INFLUENCE THE

OPIOIDS TO IMMUNITY
Name

Number

Adviser

OPIOIDS
Its called narcotic analgesic which used
to control the pain in peri operative or
post operative.
All of opioids analgesics cause
addiction/dependence.
Morfin, Petidin, and Fentanyl are the most
opioids which used in anesthesia.

OPIOIDS MOVES
1. Absorption
Big of opioids analgesic can be absorpted via
subcutaneus, intramuscularry, and oral.
2. Distribution
Its variate of opioids. Every opioids have
different affinity though the proteins, opioids
can leaves by fast the blood compartment,
then accumulated in the organ which has high
perfussion, like brain, lungs, liver, kidney, and
spleen.

OPIOIDS MOVES
4. Metabolism
Much of opioids will be changed to be
glucoronids.
5. Excretion
The glucoronids will be excretion via urine.

OPIOID RECEPTORS
Mu receptor ()
Stimulate this receptor occur analgesic, euphoric, fresh,
and depression of breathe. Morfin is an agonis at this
receptors.
Kappa receptor()
Stimulate this receptor occur analgesic, sedation, and
anesthesia. Morfin is worked at this receptors.
Sigma receptor ()
Stimulate this receptor occur disphoric, haluscination,
midriasis of pupil, and stimulate of breathe.
Delta receptor()
At human, this receptor is unknown. The hypothesis is to
support Mu receptors.

HOW OPIOIDS WORKED?

Opioids take the opioids receptor, then
block the pain perception and stimulate the
happiness center

Opioids take the opioids receptors

(Mu, k, d) at CNS and GI tract

Its used to control the pain (analgesic)

CLASSIFICATION OF OPIOIDS
Agonist
opioids

Antagonis
t opioids

Agonist
Antagonist
opioids (Mixed)

Morfin, papaveretum,
pethydin (meperidin,
demerol), fentanyl,
alfentanil, sufentanil,
remifentanyl, codein,
alfaprodin.

Naloxon

Pentazosin, nabulfin,
butarfanol, bufrenorfin.

MORFIN
CNS: Depression effect(analgesic, sedation,
emotion changed, alveolar hypoventilation) and
stimulate effect (stimulate parasimpatic, miosis,
nausea, vomit, hyperactive of spinal reflex,
convultion, and secretion antidiuretic hormones).
Indicate to stopped or reduced serious pain
which can not treated by analgesic non-opioids.
Dose to stopped or reduced moderate pain is
0,1-0,2 mg/kg.
Dose to stopped or reduced severe pain is 1-2
mg/kg in adults.

PHETYDIN
Occur analgesic effect, sedation, euphoria,
depression of breathe and others central effect.
The effectivity is low than morfin, but its
effective at neuropatic pain.
Analgesic duration is 3-5 hours.
Parenteral dose is 100 mg. For kids: 1-1,8 mg/kg.
Side effect: headache, sweat, euphoria, nausea,
vomit, vision disorders, palpitation, disphoria,
syncope, sedation.

FENTANYL
Depression effect is longer than analgesic effect.
Dose 1-3 mg /kg, analgesic time is just 30
minutes. So it is used to surgery anesthesia, it is
not used to post operative.
Big dose is 50-150 mg/kg to induction of
anesthesia and maintenance with combination
by benzodiazepin and low dose inhaled in
cardiovascular surgery.

IMMUNE SYSTEM
Non spesific immune can respon directly to the
antigens. This system called non spesific
because it is not to occur the spesific
microorganism. The component of this system is
physical and mechanic defence, humoral,
cellular, and biochemical.
Spesific immunes are humoral and cellular.

INFLUENCE OPIOIDS
TO IMMUNITY
Opioids can change the immunity by the
neuroendocrine effect or direct effect of
immune system.
Opioids for a long time will be dropped
the immune system. So its can be
immunosupressive.
Opioids changed the differentiation and
function of immune cell (progenitor cell of
bone marrow, makrophage, T-cell)

THANK YOU VERY MUCH!!