Morphine

Question 1

Presentation

Answer 1

10mg in 1ml glass ampoule

Question 2

Pharmacology

Answer 2

An opioid analgesic.
Actions:
CNS effects
- depression (leading to analgesia)
- respiratory depression
- depression of cough reflex
- stimulation (changes of mood, euphoria or dysphoria, vomiting, pin-point pupils)
- dependence (addiction)
Cardiovascular effects
- vasodialtion
- decreases conduction velocity through the AV node

Question 3

Metabolism

Answer 3

By the liver, excreted by the kidneys

Question 4

Primary emergency indications

Answer 4

1. Pain relief
2. sedation to maintain intubation
3. sedation to facilitate intubation (where fentanyl not appropriate for RSI- modified or paediatric)

Question 5

Contraindications

Answer 5

1. history of hypersensitivity
2. renal impairment/failure
3. late second stage labour

Question 6

Precautions

Answer 6

1. elderly/frail
2. hypotension
3. respiratory depression
4. current asthma
5. respiratory tract burns
6. known addiction to opioids
7. acute alcoholism
8. patients on monoamine oxidase inhibitors

Question 7

Route of administration

Answer 7

IV
IM
Subcutaneous

Question 8

Side effects

Answer 8

CNS effects

• Drowsiness
• respiratory depression
• euphoria
• nausea/vomiting
• addiction
• pin-point pupils

Cardiovascular effects

• hypotension
• bradycardia

(HANDBERP) hypotension, addiction, nausea/vomiting, drowsiness, bradycardia, euphoria, respiratory depression, pin-point pupils

Question 9

Special notes

Answer 9

Side effects can be reversed with naloxone.
Occasional wheals are seen in the line being used for IV injection. This is not an allergy, only a histamine release.
IV effects
Onset: 2-5mins
Peak: 10mins
Duration: 1-2hrs
IM effects
Onset: 10-30mins
Peak: 30-60mins
Duration: 1-2hrs