Morphine Pethidine (meperidine)
(5-4)
General Narcotic agonist-analgesic of
opiate receptors:
 Inhibits ascending pain
pathways, thus altering
response to pain
produces analgesia
 Respiratory depression
 Sedation
 Suppresses cough by acting
centrally in medulla
Efek Samping Ada di catatan
B1-B6
Fentanyl
(3-30)
 Zat sintetik yg formulanya sangat
berbeda dengan morphine, tetapi
efek klinik dan efek samping
hampir sama
 Potensi pethidine 1/10 nya
morphine
 B1 Even more as ventilatory
depressant than morphine.
 B2rarely cause bradycardia, but
instead may HR. Large dose
Myocardial contractility (unik
dibanding opioid lain).
 B3Delirium dan Seizure akibat
akumulasi normeperidine.
 B4, B5 less constipation and less
urinary retention than morphine
 B6antishivering
 Atropine like effectdry mouth,
midriasis, increase HR.
 Serotonin Syndrome (autonomic
instability with hypertension,
tachycardia, diaphoresis,
hyperthermia, behavioral changes
incl. confusion and agitation, and
neuromuscular changes manifest
as hyperreflexia) occurs when
Tramadol
 Efek analgesic fentanyl 75-125x lebih poten dari morphine  Tramadol is a centrally
acting analgesic that has
moderate affinity for mμ
receptors and weak κ and δ
opioid receptor affinity
 Tramadol is 5 to 10 times
less potent than morphine
as analgesic.
 B1Fentanil tetap berefek depresi ventilasi sama dengan morfin. Fentanil  B1Absence of depression
tidak menyebabkan histamine release (aman utk asma) of ventilation
 B2 Fentanil tidak menyebabkan vasodilatasi, fentanyl menyebabkan  B2Toxic
bradikardiaBP dan CO overdoseHipotensi and
 B3 Fentanil tetap berefek ICP (despite of unchanged PaCO2). Seizure bradikardia
like activity also in fentanyl administration.  B3Seizure (avoid in
 B6Skeletal muscle Rigidity patient with epilepsy or
lower seizure threshold by
antidepressant drug)
 B5slow gastric emptying,
nausa and vomit
 B5antishivering
 drugs capable of increasing
serotonin level. Administration
Pethidine + antidepressant drug
(MAOinh, fluoxetine) may elicit
this syndrome.
Farmakologik  Onset: PO: 15-30 min; IM:  Onset: Rapid  Onset: IM 7-15 min; IV 3-7 min  Onset 1 jam
15-30 min; IV: <5 min  Durasi 2-4 jam  Durasi: IM 1-2 jam; IV 30-60 min  Durasi 9 jam
 Durasi: IM = IV = 4 jam
 Peak plasma time: PO <
1jam; IM 30-60 min; IV 20
min
Sediaan Injeksi 10 mg/mL Injeksi 50 mg/mL Injeksi 50 mcg/mL  Injeksi 50 mg/mL
Clinical  Dosis Premedikasi: 0.05-0.2  Dosis premedikasi: 0.5-1 mg/kg IM  Dosis premedikasi: 50-100 mcg IM atau slow IV (30-60 menit sebelum  Tramadol 3 mg/kg oral, IM
dosage and mg/kg IM  Dosis analgetik: 2.5-5 mg/kg IV bedah) atau IV is treatment for
use  Dosis Analgetik: 0.1-1  Dosis post op antishivering 20- moderate to severe pain
mg/kg IV 25 mg IV  Low dose Fentanyl: 1-2 (1-3) mcg/kg IV to provide analgesia  Tramadol dapat diberikan
 Fentanyl dose 2-20 mcg/kg (before painful surgical stimulation) PO, IM, IV
blunting circulatory response to (a) direct laryngoscopy for intubation of  Dosis 50-100 mg per
the trachea; (b) sudden changes in the level of surgical stimulation pemberian dan diulang
mengurangi kebutuhan analgesia opioid post op tiap 4-6 jam. Dosis max
 Dosis besar fentanyl 50-150 mcg/kg untuk induksi anestesi dan 400mg/hari
pemeliharaan anestesi dengan kombinasi benzodiazepine dan anestesi
inhalasi dosis rendah (pada bedah jantung).

Dosis analgetik pembedahan:

 Minor surgical procedures: 0.5-2 mcg/kg/dose IV
 Major surgery: 2-20 mcg/kg/dose initially; 1-2 mcg/kg/hr maintenance
infusion IV; discontinue infusion 30-60 min prior to end of surgery; limit
total fentanyl doses to 10-15 mcg/kg for fast tracking and early extubation
 Adjunct to general anesthesia (rarely used): 20-50 mcg/kg/dose IV
Warning  Pasien asma dan bronchitis Pasien hamil, gangguan hepar dan Kombinasi opioid-benzodiazepine efek hypnosis dan depresi ventilasi Interaksi dengan antikoagulan
Drug  Pasien Hamil ginjal Fentanil menurunkan kebutuhan dosis propofol koumadin. Ondansent efek
Interaction  Gangguan Hepar dan Ginjal analgesia dari tramadol