13. Discuss the Pharmacological Effects of Morphine
Morphine is an opiate, or a derivative of opium. As such, it is a very effective pain reliever, but can also be life threatening if overused.
It is effective as a pain reliever because it binds to opiate receptors, which creates pain relief, sedation and euphoria. Unfortunately, it also depresses respiration, and can lead to both constipation and addiction over time. New research demonstrates, additionally, that it may be effective as a beta-blocker in patients with chronic pain (Frolich et al. 2011).
Possible side effects include nausea, vomiting, cramping, itching, or anaphylaxis, pupil constriction, hallucination, dizziness, and development of tolerance if overused over time.
More specifically, historically, morphine has been used to the case of acute myocardial infarction, in order to reduce the pain that is associated with oxygen reduction. However, modern research demonstrates that this may not be the most appropriate course of treatment. The use of morphine should be reserved for those who have already received pain-reducing drugs which are known to favorably alter the myocardial oxygen supply, but for whom these more advantageous pain reduction methods have failed (Conti 2011). Further morphine should never be used in patients with chest pain, unless they have already been treated with both nitrates and beta-blockers (Conti 2011).
14. What are beta-blockers and why were they prescribed to Mr. Johnson?
Beta-blockers are a drug that are used to manage ongoing cardiac arrhythmias, and which are often prescribed in order to prevent a second heart attack, though they are also increasingly prescribed for hypertension (Kaplan, 2012).
They were prescribed, just as the aspirin was prescribed, to Mr. Johnson, because the prescribing physical hopes to prevent further damage to the heart, and decrease the risk of heart attack in the future. This is also why Mr. John was encouraged to begin a smoking cessation program, and to begin a heart healthy diet. It is all of these factors, when put together that are likely to prevent damage to the heart and ongoing issues with cardiac arrest.
More specifically, with regard to acute myocardial infraction, beta blocker therapy is useful in reducing the size of the infraction, thereby reducing the risk of death, when used as a long term therapy (Rosenson, Reederer, & Kennedy 2014). It is effective because the beta blockers both decrease the tissues demand for oxygen, and provides relief of ischemic chest pain, through a number of modalities (Rosenson, Reederer, & Kennedy 2014). Further, beta blockers can effectively reduce the risk of ventricular fibrillation, and increase the tolerance, or fibrillation threshold, to reduce the overall risk of heart attack or sudden death (Rosenson, Reederer, & Kennedy 2014).
28. Why was Mr. Johnson sent home with Captopril or Capoten?
Capotril is a category D drug, and is specifically, “a specific competitive inhibitor of angiotensin I-converting enzyme (ACE), the enzyme responsible for the conversion of angiotensin I to angiotensin II (RX list, 2015).”
It is commonly used to treat high blood pressure, and to reduce the risk of heart attack. This is appropriate to the long-term treatment goals of Mr. Johnson’s medical team. While his final lab work shows a blood pressure that is in a healthy range, there is reason to believe that it will rise as he exits the hospital and is no longer on intravenous drugs, as such, Capoten is prescribed with the goal of maintaining a reduced blood pressure long-term.
References:
“Capoten” (2015). RX List. Retrieved from http://www.rxlist.com/capoten-drug.htm
Conti, R. (2011). “Intreavenous Morphine and Chest Pain.” Clinical Cardiology, 34(8): 464-4
Frolich, N., et al. (2011). “Distinct pharmacological properties of morphine metabolites at Gi-protein and β-arrestin signaling pathways activated by the human μ-opioid receptor.” Biochemical Pharmacology. 81(10):1248-1254.
Kaplan, N. (2010). “Choice of Therapy in primary (essential) hypertension: Clinical Trials” UptoDate.
Rosenson, R., Reeder, G., & Kennedy, H. (2014) “Acute Myocardial Inarction: Role of beta blocker therapy.” UptoDate.
