๋ชจ๋ฅดํ
๋ชจ๋ฅดํ์ ์์ํ์์ ์ค๋ฑ๋์์ ์ค์ฆ์ ๊ธ์ฑ ํต์ฆ ์น๋ฃ์ ์ฌ์ฉ๋๋ ๋ํ์ ์ธ **์คํผ์ค์ด๋ ์งํต์ **์ ๋๋ค. ์ํธ์์ ์ ๋ํ ์ฒ์ฐ ์์ ๋ฎค(ฮผ) ์คํผ์ค์ด๋ ์์ฉ์ฒด ์์ฉ์ ์ ๋๋ค. **์์ ์์ ๋ฐ ์ข ํน์ด์ฑ:** * **๊ฐ ๋ฐ ์์ฅ๋ฅ:** ๋ชจ๋ฅดํ์ ์ผ๋ฐ์ ์ผ๋ก ์์ธก ๊ฐ๋ฅํ ์ค์ถ์ ๊ฒฝ๊ณ ์ต์ , ์ง์ ๋ฐ ์งํต์ ์ ๋ฐํฉ๋๋ค. ํํ์์ฉ์ฒด ๋ฐฉ์์ ์์ญ(CTZ)์ ์ง์ ์๊ทนํ๊ธฐ ๋๋ฌธ์ ๊ฐ์๊ฒ ๊ฐ๋ ฅํ ๊ตฌํ ์ ๋ก ์์ฉํฉ๋๋ค. ๊ฐ๋ ์ข ์ข ์ด๊ธฐ ํฌ์ฌ ์งํ ๋ฐฐ๋ณ์ ํ๋ฉฐ, ๊ทธ ํ ์์ฅ๊ด ์ด๋์ด ๊ฐ์ํฉ๋๋คใ * **๊ณ ์์ด, ๋ง ๋ฐ ๋ฐ์ถ๋๋ฌผ:** ์ด๋ค ์ข ์ ํนํ ์ง์ ์ ๋ ์ ๊ฒฝ์์ ์ (์: ์์ธํ๋ก๋ง์ง ๋๋ ์ํ-2 ์์ฉ์ )๋ฅผ ๋ณ์ฉํ์ง ์๊ณ ํฌ์ฌํ ๊ฒฝ์ฐ ์ต์ ๋ณด๋ค๋ ์ญ์ค์ ์ธ **์ค์ถ์ ๊ฒฝ๊ณ ํฅ๋ถ**(๋ถ์พ๊ฐ, ์กฐ์ฆ, ์์ฑ๊ฑฐ๋ฆผ)์ ๋ณด์ผ ์ ์์ต๋๋ค. ๊ณ ์์ด์์ ๊ตฌํ ๋ฅผ ์ ๋ฐํ๋ ค๋ฉด ๊ฐ๋ณด๋ค ํจ์ฌ ๋์ ์ฉ๋์ด ํ์ํฉ๋๋คใ * **ํ์คํ๋ฏผ ๋ฐฉ์ถ:** ๋ชจ๋ฅดํ์ ๋น๋ง์ธํฌ์์ ๋น๋ฉด์ญํ์ ํ์คํ๋ฏผ ๋ฐฉ์ถ์ ์ ๋ฐํฉ๋๋ค. ์ฌ๊ฐํ ์ ํ์, ํ๊ด ํ์ฅ ๋ฐ ๊ธฐ๊ด์ง ์์ถ์ ํผํ๊ธฐ ์ํด ์ ๋งฅ ์ฃผ์ฌ๋ ์ฒ์ฒํ ํฌ์ฌํด์ผ ํฉ๋๋คใ * **์ฒด์จ ์กฐ์ :** ๋ชจ๋ฅดํ์ ๊ฐ์ ํ ๋ผ์์ ์ ์ฒด์จ์ฆ์ ์ ๋ฐํ ์ ์์ง๋ง, ๊ณ ์์ด, ๋ง, ์, ์ผ์์์๋ ๊ณ ์ฒด์จ์ฆ์ ์ ๋ฐํฉ๋๋คใ
์์ฉ ๊ธฐ์ : Morphine acts primarily as a full agonist at the **mu (ฮผ) opioid receptors** in the central nervous system, with some secondary activity at delta receptors. * **Mechanism:** Binding to the G-protein coupled mu-receptor โ inhibits adenylate cyclase โ decreases intracellular cAMP. * **Presynaptic effect:** Closes voltage-gated calcium channels โ decreases the release of excitatory nociceptive neurotransmitters (e.g., **Substance P**, **glutamate**). * **Postsynaptic effect:** Opens inward-rectifying potassium channels โ hyperpolarizes the neuron โ inhibits ascending pain transmission pathways. * **Secondary effects:** Direct stimulation of the **chemoreceptor trigger zone (CTZ)** causes emesis. Central vagal stimulation leads to bradycardia. Increased anti-diuretic hormone (ADH) release can reduce urine production.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- As an analgesic ยท Up to 10 mg total dose, IM ยท IM ยท once
- As an analgesic ยท Up to 10 mg total dose, IM ยท IM ยท once
- For post-op pain ยท 0.1-0.3 mg/kg IM, SC ยท IM, SC ยท Not specified
- For analgesia ยท 0.1-0.2 mg/kg IM, SC or IV (slowly because of histamine release). ยท IM, SC, IV ยท q6h or as required ยท Easily titrated to effect.
- For analgesia ยท 0.1-0.4 mg/kg IM, SC q3-6h ยท IM, SC ยท q3-6h ยท Concomitant tranquilization recommended.
- For analgesia ยท 0.02-0.1 mg/kg IV q1-4hrs; 0.2-0.5 mg/kg IM, SC q3-4h; 0.2-0.5 mg/kg PO q6-8h. ยท IV, IM, SC, PO ยท q1-4h (IV), q3-4h (IM/SC), q6-8h (PO)
- Epidural administration for pain control ยท Using preservative-free morphine: epidural at 0.1-0.2 mg/kg q8h; spinal at 0.05 mg/kg q8h. ยท Epidural, Spinal ยท q8h
- As a preanesthetic in critical patients ยท 0.5-2 mg/kg IM. ยท IM ยท once ยท Use with diazepam or midazolam. Caution with IV use due to histamine release.
- For adjunctive treatment of cardiogenic pulmonary edema ยท 0.02-0.1 mg/kg IV q1-4 hours, or 0.2-0.5 mg/kg IM or SC q3-4hr ยท IV, IM, SC ยท q1-4h (IV), q3-4h (IM/SC)
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to narcotic analgesics
- Patients receiving monoamine oxidase inhibitors (MAOIs)
- Diarrhea caused by a toxic ingestion (until toxin is eliminated)
- Scorpion envenomation (Centruroides spp. - potentiates venom)
- Conditions where vomiting is contraindicated (e.g., raised intraocular pressure)
์ด์๋ฐ์
- Histamine release (hypotension, vasodilation)
- Respiratory depression
- Bronchoconstriction
- CNS depression (dogs, primates) or excitation (cats, horses, ruminants)
- Physical dependence (with chronic use)
- Hyperthermia (cattle, goats, horses, cats)
- Hypothermia (dogs, rabbits)
- Nausea and vomiting
- Decreased intestinal peristalsis and constipation
- Initial defecation (dogs)
- Panting (dogs)
- Bradycardia or tachycardia
- Histamine release (if given rapidly IV)
- Vomiting (common in non-painful pre-operative patients)
- Transient excitation (IV administration)
์ฝ๋ฌผ ์ํธ์์ฉ
- CNS Depressants (anesthetics, antihistamines, phenothiazines, barbiturates) ยท May cause increased CNS or respiratory depression when used with morphine.
- Diuretics ยท Opiates may decrease diuretic efficacy in congestive heart failure patients.
- Monoamine Oxidase Inhibitors (MAOIs, e.g., amitraz, selegiline) ยท Use with extreme caution; contraindicated in humans due to risk of severe opiate overdose signs.
- Skeletal Muscle Relaxants ยท Morphine may enhance neuromuscular blockade.
- Tricyclic Antidepressants (clomipramine, amitriptyline) ยท Morphine may exacerbate the effects of tricyclic antidepressants.
- Warfarin ยท Opiates may potentiate anticoagulant activity.
- CNS depressants (anaesthetics, antihistamines, barbiturates, phenothiazines, tranquillizers) ยท Increased CNS or respiratory depression ยท major
๋ชจ๋ํฐ๋ง
- Respiratory rate and depth
- CNS level of depression or excitation
- Blood pressure (especially with IV use)
- Analgesic activity
- Respiratory rate and depth (especially under general anaesthesia)
- Pain scores (to assess individual efficacy)
- Signs of histamine release (hypotension, tachycardia) during IV administration
- Gastrointestinal motility
๊ณผ์ฉ๋
**Signs of Toxicity:** Overdosage may produce profound respiratory and/or CNS depression in most species. Newborns are more susceptible. Parenteral doses >100 mg/kg are thought to be fatal in dogs. Other toxic effects include cardiovascular collapse, hypothermia, and skeletal muscle hypotonia. Horses, cats, swine, and cattle may demonstrate CNS excitability (hyperreflexia, tremors) and seizures at high doses or if given rapidly intravenously. **Treatment:** * **Naloxone** is the agent of choice for treating respiratory depression. Doses may need to be repeated as naloxone's effects might diminish before sub-toxic levels of morphine are attained. * Mechanical respiratory support should be considered in severe cases. * Pentobarbital has been suggested for CNS excitement and seizures in cats, but extreme caution is required as barbiturates and narcotics have additive respiratory depressant effects.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.