All are used in bronchial asthma, except:
Correct Answer: Morphine
Description: Morphine is a drug of emergency, but due care has to be taken in its use.
Infants and the elderly are more susceptible to the respiratory depressant action of morphine.
It is dangerous in patients with respiratory insufficiency (emphysema, pulmonary fibrosis, cor pulmonale); sudden deaths have occurred. Morphine accentuates sleep apnoea; hypoxic brain damage can occur.
Bronchial asthma: Morphine can precipitate an attack by its histamine releasing action. A high potency opioid with lower histamine releasing potential (e.g. fentanyl) should be used, if unavoidable, in an asthmatic.
Head injury: Morphine is contraindicated in patients with head injury. Reasons are—
By retaining CO2, it increases intracranial tension which will add to that caused by head injury itself.
Even therapeutic doses can cause marked respiratory depression in these patients.
Vomiting, miosis and altered mentation produced by morphine interfere with assessment of progress in head injury cases.
Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 502
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