Drug Profiles: Morphine Sulfate, Naloxone Hydrochloride

Question 1

Morphine Sulfate: Indications

Answer 1

Pain, cardiac pain refractory to NTG, burns, acute pulmonary edema.

Question 1

Morphine Sulfate: Interactions

Answer 1

Potentiates other CNS depressants. Use caution with patients who have been drinking alcohol.

Question 1

Naloxone Hydrochloride: Contraindications

Answer 1

None

Question 3

Naloxone Hydrochloride: Class

Answer 3

Opiate antagonist

Question 4

Morphine Sulfate: Notes

Answer 4

Patients with allergy to sulfa are not allergic to MS. Morphine is the standard which all other analgesics are compared. 60 mg oral MS is same as 10 mg IV MS. MS is a schedule II narcotic.

Question 5

Morphine Sulfate: Side effects

Answer 5

Respiratory depression, hypotension, decreased mental status, histamine release.

Question 6

Naloxone Hydrochloride: Indications

Answer 6

Symptomatic opiate overdose (respiratory depression), Clonidine overdose.

Question 7

Morphine Sulfate: Mechanism of action

Answer 7

Combines with opioid receptors in the brain. Peripheral vasodialation of the veins and arteries resulting in decreased preload (not usually altering heart rate or blood pressure at usual doses).

Question 8

Naloxone Hydrochloride: Pharmacokinetics

Answer 8

Onset: 1-2 minutes IV, 2-5 minutes IM.

Question 9

Naloxone Hydrochloride: Interactions

Answer 9

None

Question 10

Morphine Sulfate: Class

Answer 10

Narcotic analgesic

Question 11

Morphine Sulfate: Precautions

Answer 11

Consider calling OLMC in the setting of multi-systems trauma. May cause N&V if given rapidly.

Question 13

Naloxone Hydrochloride: Notes

Answer 13

Larger doses may be required to reverse the effects of synthetic narcotics (propoxyphene, buprenorphine, butorphanol, nalbuphine, or pentazocine). Not useful in cardiac arrest even if cardiac arrest was a result of respiratory arrest caused by narcotic overdose. Naloxone will not restart and arrested heart.

Question 14

Naloxone Hydrochloride: Precautions

Answer 14

Can precipitate severe withdrawal symptoms in individuals physically dependent on opioids. Use repeated small doses (0.1-0.2 mg IV) in patients taking chronic narcotics. Consider physical restraints (and your personal safety) prior to, or concurrent with naloxone hydrochloride administration. may precipitate seizures in the neonate.

Question 15

Morphine Sulfate: Pharmacokinetics

Answer 15

Onset: less than five minutes IV; 10 to 30 minutes IM.

Duration: 4 to 6 hours.

Question 15

Morphine Sulfate: Contraindications

Answer 15

Head injury and /or decreased mental status, hypotension, abdominal pain associated with trauma (some EMS systems don’t permit use of morphine in undiagnosed abdominal pain of any origin.

Question 17

Naloxone Hydrochloride: Side effects

Answer 17

Nausea, vomiting (if administered rapidly). Narcotic withdrawal symptoms: dizziness, hypertension, tachycardia, sweating, nervousness, abdominal cramps, headache, weakness, joint and muscle pain, insomnia, and untreated pain.

Question 18

Naloxone Hydrochloride: Mechanism of action

Answer 18

Competitively displaces opioid analgesics from their receptor sites, reversing their effects. Respiratory depression, sedation, papillary miosis, and euphoric effects will be reversed.

Question 19

Morphine Sulfate: Dosage

Answer 19

2-5 mg slow IV push, titrated to effect. Max dose usually not to exceed 20 mg without OLMC approval. MS can be given IM.

Question 20

Naloxone Hydrochloride: Dosage

Answer 20

0.1 - 2 mg(IV, IM, SQ, ETT, nasal), repeated to a max of 8 mg. Naloxone is shorter acting than most opiates, repeated doses may be required.