• natural opium alkaloid
• primary effect = analgesia
• increases peripheral venous capitance, decreases venous return (chemical phlebotomy)
• causes euphoria, respiratory and CNS depression
• secondary effects = depressed responsiveness to alpha adrenergic receptors (produces peripheral vasodilation) and baroreceptor inhibition
• decreases pre and afterload, may decrease myocardial O₂ demand
• schedule II drug

• chest pain associated with MI
• pulmonary edema w/ or w/out associated pain
• moderate / severe acute or chronic pain

• hypersensitivity to narc.s
• hypotension
• hypovolemia
• head injury
• undiagnosed abdominal pain
• increased ICP
• severe respiratory depression
• pt's who have taken MAOI's w/in 14 days

Onset : 1-2 min

Duration : 2-7 hours

• hypotension
• tachycardia / bradycardia
• palpitations
• syncope
• facial flushing, diaphoresis
• itching
• respiratory depression
• euphoria
• bronchospasm
• dry mouth
• allergic rxn

• CNS depressants - may potentiate effects (resp. depression, hypotension, sedation)
• phenothiazines - may pootentiate analgesia
• MAOI's - may cause paradoxical excitation

• tablets
• suppositories
• solutions
• IV
• parenteral preps differ in strength, common in 10 mg in 1 ml sol. ampules and Tubex syringes

Adult

Pediatric

• pregnancy category B (if not for long periods or at high doses), narc.s rapidly cross placenta
• safety in neonates is not established
• caution in elderly, pt's w/ asthma and those susceptible to CNS depression
• caution in chronic pain syndromes
• may worsen bradycardia or heart block in inferior MI (vagatonic effect)
• naloxone should be readily available