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Pronunciation |
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(OH
pee um TING
chur) |
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Generic
Available |
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No |
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Synonyms |
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Deodorized Opium Tincture; DTO |
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Pharmacological Index |
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Analgesic, Narcotic; Antidiarrheal |
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Use |
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Treatment of diarrhea or relief of pain |
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Restrictions |
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C-II |
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Pregnancy Risk
Factor |
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B/D (if used for prolonged periods or in high doses at
term) |
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Contraindications |
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Increased intracranial pressure, severe respiratory depression, severe liver
or renal insufficiency, known hypersensitivity to morphine
sulfate |
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Warnings/Precautions |
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Opium shares the toxic potential of opiate agonists, and usual precautions of
opiate agonist therapy should be observed; some preparations contain sulfites
which may cause allergic reactions; infants <3 months of age are more
susceptible to respiratory depression, use with caution and generally in reduced
doses in this age group; this is not paregoric, dose
accordingly |
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Adverse
Reactions |
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>10%:
Cardiovascular: Palpitations, hypotension, bradycardia
Central nervous system: Drowsiness, dizziness
Neuromuscular & skeletal: Weakness
1% to 10%:
Central nervous system: Restlessness, headache, malaise
Genitourinary: Decreased urination
Miscellaneous: Histamine release
<1%: Peripheral vasodilation, CNS depression, increased intracranial
pressure, insomnia, mental depression, nausea, vomiting, constipation, anorexia,
stomach cramps, biliary tract spasm, urinary tract spasm, miosis, respiratory
depression, physical and psychological dependence |
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Overdosage/Toxicology |
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Primary attention should be directed to ensuring adequate respiratory
exchange; opiate agonist-induced respiratory depression may be reversed with
parenteral naloxone hydrochloride |
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Drug
Interactions |
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Decreased effect: Phenothiazines may antagonize the analgesic effect of
opiate agonists
Increased toxicity: CNS depressants, MAO inhibitors, tricyclic
antidepressants may potentiate the effects of opiate agonists; dextroamphetamine
may enhance the analgesic effect of opiate agonists |
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Stability |
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Protect from light |
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Mechanism of
Action |
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Contains many narcotic alkaloids including morphine; its mechanism for
gastric motility inhibition is primarily due to this morphine content; it
results in a decrease in digestive secretions, an increase in GI muscle tone,
and therefore a reduction in GI propulsion |
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Pharmacodynamics/Kinetics |
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Duration of effect: 4-5 hours
Absorption: Variable from GI tract
Metabolism: In the liver
Elimination: Urine |
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Usual Dosage |
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Oral:
Diarrhea: 0.005-0.01 mL/kg/dose every 3-4 hours for a maximum of 6 doses/24
hours
Analgesia: 0.01-0.02 mL/kg/dose every 3-4 hours
Adults:
Diarrhea: 0.3-1 mL/dose every 2-6 hours to maximum of 6 mL/24 hours
Analgesia: 0.6-1.5 mL/dose every 3-4 hours |
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Dietary
Considerations |
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Alcohol: Additive CNS effect, avoid use |
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Monitoring
Parameters |
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Observe patient for excessive sedation, respiratory depression, implement
safety measures, assist with ambulation |
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Test
Interactions |
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aminotransferase [ALT
(SGPT)/AST (SGOT)]
(S) |
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Mental Health: Effects
on Mental Status |
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Dizziness and drowsiness are common; may cause restlessness; may rarely cause
insomnia or depression |
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Mental Health:
Effects on Psychiatric
Treatment |
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Concurrent use with psychotropics may alter the analgesic effects of opioids;
monitor for altered response |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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If self-administered, use exactly as directed (do not increase dose or
frequency); may cause physical and/or psychological dependence. While using this
medication, do not use alcohol and other prescription or OTC medications
(especially sedatives, tranquilizers, antihistamines, or pain medications)
without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids
unless instructed to restrict fluid intake). May cause hypotension, dizziness,
drowsiness, impaired coordination, or blurred vision (use caution when driving,
climbing stairs, or changing position - rising from sitting or lying to
standing, or when engaging in tasks requiring alertness until response to drug
is known); dry mouth (frequent mouth care, small frequent meals, chewing gum, or
sucking lozenges may help). Report slow or rapid heartbeat, acute dizziness, or
persistent headache; changes in mental status; swelling of extremities or
unusual weight gain; changes in urinary elimination or pain on urination; acute
headache; trembling or muscle spasms; blurred vision; skin rash; or shortness of
breath. Pregnancy/breast-feeding precautions: Inform prescriber if you
are or intend to be pregnant. If you are breast-feeding, take medication
immediately after breast-feeding or 3-4 hours prior to next
feeding. |
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Nursing
Implications |
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Monitor patient for excessive sedation, respiratory depression, implement
safety measures, assist with ambulation |
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Dosage Forms |
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Liquid: 10% [0.6 mL equivalent to morphine 6 mg] |
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References |
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Kraus DM and Hatzopoulos FK, "Neonatal Therapy," Applied Therapeutics: The
Clinical Use of Drugs, 6th ed, Young LY and Koda-Kimble MA, eds, Vancouver,
WA: Applied Therapeutics, Inc, 1995.
Levy M and Spino M,
"Neonatal Withdrawal Syndrome: Associated Drugs and Pharmacologic Management,"
Pharmacotherapy, 1993, 13(3):202-11.
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