MORPHINE

• TRADE NAME: DURAMORPH, INFUMORP

• GENERIC NAME: MORPINE

• PHARMACEUTICAL PREPARATION: ORAL, INJECTION

• DOSAGE: 2.5mg – 5 – 7.5 – 10 – 15 – 20 – 30 – 40 – 60 – 80 – 100 –

120mg 4 hrly
• INDICATIONS:
 moderate to severe pain that may be acute or chronic.
 pain management
 management of palliative/end-of-life care, active cancer treatment,
and vaso-occlusive pain during sickle cell crisis
 musculoskeletal pain, abdominal pain, chest pain, arthritis

• MECHANISMS OF ACTION: This drug produces the majority of its analgesic

effects by binding to the mu-opioid receptor within the central nervous
system (CNS) and the peripheral nervous system (PNS).The net effect
of morphine is the activation of descending inhibitory pathways of the
CNS as well as inhibition of the nociceptive afferent neurons of the PNS,
which leads to an overall reduction of the nociceptive transmission.
 PETHIDINE
• TRADE NAME: MEPERGEN, MEPERGEN FORTIS, MEPROZINE
• GENERIC NAME: PETHIDINE
• PHARMACEUTICAL PREPARATION: Injectable Solution
Oral Capsule, Oral Solution, Oral Tablet, Prefilled Syringe
• DOSAGE:
 Meperidine 10 Mg/ml Injectable Solution
 Meperidine 10 Mg/ml-nacl 0.9% Intravenous Solution
 Meperidine 100 Mg Oral Tablet
 Meperidine 100 Mg/ml Injectable Solution
 Meperidine 25 Mg/ml Injectable Solution
 Meperidine 50 Mg Oral Tablet
  Ml Oral SyrupMeperidine 50 Mg/5
 Meperidine 50 Mg/ml Injectable Solution
 Meperidine 75 Mg/ml Injectable Solution
 Meperidine Compounding Powder

• INDICATIONS:
 treatment of moderate to severe pain.
 reduce shivering
 management of acute pain
 the management of some patients with chronic pain.

• MECHANISM OF ACTION: same mechanism of action as morphine,

which is acting as an agonist to the mu-opioid receptor. The anti-
shivering effect may involve the stimulation of k-opioid receptors.
 • Meperidine also has some local anesthetic effects because of
interactions with sodium ion channels. Also, meperidine has stimulant
effects by inhibition of the dopamine transporter (DAT) and
norepinephrine transporter (NET)

• ADVERSE REACTION/SIDE EFFECTS:

Serious Reactions Common Reactions
 Shock,  Tachycardia,
 seizure,  urinary retention,
 syncope,  tremor,
 bradycardia,  movements,
 cardiac arrest,  xerostomia,
 severe hypotension,  constipation,
 apnea,  dysphoria, weakness,
 respiratory failure.  palpitation,
 PHENOBARBITONE
• TRADE NAME:  Luminal, Solfoton
• GENERIC NAME: PHENOBARBITONE
• PHARMACEUTICAL PREPARATION: ORAL , INJECTION
• DOSAGE:
 15 mg Tablet
 30 mg Tablet
 20 mg/5 ml Syrup or 20 mg/4 ml Syrup
• INDICATIONS:
 Short-term treatment of insomnia;
 relieve anxiety, tension & apprehension;
 long-term anticonvulsant therapy for the treatment of generalised
tonic clonic & simple partial seizures.
 Prophylaxis & treatment of febrile seizures.
 Prevention & treatment of hyperbilirubinemia in neonates.
• MECHANISM OF ACTION:
Phenobarbitol is as an allosteric modulator 
which extends the amount of time the chloride ion channel is open
by interacting with GABAA receptor subunits. Through this action,
phenobarbital increases the flow of chloride ions into the neuron
which decreases the excitability of the post-synaptic neuron. 
Hyperpolarizing this post-synaptic membrane leads to a decrease in
the general excitatory aspects of the post-synaptic neuron. By
making it harder to depolarize the neuron, the 
threshold for the action potential of the post-synaptic neuron will be
increased. Phenobarbital stimulates GABA to accomplish this
hyperpolarization.[36] Direct blockade of excitatory glutamate
 signaling is also believed to contribute to the
hypnotic/anticonvulsant effect that is observed with the barbiturates.
• ADVERSE REACTION/SIDE EFFECTS:
 Confusion,
 hallucinations,
 mental depression,
 skin rash or hives or swelling of eye lids, face or lips,
 wheezing or tightness in chest,
 sore throat & fever,
 unusual excitement & tiredness or weakness,
 yellowing of eyes & skin, clumsiness or unsteadiness,
 dizziness or lightheadedness, drowsiness,
 hangover's effect, anxiety or nervousness,
 constipation,headache,
 nausea, vomiting,
 nightmare or trouble in sleeping, unusual irritability.
 DIAZEPAM
• TRADE NAME:   Valium, Diastat, Diastat AcuDial
• GENERIC NAME: DIAZEPAM
• PHARMACEUTICAL PREPARATION: ORAL ,INJECTION
• DOSAGE: Rectal gel:
Tablet: 2.5 mg
2 mg 10 mg
5 mg 20 mg
10 mg Injectable solution:
Oral solution: 5mg/mL
1mg/1mL Intramuscular device:
5mg/mL 5mg/mL
• INDICATIONS
 anxiety,
 seizures,
 alcohol withdrawal syndrome,
 benzodiazepine withdrawal syndrome,
 muscle spasms, insomnia, and restless legs syndrome

• MECHANISM OF ACTION: bind to receptors in various regions of

the brain and spinal cord. This binding increases the inhibitory
effects of gamma-aminobutyric acid (GABA). GABAs functions
include CNS involvement in sleep induction. Also involved in the
control of hypnosis, memory, anxiety, epilepsy and neuronal
excitability
• ADVERSE REACTION/SIDE EFFECTS:

 Loss of control of bodily movements

 Euphoria (rectal gel)  Respiratory depression
 Incoordination (rectal gel)  Urinary retention
 Drowsiness  Depression
 Rash (rectal gel)  Incontinence
 Diarrhea (rectal gel)  Blurred vision
 Low blood pressure (hypotension)  Difficulty speaking
 Fatigue  Headache
 Muscle weakness  Skin rash
 Changes in salivation
 Codeine Phosphate
• TRADE NAME:  Tylenol/Codeine TAB
• GENERIC NAME: Codeine Phosphate
• PHARMACEUTICAL PREPARATION: ORAL
• DOSAGE:
o As a solution for injection, as phosphate: 30 mg/ml
o As an oral solution, as phosphate: 25 mg/ml
o As a controlled-release tablet: 50 mg, 100 mg, 150 mg and 200
mg
o As an immediate-release tablet, codeine sulfate: 15mg, 30mg, 60
mg
• INDICATIONS:
 treat pain, coughing, and diarrhea
 treat mild to moderate degrees of pain.

• MECHANISM OF ACTION: Codeine is an opioid and an agonist of the

mu opioid receptor. It acts on the central nervous system to have an
analgesic effect.It is metabolised in the liver to produce morphine
which is ten times more potent against the mu receptor. Opioid
receptors are G-Protein coupled receptors that positively and
negatively regulate synaptic transmission through downstream
signalling. Binding of codeine or morphine to the mu opioid receptor
results in hyperpolarization of the neuron leading to the inhibition of
release of nociceptive neurotransmitters causing an analgesic effect
and increased pain tolerance due to reduced neuronal excitability.
• ADVERSE REACTION/SIDE EFFECTS:
 stomach cramps
 dry mouth less common side effects:
 loss of appetite • itchy, raised or red skin rash
 constipation • swelling of face
 nausea (feeling sick) • muscle stiffness
 vomiting • breathing difficulties
 dizziness • heartbeat irregularities
 drowsiness • blurred or double vision
 feeling faint • difficulty in urinating (passing water)
 excitability
 skin rashes
 unable to sleep
 unusual dreams
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