الفهرس 
PHARMACOLOGY OF NARCOTICSOnly 14 pages are availabe for public view
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Abstract
The majority of opioids undergoes extensive first pass metabolism in the liver before entering the systemic circulation. Hepatic metabolism is generally intended to facilitate renal excretion through a transformation to hydrophilic substances that are easy to eliminate.
In the ICU, side effects of narcotic opioids include endocrinopathy, opioid induced hyperalgesia (OID), Cardiac toxicity, Narcotic Bowel Syndrome (NBS), Opioid-Induced Constipation (OIC), Opioid-induced respiratory depression (OIRS) and Opioid induced nausea and vomiting.
Endocrinopathy is diagnosed on the basis of clinical and laboratory assessment. Suggested management options for opioid endocrinopathy include discontinuing opioid therapy, reducing the opioid dose, switching to a different opioid or adding hormone supplementation.
Pain from OIH is not necessarily located at the source of injury or disease. Instead, pain manifests as generalized, diffuse, and ill defined. Treating OIH is often very challenging and time consuming but one option available to manage OIH includes weaning off opioids completely.Another option to manage OIH is to rotate to a different class of opioids.
For diagnosis of cardiac toxicity, Electrocardiogram (ECG) monitoring of QTc at baseline and following dose increases is appropriate in patients receiving these medications. Decreases in systemic vascular resistance and blood pressure can be treated with the administration of H1 and H2 antagonists, and may require the administration of vasopressors and intravenous fluids.
NBS is characterized by the development or worsening of abdominal pain linked to chronic or escalating doses of opioids. For treatment, a detoxification program for NBS involving inpatient medical hospitalization with careful opioid tapering using reduced intravenous morphine equivalents was suggested. Medications available included duloxetine, milnacipran, pregabalin and gabapentin.