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In my research of the drugs that Johnny was given I have found a lot of what I believe to be usefull information. I search out the drugs he was given and find the sites and information that will be most valuable to anyone who is being treated for cancer. As you know if you try to find information on anything you will usually find thousands of sites that contain the word tho only a few have real information. I found out while researching morphine that many sites are just junkies reporting on their highs from useing it for their own purposes. Following is some of the informatiion that I have found. Someday soon I am planning on having a web sit that will give as much information as I can find along with stories of hope and those of heartbreak. I think everyone who is confronted with cancer needs to know all that they can and it should be easy for them to access. Maybe this information can help some of you. God Bless you all. Keep fighting and supporting each other. Lillianmorphine information

Contraindications: Hypersensitivity to morphine; respiratory insufficiency or depression; severe CNS depression; attack of bronchial asthma; heart failure secondary to chronic lung disease; cardiac arrhythmias; increased intracranial or cerebrospinal pressure; head injuries; brain tumor; acute alcoholism; delirium tremens; convulsive disorders; after biliary tract surgery; suspected surgical abdomen; surgical anastomosis; concomitantly with MAO inhibitors or within 14 days of such treatment. is contraindicated in any patient who has or is suspected of having a paralytic ileus

Respiratory depression is the chief hazard of all morphine preparations. Respiratory depression occurs most frequently in the elderly and debilitated patients as well as in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation.

Interaction with Other Central-Nervous-System Depressants--Morphine should be used with caution and in reduced dosage in patients who are concurrently receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative-hypnotics, tricyclic antidepressants, and other CNS depressants (including alcohol). Respiratory depression, hypotension, and profound sedation or coma may result.

Adverse Reactions: Major hazards of morphine as of other narcotic analgesics, are respiratory depression. To a lesser degree, circulatory depression, respiratory arrest, shock, and cardiac arrest have occurred.

Other adverse reactions include the following:

Central Nervous System--Euphoria, dysphoria, weakness, headache, insomnia, agitation, disorientation, and visual disturbances.

Gastrointestinal--Dry mouth, anorexia, constipation, and biliary tract spasm.

Cardiovascular--Flushing of the face, bradycardia, palpitation, faintness and syncope.

Allergic--Pruritus, urticaria, other skin rashes, edema, and rarely hemorrhagic urticaria.

Treatment of the most frequent adverse reactions:

Overdosage: Manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, and sometimes bradycardia and hypotension. The pure opioid antagonist, naloxone, is a specific antidote against respiratory depression which results from opioid overdose. Usually 0.4 to 2.0mg is administered intravenously and the patient is carefully monitored.

Before taking this medication, tell your doctor if you have

·kidney disease,

·liver disease,


·urinary retention,

·an enlarged prostate,


·seizures or epilepsy,

·gallbladder disease,

·a head injury, or

·Addison's disease.

• You may not be able to take morphine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions

If you are younger than 18 years of age or older than 60 years of age, you may be more likely to experience side effects from morphine therapy. Use extra caution.

What happens if I overdose?

• Seek emergency medical attention.

• Symptoms of a morphine overdose include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, and small pupils.Also avoid sleeping pills, tranquilizers, sedatives, and antihistamines except under the supervision of your doctor. These medications also may cause dangerous sedation.

• If you experience any of the following serious side effects, stop taking morphine and seek emergency medical attention:

·an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

·slow, weak breathing;


·cold, clammy skin;

·severe weakness or dizziness; or

·unconsciousness.• The most serious interactions affecting morphine are with those drugs that also cause sedation. The following drugs may lead to dangerous sedation if taken with morphine:

·antihistamines such as brompheniramine (Dimetane, Bromfed, others), diphenhydramine (Benadryl, Nytol, Compoz, others), chlorpheniramine (Chlor-Trimeton, Teldrin, others), and others;

·tricyclic antidepressants, such as amitriptyline (Elavil) and doxepin (Sinequan), and serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil);

·other commonly used antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil);

·anticholinergics such as belladonna (Donnatal), clidinium (Quarzan), dicyclomine (Bentyl, Antispas), hyoscyamine (Levsin, Anaspaz), ipratropium (Atrovent), propantheline (Pro-Banthine), and scopolamine (Transderm-Scop);

·phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril), and prochlorperazine (Compazine); and

·tranquilizers and sedatives such as phenobarbital (Solfoton, Luminal), amobarbital (Amytal), secobarbital (Seconal), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flurazepam (Prosom), and temazepam (Restoril).

• Do not take any of the drugs listed above without the approval of your doctor.

The warnings for morphine are the same for all narcotics only it is stronger.

it suppresses the breathing reflex. It can cause resptary failure and coma and death. It is to be used for pain or cough but it warns about giving to people with inpared breathing or elderly or people with serious illness. It says they should be started at a low dose and only increased if the pain increases and then the patient should be monitored for possible serious side effects. The symptoms of overdose are:

decreased urination


cold clammy skin

slower breathing



everything that happened to Johnny that last day and those b------s had to know that.!!!

ETHIOLOGY & PATHOGENESIS: The PaCO2 level is controlled by the rate of alveolar ventilation, while CO2 production varies with the percentage of calories (utilized for energy metabolism) that are derived from carbohydrate; any increase in PaCO2 (due to increased CO2 production) is rapidly handled by increased alveolar ventilation. Thus, respiratory acidosis is the result of alveolar hypoventilation leading to pulmonary CO2 retention. It occurs with (1) depression of the central respiratory center caused by drugs, anesthesia, neurologic disease, abnormal sensitivity to CO2 (e.g., cardiopulmonary obesity syndrome); (2) abnormalities of the chest bellows (e.g., poliomyelitis, myasthenia gravis, Guillain-BarrŽ syndrome, crush injuries of the thorax); (3) severe reduction of alveolar surface area for gas exchange (conditions characterized by ventilation/perfusion imbalance; e.g., chronic obstructive pulmonary disease [emphysema, chronic bronchitis], severe pneumonia, pulmonary edema, asthma, or pneumothorax); and (4) laryngeal or tracheal obstruction. Neurologic changes with CO2 retention may depend upon the development of CSF acidosis or intracellular acidosis in the brain. Hypoxemia and metabolic alkalosis frequently accompany respiratory acidosis and may contribute to the neurologic abnormalities.

SYMPTOMS, SIGNS, & DIAGNOSIS: The most characteristic change is metabolic encephalopathy with headache and drowsiness progressing to stupor and coma. It usually develops slowly with advancing respiratory failure, but abrupt, full-blown encephalopathy may be precipitated by sedatives, pulmonary infection, or O2 enrichment of inspired air in patients with advanced respiratory insufficiency. Asterixis and multifocal myoclonus are generally present; in some patients, dilation of retinal venules and papilledema result from increased intracranial pressure. The encephalopathy may be reversible if hypoxic brain damage has not occurred.

TREATMENT: The treatment must improve the underlying pulmonary disturbance. Severe respiratory failure with marked hypoxemia often requires mechanically assisted ventilation. Sedative drugs (narcotics, hypnotics) should be avoided except as necessary to facilitate mechanical ventilation. Although most patients with chronic CO2 retention and hypoxia tolerate modest O2 enrichment of inspired air, some patients respond with a significant fall in respiratory minute volume and further acute elevation of the PaCO2. Presumably, such patients have adapted to chronic hypercapnia (CO2 narcosis) so that their major respiratory stimulus is hypoxemia. Therefore the lowest O2 concentration required to elevate the PaCO2 to acceptable levels (> 50 mm Hg) should be given. This can be accomplished with O2 administration by a mask, beginning with a 24% O2 concentration. The PaCO2 should be carefully monitored and, if it rises to dangerous levels (> 50 to 55 mm Hg), mechanical ventilation must be considered.

Acute Respiratory Failure


Acute Respiratory Failure: or ARF - This disorder occurs when the lungs no longer meet the body's metabolic needs. It isn't easily defined because it has many causes and variable clinical presentation. Cause: Acute respiratory failure may develop in patients with Chronic obstruction pulmonary disease (COPD ) from any condition that increases the work of breathing and decreases the respiratory drive. Conditions includes: respiratory tract infection, bronchospasm, or accumulating secretions secondary t cough suppression. Other causes of ARF in COPD include: Central nervous system (CNS) depression - head trauma or injudicious use of sedatives, narcotics, tranquilizers, or oxygen Cardiovascular disorders - myocardial infarction (MI), congestive heart failure (CHF), or pulmonary emboli Airway irritants - smoke or fumes Endocrine and metabolic disorders - myxedema or metabolic alkalosis Thoracic abnormalities - chest trauma, pneumothorax, or thoracic or abdominal surgery Symptoms: In COPD patients with ARF: hypoxemia (deficient oxygenation of the blood) and acidemia affect all body organs Altered respirations. Rate may be increased, decreased, or normal; respirations may be shallow, deep, or alternate between the two. Cyanosis may or may not be present. Auscultation of the chest may reveal crackles, rhonchi, wheezes, or diminished breath sounds Altered mentation. The patient show evidence of restlessness, confusion, loss of concentration, irritability, tremulousness, diminished tendon reflexes, and papilledema Cardiac dysrhythmias. Tachycardia (rapid heart rate), with increased cardiac output and mildly elevated blood pressure secondary to adrenal release of catecholamine, occurs early in response to low PaO2 (oxygen level). With myocardial hypoxia, dysrhythmias may develop. Pulmonary hypertension also occurs Treatment: Antibiotic for infection Bronchodilators Steroids In COPD patients, ARF is an emergency that requires cautious oxygen therapy In significant respiratory acidosis persists, mechanical ventilation through an endotracheal or a tracheostomy tube may be necessary High - frequency ventilation may be used if the patient doesn't respond to conventional mechanical ventilation The effects of narcotics on respiratory drive are well known and recognized. The concept of Dyspnoea as a " pain equivalent" regulated by endogenous opiates is supported the observation that naloxone, an opiate antagonist, restores blunted ventilated load responses in COPD patients10. It has been suggested by Woodcock and associates11 that narcotics may improve dyspnoea by decreasing oxygen consumption out of proportion to minute ventilation. Although acute administration of dihydrocodeine reduces dyspnoea by up to 20% long-term opiate treatment has variable effects on breathlessness and is associated with significant side effects notably increases in PCO2, which probably outweigh the potential benefits.

Symptomatic drug treatment of breathlessness using benzodiazpines or systematic opiates is of a very limited value and associated with unacceptable adverse effects. Recently there has been much interest in the use of nebulized morphine for the relief of dyspnoea in COPD12 and also in patients with malignant disease. It is simple and bloodless, delivers morphine directly into the pulmonary blood stream avoiding hepatic first pass metabolism and is reported to result in rapid analgesia13 presenting with dyspnoea.

It may be particularly suitable for patients unable to take morphine by mouth who wish to avoid injections. It is also believed that nebulized morphine can relieve breathlessness associated with cancer and chronic chest diseases by a direct action on lung receptors13. One placebo-controlled trial showed a small increase in exercise endurance in patients with chronic airflow obstruction12, while another study has not14. More recently, Masood and colleagues15 used nebulized morphine in patients with severe chronic airflow obstruction and noticed that their studies did not support the hypothesis that nebulized morphine relieves breathlessness and altered sensation of breathlessness.

The observed improvements in dyspnoea with these agents are modest at best and probably due to nonspecific sedation by these drugs. The concomitant reduction in minute ventilation is a potentially serious adverse effect in patients with marginal pulmonary function and the use of such drugs cannot be routinely recommended in patients with severe COPD.

From nurses manual on drugs


Use with caution if at all in geriatric or debilitated clients with pulmonary disease.

Side effects: light headedness,dizziness, sedation, mental clouding, lethargy, impaired mental and physical performance, anxiety, fear, dysphoria, psychological dependence, mood changes, respiratory depression, I rregular and periodic breathing, urinary retention.

Practice cough and deep breathing exercises and incentive spirometry to decrease risk of atelectasis

Another nurses manual on drugs:


Assessment and drug effects

Before administering morphine, note respiratory rate and depth and rhythm and size of pupils. Respirations of 12 per minute or below and misosis are signso of toxicity withhold drug and report to physician.

Diffenentiate among restlessness as a sign of pain and the need for medication, restlessness associated with hypoxia, and restlessness caused by morphine induced CNS stemulation ( a paradoxical reaction that is particularly common in women and elderly patients.

Monitor vital signs at regular intervals.Morphine induced respiratory depression may occur even with the smallest dose, and increases progressively.

Monitor In and Out ratio and pattern, Report oliguria or urinary retention, morphine may dull perception of bladder stemuli. Therefore encourage the patient to void at least every 4 hours. Palpatate lower abdomen to detect dladder distention.

Adverse side effects: puritus, rash,uticaria, edema, paradoxical CNS stemulation (restlessness, tremor, delirium, insomnia) dysuria, oliguria

Drug interactions: CNS depressants, sedatives, barbituates, alcohol, Benzadiapines, and tricylic antidepressants.

Cautious use in toxic psycosis, emphysema and dibilitated patients.

Myoclonus: a brief, sudden, shock-like muscle contraction, mediated by an electrical nerve discharge originating in the central nervous system

Drug-induced myoclonus: about 80 causal agents (toxins and drugs) including:

Tricyclic antidepressants e.g. amitriptyline

SSRIs e.g. Prozac


(Morphine ) the jerks that John had that started to get so sever while on morphine

Hydromorphone (an opiate related to morphine)



Pseudoephedrine (available in some over-the-counter common cold preparations)

Treatment: Clonazepam(benzodiazepine), valproate (anticonvulsant); some reports of baclofen, fluoxetine (an SSRI antidepressant), propanolol (antihypertensive) and 5-hydroxytryptophan (5-HT) being of help.

Acute Abdominal Conditions: Narcotics may interfere with the diagnosis and treatment of these conditions. If you suspect a serious abdominal condition, seek medical treatment, and allow the attending medical personnel to manage your pain control.

Alcohol or Drug Addiction: There is an increased risk of chemical dependence with these medications, particularly for addiction prone individuals. If an addiction is untreated, combining alcohol or drugs with these medications poses a greatly increased risk for organ damage and dangerous or fatal overdose.

Allergies: An allergy to a narcotic medication in the past would indicate that you should seek another type of treatment. Allergies to NSAIDs or aspirin indicate that you should not use narcotic medications combined with these drugs. Mention any other food or drug allergies you may have experienced, to be sure that your doctor can prescribe an appropriate medication.

Asthma or Chronic Lung Disease: These medications may increase the risk of respiratory depression, and should be used with caution. If you have ever had an asthmatic reaction to aspirin, or any NSAID, you should not use narcotic preparations containing them for pain control. You are at increased risk of bronchospasm or an anaphylactic reaction. Do not take opiates during an asthma attack, this could cause dangerous respiratory depression.

Bowel Disorder: Narcotics may worsen symptoms of constipation.

Brain Disease or Head Injury: Narcotic medications may increase pressure in the cerebral and spinal fluid, possibly interfering with accurate diagnosis or treatment.

Dependence: Physical dependence and withdrawal are known risks for these drugs. While many medications can cause withdrawal symptoms when use is stopped, opiates have a higher risk of actual addiction. Addiction should be distinguished from physical dependence, as it is a psychological need to seek out a drug even when there is no compelling health need, to the point of decreasing the quality of life. Addiction is rarely an issue in individuals who require pain control, but the risk is there, and narcotic use should be considered carefully.

Emotional Problems: You are at an increased risk of side effects and drug interactions with prescription treatments for your condition.

Gallbladder Disease: You are at an increased risk for adverse side effects, and should only take these medications with the consent of your physician.

Heart Disease: You may be at an increased risk for adverse side effects.

Intracranial Lesion: Do not use narcotic analgesics.

Kidney Disease: These medications may stress damaged kidneys. Ask your doctor if this treatment is right for you, or if there are dosing guidelines that would make it safe. Drink 6-8 glasses of water daily to reduce strain on the kidneys.

Liver Disease: These medications may cause liver damage, and stress damaged livers. Speak to your doctor about appropriate dosage guidelines, or other available pain control methods. Do not combine alcohol use with your treatment.

Medical Emergencies: Inform medical personnel if you have taken these medications recently, as they may interfere with diagnosis of certain conditions or interact with some treatments. Do not take these medications if you need to seek out emergency services; instead allow the ambulance or hospital staff to manage your pain control.

Overdose: This may be indicated by cold or clammy skin, exaggerated CNS depression (extreme weakness, dizziness, stupor, or difficulty breathing), paradoxical restlessness, pinpoint puils, seizure, or slowed heartbeat. If you suspect an overdose of these medications, seek emergency medical treatment immediately. To avoid, keep medication out of reach of children, follow maximum dosing instructions, and do not mix with alcohol or other drugs which may cause drowsiness.

Pregnancy: Certain narcotics appear to increase the risk of birth defects. There is a risk of fetal dependence and withdrawal symptoms if the medications are used during pregnancy. Respiratory depression and muscle weakness may also occur in newborns whose mothers used opiates during pregnancy. While clinical trials have not been conducted with each of these medications in pregnancy, they are generally considered too risky to prescribe to pregnant women and are not recommended for nursing mothers.

Seizures: Some of these medications may increase the risk of seizure. Discuss this with your prescribing physician if you have a history of seizure or are taking medication that makes seizure more likely.

Surgery: Inform your doctor or dentist beforehand that you use these medications, and follow any instructions they may give you.

Thyroid Problems: Narcotic medications should be prescribed with caution and be attended by medical supervision.

Urogenital Tract Problems: Narcotics may worsen these conditions, particularly difficult urination, and should only be undertaken with medical supervision. This also applies to individuals with enlarged prostrates.

Withdrawal: Long-term and frequent use of these medications may result in withdrawal symptoms if treatment is stopped abruptly. The severity of symptoms is usually dependent on dosage and length of use. They may include aches, agitation, decreased appetite, diarrhea, fever, gooseflesh, insomnia, large pupils, nausea or vomiting, rapid heartbeat, shaking, stomach cramping, sweating, weakness, or yawning. Your physician may be able to reduce the severity of this condition by stepping you off your medication gradually, or by other methods. Moderate, periodic use of these medications will not generally cause withdrawal symptoms.


Narcotics may interact with other medications you may be taking. The following drugs are especially likely to interact with these treatments, but you should always check the labels of each individual medication you use to decrease the likelihood of undesirable side effects. If medications increase each other's effects, or lead to undesirable drug buildups in the body, your doctor may recommend adjusting the dosages of one of the medications if it seems appropriate to use both treatments.

Medications which increase central nervous system depression should not generally be taken with narcotics, or within the time frame that they are active in the body. If your doctor prescribes other medications that have CNS depressant effects, be sure to work out a medication schedule that won't leave you oversedated or increase your risk for overdose.

If you are taking a narcotic preparation which is combined with acetaminophen, aspirin, or ibuprofen, you will need to look into potential drug interactions and warnings for those drugs as well.

Alcohol - Narcotics and alcohol can accelerate central nervous system depression. Avoid mixing the two, as this could result in liver damage, or a dangerous and potentially fatal overdose.

Antihistamines like Tavist or Benadryl may cause oversedation.

Benzodiazepines (a class of antidepressants, anti-panic agents, and muscle relaxants) such as Ativan (lorazepam) <../ativan-lorazepam.html>, Valium (diazepam) <../valium-side-effects.html>, Halcion (triazolam) <../triazolam-halcion.html>, Restoril (temazepam) <../restoril-temazepam.html>, Librium (chlordiazepoxide) <../librium-side-effects.html>, Xanax (alprazolam) <../online-prescription-xanax.html>, Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam) <../klonopin-side-effects.html>, and others, may increase CNS depression in combination with narcotics. Benzodiazepines may make narcotic pain medication less effective, and may produce this effect for up to a full day depending on how long-acting the particular medication is.

Desyrel (trazodone) <../trazodone.html> - Risk of additive CNS depression.

MAO inhibitors - Narcotics must not be mixed with MAO (monoamine oxidase) inhibitors such as the antidepressants Nardil, Marplan, or Parnate. They should not be used within 2 weeks of stopping these medications.

Narcotic pain medications should not be mixed with each other. Brands like Tylenol with Codeine, Demerol (meperidine), Buprenex (buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone), Stadol (butorphanol), Talwin compound (pentazocine), Vicodin (hydrocodone, acetaminophen), or Vicoprofen (hydrocodone, ibuprofen) should not be mixed in treatment.

Rifadin (Rifampin) - May decrease the effectiveness of methadone, triggering withdrawal symptoms in individuals using it for addiction treatment.

Sedatives like Fioricet <../buy-fioricet-online.html> (butalbital, acetaminophen, and caffeine), Fiorinal <../fiorinal-online.html> (butalbital, aspirin, and caffeine), Phenobarbitol, Seconal, or other barbiturates.

Sleep medication like Ambien (zolpidem) <../ambien-side-effects.html>, Sonata (zaleplon) <../sonata-sleeping-pill.html>, or over the counter sleeping pills should be used with narcotics only as, and if, advised by your doctor.

Skeletal muscle relaxants - such as Flexeril (cyclobenzaprine) <../flexeril-side-effects.html>, Norflex (orphenadrine) <../norflex-orphenadrine.html>, Skelaxin (metaxalone) <../skelaxin-metaxalone.html>, Soma (carisoprodol) <../soma-carisoprodol.html>, or Robaxin (methocarbamol) <../robaxin-methocarbamol.html> may increase respiratory depression when mixed with narcotics.

Street drugs of any type must never be mixed with opiates as this could result in a fatal overdose.

Tegretol (carbamazepine) - May build up to toxic levels when used with narcotics.

Tranquilizers such as Haldol (haloperidol), Mellaril (thioridazine), or Thorazine (chlorpromazine) may cause oversedation.

Trexan (naltrexone) - Causes narcotic pain medication to be ineffective.

Tricyclic antidepressants such as Elavil (amitriptyline) <../elavil-side-effects.html>, Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin) <../sinequan-side-effects.html>, Tofranil (imipramine), Aventyl or Pamelor (nortriptyline <../aventyl-nortriptyline.html>), Vivactil (protriptyline), and Surmontil (trimipramine), may increase the central nervous system suppressant effects from either the antidepressant, or the narcotic.

Ultram (tramadol) <../ultram-tramadol.html> - This medication works partially by activating opiate receptors, and increases central nervous system depression. Do not combine with narcotics.

Zidovudine (AZT, Retrovir) - Narcotic pain medication increases blood levels of this drug, potentially making side effects more severe.


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