Morphine, Pethidine and Codeine

Morphine

It can be produced from the unripe seed capsules of the opium poppy plant and is a pure opioid.

Indication

• Severe to very painful.
• Pre-anesthetic drugs.
• Surgical anesthesia and balanced anesthesia
• Following surgery, pain

Dose

• Obtainable as a 10 mg morphine tablet, 10 mg SR, 15 mg/ml morphine injectable, and inj.
• Adult
  • 15 to 30 mg every four hours.

Side Effects

• Postural hypotension
• Dizziness
• Facial flushing
• Lethargy
• Blurred vision
• Urinary retention
• Constipation
• Nausea
• Vomiting
• Dry mouth
• Abdominal cramps
• Respiratory depression are just a few of the symptoms.

Contraindication

• Infants
• Hypothyriodism
• Bronchial asthma
• Respiratory insufficiency
• Hyposensitivity
• People with COPD
• Hypersensitivity
• Head injuries are among conditions that may be present.

Nursing Consideration

• Due to its potent opioid analgesic and mu receptor binding qualities, it may cause respiratory depression and is therefore inappropriate for usage in head traumas.
• The alkaloid can be created from the grass Papaver somniferum.
• You might become nauseous and vomit as a result.
• Additionally, the pressure inside the skull may increase.
• Nurses are instructed to record patient wells rather than abusing them.
• Find out about any allergies, pulmonary, cardiac, renal, biliary, or mental or sleep disorders, as well as your entire medical history.
• You should call the doctor right away if your patient experiences any unusual or rebound pain, restlessness, anxiety, sadness, hallucinations, dizziness, or itching.
• Inquire about the kind, severity, frequency, and duration of the patient's pain; use a nominal scale to determine the level of pain.
• Keep track of your vital signs, heart rate, central venous pressure, and any changes to your sensations that could point to medication toxicity in a 1/0 chart (tinnitus, blurred vision.)
• The patient should be instructed to call the nurse if their pain returns or worsens, if their senses change, or if they feel dysphoric.
• You should contact your doctor right away if you experience any of the following hepatic toxicity symptoms: nausea, vomiting, diarrhea, jaundice, stomach pain, tenderness, a change in the color of your stools, or any shortness of breath accompanied by frothy sputum.
• Nurses are advised to create accurate documentation and refrain from misusing it.

Pethidine

It is a synthetic opioid. It is chemically unrelated to morphine and less potent than morphine.

Indication

• Harsh to very painful.
• Pre-anesthetic drugs.
• Surgical anesthesia and balanced anesthesia
• Postoperative discomfort
• Due to less obvious neonatal respiratory depression during labor.

Dose

• Mild to Moderate Pain
  • 50-100mg qid.
• Obstructive Pain
  • SC/IM: 50–100 mg every three hours (up to 400 mg every 24 hours).
• Child
  • IM 0.5-2mg/kg 4 hourly.

Contraindication

• Breathing depression
• Pulmonary obstructive disease
• Significant renal impairment
• Serious liver impairment
• Chronic alcoholism
• Dementia tremens
• An increase in intracranial pressure
• Hypersensitivity
• Tachycardia supraventricular.

Side Effect

• Though similar to morphine, it has the potential to cause more severe nausea and hypertension.

Nursing Consideration

• Similar to morphine (but it is prepared as synthetically and less potent than Morphine).

Codeine

It is an organic opioid and one of the main alkaloids found in opium. Because constipation is common, it is a selective cough suppressant, less analgesic than morphine, and used to treat diarrhea.

Mechanism of Action

• By binding to different opioid receptors in the central nervous system, it has analgesic, sedative, and antitussive effects.
• By decreasing the peristaltic motility of the intestinal smooth muscle and raising intestinal tone and anal sphincter tone, it induces constipation and alleviates diarrhea and dysentery.

Indication

• Harsh to very painful.
• A fruitless cough
• Indiscriminate diarrhea.

Dose

• Moderate to Severe Pain
  • Adult
    • 30-60 mg qid or sos, with a daily maximum of 240 mg
  • Child
    • 1–12 years: 3 mg/kg per day, divided
• Non-Productive Cough
  • Adult
    • 15-30mg tds or qid
  • Child
    • 5-12 years: 7.5-15mg tds or qid
• Acute Nonspecific Diarrhoea
  • Adult
    • Maximum of 240mg per day (15-60mg qid)

Contraindication

• Liver illness
• Respiration difficulty

Side Effects

• Sedation
• Confusion
• Drowsiness
• Dizziness
• Agitation
• Hallucination
• Dysphoria
• Constipation
• Wheezing
• Breathing depression
• Hypotension
• Bradycardia
• Nausea
• Vomiting
• Urinary incontinence
• Sweating
• Tolerance for flushing
• Dependence on both physical and mental health

Nursing Consideration

• Similar to morphine/petroleum.