بالنسبة لل other opioid فهنركز على أهم حاجه من كل دوا :
1- codeine :
. it's methylated morphine
. Bioavailability= 60% then metabolized to morphine by CYP2D6
. Potency: 20% so with high dose give the same effect of morphine so, respiratory depression is high incident with it
. Used as antitussive
. Contraindicated with post tonsillectomy in children
2- tramadol :
. Less potent than morphine
. Prevent reuptake of serotonin and NE so with high dose cause seizure due to ↑ NE and serotonin
. Used during labor and delay premature ejaculation
. Adverse effects: seizure
. Contraindicated with epilepsy
3- meperiden
. Metabolized to nor meperidine which neurotoxic that cause inhibition of serotonin reuptake and have atropine like action
. Selective on kappa receptor
. 4 less: → analgesic
→ addiction
→ respiratory depression
→ emitic
. 5 NO : → used in cough
→ vagal stimulatio
→ miosis
→ constipation
→ narcosis
. 2 L: → local anathitic
→ large dose cause neurotoxicity
. Uses : billary colic, inferior MI and Bradycardia and preanesthetic and obstric analgisia
. Adverse effects: hypertension, hyperthermia and atropine like side effects
. Contraindicated with MAO inhibitors
4- fentanyl :. About 100 times potent than morphine
. Administrated IV intrathecal not orally because it's extensive 1 st pass metabolism
. Used as analgesic supplementery for preanesthia
. Adverse effects: respiratory depression More serious with it
✅ Opioid antagonist
. Naloxone and Naltrexone: used with acute toxicity with morphine for relief respiratory depression and neonatal ataxia
. Side effects: withdrawl effects with addicted patients
✅ Partial antagonist
. Pentazocine and Nalbuphone used as:In absence of morphine → agonist In presence of morphine → antagonist → withdrawl effects with addicted patient and Have celling effect