하이드로모르폰

오피오이드 작용제 / 진통제

하이드로모르폰은 강력한 반합성 **순수 뮤-오피오이드 수용체 작용제**로, 수의학에서 진정제, 보정제, 진통제 및 마취 전 투약으로 널리 사용됩니다. 주요 임상적 특징: - **역가**: 체중 당 기준으로 모르핀보다 약 5배 더 강력하며, 옥시모르폰과 거의 동등한 역가를 가집니다. - **모르핀 대비 장점**: 일반적으로 진정 작용이 덜하고, 정맥 투여 후 히스타민 방출이 최소화되며, 유의미한 혈관 확장이나 저혈압을 유발하는 경우가 드뭅니다. - **임상적 유용성**: 진통 효과와 작용 시간이 옥시모르폰과 비슷하지만 비용이 훨씬 저렴하여 수의 임상에서 옥시모르폰을 빠르게 대체하고 있습니다. - **규제 상태**: 남용 및 신체적 의존성 위험이 높아 **스케줄 II (C-II)** 향정신성의약품으로 분류됩니다.

작용 기전: Hydromorphone exerts its effects by binding to opioid receptors, primarily the **mu (μ) receptors**, with some affinity for **delta (δ) receptors**. Mechanism pathway: Agonist binding to **mu-receptors** in the CNS (limbic system, spinal cord, thalamus, midbrain) and peripheral tissues (GI tract, smooth muscle) → activation of G-proteins → inhibition of **adenylate cyclase** → decreased intracellular cAMP → opening of **potassium channels** (causing hyperpolarization) and closing of **voltage-gated calcium channels** → decreased presynaptic release of excitatory neurotransmitters (e.g., **Substance P**, glutamate) → profound **analgesia** and altered pain perception. Secondary effects include respiratory depression (decreased sensitivity of the respiratory center to CO2), antitussive activity, and increased GI sphincter tone leading to decreased motility.

동물 종별 용량

Cats

As an analgesic · 0.05-0.1 mg/kg IM, IV or SC q2-6 hours · IM/IV/SC · q2-6h
For cancer pain · 0.08-0.2 mg/kg IV, IM, or SC · IV/IM/SC · Not specified
For moderate to severe pain · 0.08-0.3+ mg/kg IV, IM or SC q2-6 hours · IV/IM/SC · q2-6h
As a premed prior to moderately painful procedures · 0.1 mg/kg · Not specified · Once · May be combined with acepromazine (0.05-0.2 mg/kg) in young, healthy patients.
As an alternate induction method (especially in critical patients) · 0.05-0.2 mg/kg IV, slowly to effect followed by diazepam 0.02 mg/kg IV · IV · Once · Do not mix two drugs together. Positive pressure ventilation likely necessary.

Ferrets

As a pre-op · 0.05-0.1 mg/kg IV · IV · Once
As a CRI post-op · 0.05 mg/kg IV loading dose, then 0.05-0.1 mg/kg/hr · IV · CRI

SmallMammals

As a pre-op (Rabbits) · 0.05-0.1 mg/kg IV · IV · Once
As a CRI post-op (Rabbits) · 0.05 mg/kg IV loading dose, then 0.05-0.1 mg/kg/hr · IV · CRI

Dogs

투여 경로

IVIMSCPORectal

금기

Hypersensitivity to narcotic analgesics
Diarrhea caused by toxic ingestion (until toxin is eliminated)
Prior to GI obstructive surgery (due to vomiting risk)
Patients stung by scorpion species Centruroides sculpturatus Ewing and C. gertschi Stahnke (may potentiate venom)

이상반응

Dogs: Nausea, vomiting, defecation, panting, vocalization, sedation, CNS depression, respiratory depression, bradycardia, decreased GI motility (constipation with chronic use)
Cats: Nausea, ataxia, hyperesthesia, hyperthermia, behavioral changes (mania/excitement if given without tranquilization)
Mild histamine release (infrequent compared to morphine)

약물 상호작용

Butorphanol, Nalbuphine · Potentially could antagonize opiate effects
CNS Depressants · Additive CNS depression effects possible
Diuretics · Opiates may decrease diuretic efficacy in CHF patients
Monoamine Oxidase Inhibitors (e.g., amitraz, selegiline) · Severe and unpredictable opiate potentiation; not recommended if MAOI used within 14 days
Skeletal Muscle Relaxants · Hydromorphone may enhance muscle relaxant effects
Phenothiazines · May antagonize analgesic effects and increase risk for hypotension
Tricyclic Antidepressants (clomipramine, amitriptyline) · Hydromorphone may exacerbate the effects of tricyclic antidepressants
Warfarin · Opiates may potentiate anticoagulant activity

모니터링

Respiratory rate and depth (pulse oximetry highly recommended)
CNS level of depression or excitation
Blood pressure (especially with IV use)
Cardiac rate (monitor for bradycardia)
Analgesic efficacy

과용량

Massive overdoses may produce profound **respiratory and/or CNS depression** in most species. Other potential effects include: - Cardiovascular collapse - Hypothermia - Skeletal muscle hypotonia - Mania (especially in cats) **Treatment**: - **Naloxone** is the specific reversal agent of choice for treating respiratory depression. - In massive overdoses, naloxone doses may need to be repeated, as naloxone's duration of action may be shorter than that of hydromorphone. - Mechanical respiratory support should be considered in cases of severe respiratory depression. - Provide supportive care as needed.

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