mitty
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A 42-year-old man involved in an automobile accident sustains multiple fractures of the right leg and arm and is suffering from severe pain. In the emergency department, his wife reports that her husband is a recovering heroin addict who has been enrolled in a methadone program for 3 months and is also taking phenelzine for depression. The most appropriate drug to alleviate the patient’s severe pain is
A. butorphanol.
B. meperidine.
C. morphine.
D. nalbuphine.
E. pentazocine.
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| sandra
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i think its a . since he is recovering from morphine addiction its not appropriate to give morphine or meperidine. c and d are mu antagonists which will displace morphine and cause a morphine withdrawal like state. so the only choise left is a. please correct me if im wrong.
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| sandra
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Butorphanol exhibits partial agonist and antagonist activity at the μ opioid receptor and agonist activity at the κ opioid receptor. Stimulation of these receptors on central nervous system neurons causes an intracellular inhibition of adenylate cyclase, closing of influx membrane calcium channels, and opening of membrane potassium channels. This leads to hyperpolarization of the cell membrane potential and suppression of action potential transmission of ascending pain pathways. Because of its κ-agonist activity, at analgesic doses butorphanol increases pulmonary arterial pressure and cardiac work. Additionally, κ-agonism can cause dysphoria at therapeutic or supertherapeutic doses; this gives butorphanol a lower potential for abuse than other opioid drugs, and narcotic addicts do not like it.
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