INFLUENCE THE

OPIOIDS TO IMMUNITY
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 OPIOIDS
• It’s 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
It’s 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
Morfin, papaveretum, pethydin
Agonist (meperidin, demerol), fentanyl,
opioids alfentanil, sufentanil,
remifentanyl, codein, alfaprodin.

Antagonist
Naloxon
opioids

Agonist
Antagonist opioids Pentazosin, nabulfin,
(Mixed) 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!!