1. PK
   1. ABSORPTION
      1. GI tract
      2. nasal mucosa
      3. Lungs
      4. Subcutaneous
      5. IM
      6. IV
   2. DISTRIBUTION
      1. morphine accumulates in kidney, lung, liver, and spleen
      2. CNS: primary site of action (analgesia/sedation)
   3. METAB./excrete
      1. metab: liver
      2. conjugate w/glucuronic acid
      3. excrete: kidney
      4. T1/2: 2.5 to 3 hours (x stay in body tissue)
      5. main excretion product : morphine-3-glucoronide
      6. DOA 10mg : 3 to 5 hrs
   4. ADMINISTRATION
      1. x oral- erratic
      2. 1st pass efect varies in person
      3. Subtopic 3
      4. iv- works fast
      5. main effect: CNS
2. EFFECT in cns
   1. analgesia
      1. rxn & perception
      2. cancer pts tolerate more
      3. most effective dull aching pain
      4. sharp
      5. stabbing
      6. shooting pain
      7. pain-free person. 1-> dysphoric
   2. sedation
      1. sedation. yes!
      2. LOC no!
   3. euphoria
   4. mood change
   5. mental cloudiness
   6. Respiratory depression
      1. < rate
      2. < vol
      3. < tidal volume
      4. mu recep. activxn
      5. < responsive to PCO2. build up PCO2
      6. irregular breathing patern. apnea
   7. nausea & vomiting
      1. activxn of CTZ
      2. afferent: ear & gut
      3. motion sickness
   8. pupil size
      1. miosis (pinpoint pupil)
      2. kappa recept.
      3. oculomotor (CNIII) stimulated)
   9. cough supression
3. EFFECT on CVS
   1. vasodilation -> < bp
   2. release of histamine
   3. suppression of central adrenergic tone
   4. supress reflex vasoconstriction
4. EFFECT on GIT
   1. > tone, < motility= constipation
   2. < HCL in stomach
   3. x tolerance
5. EFFECT on SMOOTH MUSCLE
   1. biliary tract
      1. > pressure biliary tract
      2. > contraction Sphincter of Oddi
   2. bladder
      1. tone of detrusor muscle increased
      2. urinary urgency
      3. urinary retention -> > muscle tone ? sphincter closed off
   3. bronchial muscle
      1. bronchoconstriction
      2. contraI: asthmatic
   4. uterus
      1. > tone, prolong labor
6. EFFECT on neuroendocrine
   1. < GNRH, < CRF
   2. < LH ,FSH, ACTH
   3. < cortisol & testosterone
7. TOLERANCE
   1. YES
      1. nausea
      2. analgesia
      3. sedation
      4. respiratory depression        
      5. cardiovascular
      6. euphoric
   2. NO
      1. miosis
      2. constipation
8. TOXICITY
   1. excitatory and spinal reflexes
   2. >OPIOID = convulsions (agonist antagonist)
   3. Respiratory depression
   4. pinpoint pupils
   5. coma
9. TX
   1. 1. establish adequate ventilation
   2. 2. give OPIOID antagonist (naloxone)