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Mechanism of Action
Activates opiate receptor in limbic system of CNS, analgesic similar to morphine on a milligram for milligram basis, agonist and antagonist properties; may be preferred for chest pain in setting of acute MI as it reduces the myocardial oxygen demand without reducing the blood pressure.
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Indications
Chest pain associated with acute MI; moderate to severe acute pain; pulmonary edema, with or without associated chest pain (morphine remains first line).
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Contraindications
Head injury or undiagnosed abdominal pain, diarrhea caused by poisoning, hypovolemia, hypotension.
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Adverse Reactions
Hypotension, bradycardia, facial flushing, respiratory depression, CNS depression, euphoria, paradoxical CNS stimulation, blurred vision.
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Drug Interactions
CNS depressants may potentiate effects.
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How Supplied
10 mg in 1-mL ampule (10 mg/mL), 20 mg in 1-mL ampule.
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Dosage and Administration
- Adult: 2-5 mg slowly IV; may repeat 2-mg doses PRN to maximum dose of 10 mg.
- Pediactric: Not recommended
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Duration of Action
- Onset: 2-3 minutes.
- Peak Effect: variable.
- Duration: 3-6 hours.
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Special Considerations
Pregnancy safety: Category B. Use with caution in patients with impaired respiratory function. May precipitate withdrawal syndromes in narcotic-dependant patients. Naloxone should be readily available.
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