is the possibility of reducing the severity of analgesic effect of narcotic analgesics, stimulates the development of cross-tolerance.
When concomitantly with beta-blockers may increase the inhibitory action on the central nervous system with dopamine – a decrease in analgesic effect of morphine, cimetidine – strengthening respiratory depression, with other opioid analgesics -. central nervous system depression, respiratory depression, decreased blood pressure
Chlorpromazine strengthens myotic, sedative and analgesic effects of morphine.
phenothiazines and barbiturates increase the hypotensive effect and increases the risk of respiratory depression.
Naloxone reduces the effect of opioid analgesics, and as they cause respiratory depression and central nervous system; may require higher doses to the leveling effects of butorphanol, nalbuphine and pentazocine, who were appointed to eliminate the adverse effects of other opioids; can accelerate the emergence of symptoms of “withdrawal” on the background of drug addiction.
Naltrexone accelerates the appearance of symptoms of “withdrawal” on the background of drug dependence (symptoms may appear within 5 minutes after administration, continued for 48 hours, characterized by stability and the difficulty of their elimination) ; reduces the effect of opioid analgesics (analgesic, antidiarrheal, anti-cough); no effect on symptoms caused by histamine response. Nalorfin eliminates the respiratory depression caused by morphine.
Enhances the hypotensive effect of drugs that lower blood pressure (including ganglioblokatorov, diuretics).
Competitive inhibits hepatic metabolism of zidovudine and reduces its clearance (increased risk of mutual intoxication).
Drugs with aptiholinergicheskoy activity, antidiarrheal drugs (including loperachid) increase the risk of constipation until the ileus, urinary retention, and depression of the central nervous system. It reduces the effect of metoclopramide.

Cautions
With careful use of morphine in elderly patients, with general exhaustion, liver and kidney insufficiency adrenal cortex. Under close supervision and in small doses should be used morphine on a background of action of drugs acting on the central nervous system (anesthetic drugs, hypnotics, anxiolytics, antidepressants, neuroleptics, anti-histamine, and other non-narcotic pain medications) to prevent excessive depression of the central nervous system ., and the suppression of the respiratory center active
drug should not be combined with narcotic analgesics from the group of partial agonists (buprenorphine) and agonists – antagonists (nalbuphine, butorphanol, tramadol) opioid receptors because of the risk of weakening of analgesia and the possibility of provoking a withdrawal syndrome in patients with addiction to opioids . The analgesic effect and the undesirable effects of opioid agonists (trimeperidine, fentanyl) in therapeutic doses of morphine are added to the effects. During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions, prevent the use of ethanol.
Do not use in situations where it may cause paralytic ileus. With the threat of occurrence of paralytic ileus use of morphine should be stopped immediately.
In patients with suspected heart surgery or other surgery with intense pain, the use of morphine should be discontinued 24 hours before surgery. If you later therapy is indicated, the dosage regimen is selected based on the severity of the operation.
Sometimes there may be tolerance and dependence on the drug. If you have nausea and vomiting can be used with a combination of phenothiazine. To reduce the side effects of morphine drugs in the intestine should be used laxatives.
It should be borne in mind that children under 2 years of age are more susceptible to the effects buy testosterone propionate of opioid analgesics, and they can have paradoxical reactions.

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