a. Amitriptyline Hydrochloride (Elavil Hydrochloride). This drug can be given at
bedtime since it has a significant sedative effect.
b. Imipramine Hydrochloride (Tofranil).
c. Desipramine Hydrochloride (Norpramin; Pertofrane).
d. Nortriptyline Hydrochloride (Aventyl).
Section IV. NARCOTIC ANALGESICS
3-19. EFFECTS OF NARCOTIC ANALGESICS
Morphine is the standard of comparison for all addictive, or narcotic, analgesics
(painkillers). Morphine is an ingredient of opium, which in its crude state is a sticky
brown gum from a particular type of poppy. Though addiction to morphine and its
derivatives, particularly to illegal heroin, is a serious social problem, morphine and its
derivatives are essential to the practice of medicine. Heroin, however, is not used for
a. Analgesia. The first reactions to morphine are muscle relaxation and
perhaps euphoria, a general feeling of well being. The pain-killing effects of morphine
are of three different types. The first of these is an indifference to perceived pain.
Though the client is aware of a pain, he does not react with fright, anxiety, or action.
This effect has been compared to a temporary prefrontal lobotomy. The second source
of relief is an actual reduction of perceived pain. Morphine does this by raising the
"threshold" to pain stimuli so that a stimulus must be of greater intensity to be
perceived. Thus, morphine is more effective against continuous pains than against
intermittently sharp pains (which are occasionally great enough to get past the
threshold raised by the morphine). Third, if the morphine is in a large enough dose, the
client will become lethargic and perhaps go to sleep.
b. Respiratory Depression. Morphine slows the rate of breathing. In the case
of an overdose, breathing may cease altogether, with death soon following.
c. Nausea. Soon after the drug is administered, the client may experience
nausea. Morphine stimulates the vomiting center during its onset of action and
thereafter depresses it. If the client vomits, he usually does so without great emotion or
d. Antitussive Action. Morphine depresses the cough reflex.