DTP Morphine

Question 1

Morphine drug class

Answer 1

Narcotic analgesic

Question 2

Pharmacology of morphine

Answer 2

• Acts on the CNS
• Binds to opioid receptors
• Alters pain perception and emotional response to pain.
• decreases gag reflex and av node conduction
• causes respiratory depression and vasodilation.

Question 3

Metabolism of morphine

Answer 3

Liver, kidneys and lungs

Question 4

Indications for morphine

Answer 4

1. Significant pain
2. Autonomic dysreflexia with systolic bp > 160 mmHg
3. Sedation to maintain or establish ett

Question 5

Contraindications of morphine

Answer 5

KSAR

Renal Failure

Question 6

Precautions of morphine

Answer 6

1. Elderly pts
2. Hypotension
3. Respiratory tract burns
4. Respiratory depression and or failure
5. Known addiction to narcotics
6. Pts on monoamine oxidase inhibitors

Question 7

Side effects of morphine

Answer 7

1. Drowsiness
2. Pin point pupils
3. Respiratory depression
4. Bradycardia
5. Nausea / vomiting
6. Hypotension

Question 8

Presentation of morphine

Answer 8

10 mg in 1 ml

Question 8

Preparation of morphine IV

Answer 8

10ml syringe
9ml of saline
1ml of morphine 10mg/1ml

Question 9

Duration of Morphine

Answer 9

1-2 hrs

Question 10

Onset of morphine

Answer 10

IM 5-10 mins

IV 2-5 mins

Question 11

Half life of Morphine

Answer 11

2 hrs

Question 12

Schedule of morphine

Answer 12

S8 controlled drugs

Question 13

Adult >70yrs Doses of IM Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 13

2.5 - 5mg repeat every 10 mins

Max dose 10mg

Question 14

Adult >70yrs Doses of IV Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 14

> 70yrs = 2.5mg repeat every 5mins | Max dose 10mg

Question 15

Adult <70yrs Doses of IM Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 15

2.5-10mg repeat at up to 5mg every 10 mins | Max dose 20mg

Question 16

Adult <70yrs Doses of IV Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 16

2.5-5mg repeat at up to 5mg every 5mins | Max dose 20mg

Question 17

Paediatric >1yr IM Doses of Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 17

> 1 yr old = 100-200mcg/kg (max single dose = 5mg) repeat every 10 mins. Max dose = 200mcg/kg

Question 18

Paediatric >1yr IV Doses of Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 18

> 1yr old = 100 mcg / kg (single max dose 2.5mg) repeat every 5 mins at 50 mcg / kg. Max dose = 200mcg/kg

Question 19

Paediatric <1yr IV Doses of Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 19

<1yr = consult only

Question 20

Paediatric <1yr IV Doses of Morphine for Significant Pain and Autonomic Dysreflexia (SBP >160mmHg)

Answer 20

<1yr = consult only

Question 21

Morphine with a hypotensive patient, what must an ACP do and what are the incremental doses?

Answer 21

1. When administered, ACP must call ICP backup where available
2. incremental doses are to be no greater than
   2.5 - 5mg IV
   5mg IMI

Question 22

IM Morphine Doses >20mg

Answer 22

intravenous access must be established, if it cannot be established ACP must consult.

Question 23

Autonomic dysreflexia treatment

Answer 23

GTN is the first line treatment for autonomic dysreflexia, but Morphine should be considered as part of the treatment regime

Question 24

Morphine special notes

Answer 24

All cannulae must be flushed with saline