Morphine Flashcards
What drug class is Morphine Sulfate in?
Opioid analgesic
Schedule II drug
What is the onset and duration of Morphine?
Onset 1-2 minutes after administration.
Duration 2-7 hours.
What are the indications for Morphine?
- CP associated with ACS unresponsive to nitrates
- acute cardiogenic pulmonary edema (with or without associated pain)
- moderate to severe acute and chronic pains
What are the contraindications for Morphine?
- hypersensitivity to narcotics
- hypovolemia
- hypotension
- head injury
- undiagnosed abdominal pain
- increased intracranial pressure
- severe respiratory depression
- people who have taken MAO Inhibitors within 14 days
- use with caution in RV infarction
What are adverse reactions of Morphine?
- hypotension in volume depleted patients
- tachycardia
- bradycardia
- palpitations
- syncope
- facial flushing, diaphoresis, pruritus
- Respiratory depression
- euphoria
- bronchospasm
- dry mouth
- allergic reaction
What are some drug interactions with Morphine?
- CNS depressants may potentiate effects (respiratory depression, hypotension, sedation)
- phenothiazines may potentiate analgesia
- MAO Inhibitors may cause paradoxical excitation
How is Morphine supplied?
Tablets, suppositories and solution. In emergency care, Morphine is usually given IV.
What is the adult dosage for Morphine for STEMI?
2-4mg IV
May give additional doses of 2-8mg IV at 5-15min intervals
What is the adult dosage of Morphine for UA/NSTEMI?
1-5mg IV only if symptoms are not relieved by nitrates or if symptoms recur (use with caution)
What is the adult dosage of Morphine for general pain?
2-4mg slow IV push over 1-5min every 5-30min
Titrate to effect
What are some special considerations for Morphine?
- pregnancy safety category B (safe if not used for prolonged periods or in high doses; narcotics rapidly cross placenta)
- not safe for neonates
- use cautiously with elderly, asthma patients, and patients susceptible to CNS depression
- use cautiously with chronic pain patients
- may worsen bradycardia or heart block in inferior MI (vagotonic effect)
- Naloxone (0.4-2 IV) should be readily available
What drug class is Furosemide (Lasix)?
Loop diuretic
What is the onset and duration of Lasix?
Onset: (IV) diuretic effects in 15-20min; vascular effects in 5min
Duration: 2 hour
What are the indications for Furosemide?
- acute pulmonary edema in patients with SBP >90-100
- hypertensive emergencies
- hyperkalemia
What are the contraindications for Furosemide?
- anuria
- hypersensitivity
- hypovolemia/dehydration
- known hypersensitivity to sulfonamides
- severe electrolyte depletion (hypokalemia)
What are adverse reactions of Lasix?
- hypotension
- EKG disturbances associated with electrolyte imbalance
- dry mouth
- hypochloremia
- hypokalemia
- hyponatremia
- hypocalcemia
- hyperglycemia
- hearing loss can occur (rarely) after too rapid infusion of large doses
What are drug interactions of Furosemide?
- digitalis toxicity may be potentiated because of potassium depletion
- Furosemide increases ototoxic potential of aminoglycoside antibiotics
- lithium toxicity may be potentiated because of sodium depletion
- Furosemide may potentiate therapeutic effects of other antihypertensive drugs
How is Lasix supplied?
10mg/mL in 2-, 4-, 8-mL ampules
10mg/mL in 10mL vial
What is the adult dosage of Lasix?
IV
0.5-1mg/kg over 1-2min
If no response, double dose, give over 1-2min
New onset pulmonary edema with hypovolemia
<0.5mg/kg
Hyperkalemia
40-80 mg IV
What are some special considerations for Furosemide?
- Pregnancy safety category C
- known to cause fetal abnormalities
- protect it from light and store at room temp; do not use if discolored or yellow
What drug class is Nitroglycerin in?
Vasodilator
It is lipid soluble, so it is given PO more rather than IV.
What is the onset and duration of Nitroglycerin?
Onset: 1-3min
Duration: 30-60min
What are indications for Nitroglycerin?
- ischemic chest pain
- CHF
- AMI
- hypertensive emergencies with ACS
What are contraindications for Nitroglycerin?
- volume depletion
- hypersensitivity
- hypotension
- head injury
- extreme bradycardia
- extreme tachycardia
- right ventricular infarction
- cerebral hemorrhage
- recent use of ED drugs
- aortic stenosis
What are adverse reactions of Nitroglycerin?
- transient headache
- reflex tachycardia
- hypotension
- nausea and vomiting
- postural syncope
- diaphoresis
- flushing
What are some drug interactions with Nitroglycerin?
Other vasodilator may have additive effects.
Do not mix with other drugs.
How is Nitroglycerin supplied?
Tablets
0.15mg, 0.3mg, 0.4mg
Transdermal paste
Metered spray
0.4mg per spray (do not shake)
What is the adult dosage for Nitroglycerin?
0.3-0.4mg SL
May repeat to total of 3 doses every 5 min
Metered spray
1-2 sprays at 5min intervals, up to sprays in 15 minutes
What are special considerations of Nitroglycerin?
- pregnancy safety category C
- increased susceptibility to hypotension in elderly
- decomposed when exposed to light or heat
- “stings” when given SL
- use with caution for patients with inferior AMI with possible right ventricular involvement
What kind of drug is Dobutamine (Dobutrex)?
Sympathomimetic
Synthetic catecholamine that primarily stimulates beta1-adrenergic receptors.
Positive inotropic effects with minimal changes in chronotropic activity.
Great for CHF when an increase in HR is not desired.
What is the onset and duration of Dobutamine?
Onset: 1-2min, peak after 10min
Duration: 10-15min
What are indications for Dobutamine?
Pump problems (CHF, pulmonary congestion) with SBP of 70-100 and no signs of shock
What are the contraindications of Dobutamine?
- tachydysrhythmias
- severe hypotension with signs of shock
- idiopathic hypertrophic subaortic stenosis
- suspected or known drug-induced shock
What are adverse reactions of Dobutamine?
- anxiety
- headache
- nausea
- fluctuations in BP
- dose related tachydysrhythmias
- hypertension
- ventricular ectopic
What are some drug interactions with Dobutamine?
- beta-adrenergic antagonists may blunt inotropic responses
- sympathomimetics and phosphodiesterase Inhibitors may exacerbate dysrhythmia responses
- incompatible with Lasix and sodium bicarbonate in the same IV line; must have separate IV
How is Dobutamine supplied?
12.5mg/mL injectable
What is the adult dosage for Dobutamine?
2-20mcg/kg/min IV
Titrate so HR doesn’t increase by >10% of baseline
What are some special considerations for Dobutamine?
- pregnancy safety category C
- administer via infusion pump to ensure precise flow rate
- monitor BP closely
- do not mix with sodium bicarbonate
- may exacerbate ischemia if HR increases
- Lidocaine should be readily available
- correct hypovolemia before Dobutamine
- elderly may have significantly decreased responses
What kind of drug is Dopamine (Intropin)?
Sympathomimetic
Increases cardiac output, myocardial contractility and rises BP. Acts primarily on Alpha1 and Beta1 adrenergic receptors.
Second line drug for bradycardia after Atropine.
What is the onset and duration of Dopamine?
Onset: 2-4min
Duration: 10-15min
What are the indications for Dopamine?
- hypotension in the absence of hypovolemia
- symptomatic bradycardia (second line drug after Atropine)
What are contraindications for Dopamine?
- tachydysrhythmias
- Vfib
- patients with pheochromocytoma (tumor of the adrenals that produces Adrenaline, causing high BP and tachy)
What are some adverse reactions of Dopamine?
- tachycardia
- hypertension
- increased oxygen demand of the heart
- headache
- anxiety
- N/V
What are some drug interactions with Dopamine?
- deactivated with alkaline solutions (sodium bicarbonate and Lasix)
- MAO Inhibitors may potentiate Dopamine effects
- sympathomimetic she and phosphodiesterase Inhibitors may exacerbate dysrhythmia response
- beta-adrenergic antagonists may blunt inotropic response
- when given with phenytoin, hypotension, bradycardia and seizures may develope
How is Dopamine supplied?
200, 400, 800 mg in 5mL profiled syringe and ampule for IV infusion (piggyback)
What is the adult dosage of Dopamine?
Infusion at 2-20mcg/kg/min, titrate to patient response, taper slowly
What are some special considerations for Dopamine?
- pregnancy safety category C
- infuse through large, stable vein to avoid possibility of extravasation injury
- use infusion pump
- monitor for signs of compromised circulation
- correct hypovolemia before using Dopamine
- do not mix with Sodium Bicarbonate
What type of drug is Norepinephrine (Levophed)?
Sympathomimetic
Alpha1 and Beta1 adrenergic agonist. Last resort in management of ischemic heart disease because it tends to constrict renal and mesenteric blood vessels.
What is the onset and duration of Norepinephrine?
Onset: 1-3min
Duration: 5-10min
What are the indications for Norepinephrine?
- severe cardiogenic shock
- neurogenic shock
- inotropic support
- significant hypotension (SBP <70)
What are the contraindications for Norepinephrine?
Hypotension patients with hypovolemia
What are some adverse reactions of Norepinephrine?
- headache
- dysrhythmias
- tachycardia
- reflex bradycardia
- angina pectorals
- hypertension
What are some drug interactions with Norepinephrine?
- can be deactivated with alkaline solutions
- MAO Inhibitors and bretylium may potentiate the effects of catecholamines
- beta-adrenergic antagonists may blunt inotropic response
- sympathomimetic and phosphodiesterase Inhibitors may exacerbate dysrhythmia response
How is Norepinephrine supplied?
1mg/mL, 4mL ampule
What is the adult dosage of Norepinephrine?
Dilute 4mg in 250mL of D5W or D2NS
Begin infusion at 0.1-0.5mcg/kg/min titrate to desired effect
What are some special considerations for Norepinephrine?
- pregnancy safety category C
- may cause fetal anoxia when used in pregnancy
- infuse through a large, stable vein to avoid extravasation and tissue necrosis
- use infusion pump
- do not give in the same IV as alkaline infusions
- may induce dysrhythmias
