Morphine Flashcards

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1
Q

What is morphine?

A

A strong opioid

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2
Q

What is the mechanism of action of morphine?

A

Full agonist for G-protein coupled receptors

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3
Q

What are the routes of delivery of morphine?

A
  • PO
  • IV
  • IM
  • SC
  • PR
  • Intrathecal
  • Epidural
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4
Q

How does patient controlled analgesia (PCA) prevent overdose?

A

PCA has lock-out mechanism in place to prevent accidental overdose

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5
Q

What are the indications for morphine?

A
  • Moderate to severe pain of acute or chronic nature

- Palliative treatment

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6
Q

What should you do before prescribing morphine for pain relief?

A

Escalate pain relief up the pain ladder

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7
Q

What is the purpose of morphine in palliative treatment?

A

To keep patient comfortable at the end of life

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8
Q

In what conditions are all opioids, including morphine, contraindicated in?

A
  • Respiratory depression
  • Head injury
  • Raised ICP
  • Patients at risk of paralytic ileus
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9
Q

In what conditions is morphine contraindicated in?

A
  • Acute abdomen
  • Delayed gastric emptying
  • Heart failure secondary to chronic lung disease
  • Pheochromocytoma
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10
Q

What can be used to monitor respiratory and CNS depression with morphine?

A

Sedation scores

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11
Q

What is the reversal agent for opioid-induced respiratory and CNS depression?

A

Naloxone

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12
Q

What might morphine interact with?

A
  • CNS depressants, such as alcohol, sedatives, and anaesthetic agents
  • MAOIs
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13
Q

What might happen if morphine is given with CNS depressants?

A

Increased risk of respiratory depression

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14
Q

What might happen if morphine is given with MAOIs?

A

Enhanced effects of morphine

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15
Q

What are the common side effects of morphine?

A
  • Nausea and vomiting
  • Constipation
  • Urinary retention
  • Itching
  • Respiratory depression
  • Hypotension
  • Paralytic ileus
  • Sedation
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16
Q

What are the other side effects of morphine following long term use?

A
  • Adrenal insufficiency
  • Hyperalgesia
  • Hypogonadism
17
Q

What counselling is required with morphine?

A
  • Impairment of normal abilities

- Alcohol use not recommended

18
Q

What is the equivalent to 10mg morphine PO in codeine?

A

100mg PO

19
Q

What is the equivalent to 10mg morphine PO in tramadol?

A

67mg PO

20
Q

What is the equivalent to 10mg morphine PO in oxycodone?

A

6.6mg PO

21
Q

What is the equivalent to 10mg morphine PO in morphine SC?

A

5mg

22
Q

What is the equivalent to 10mg morphine PO in morphine IV?

A

5mg

23
Q

What is the equivalent to 10mg morphine PO in morphine IM?

A

5mg

24
Q

What is the equivalent to 45mg morphine PO in fentanyl patch?

A

12micrograms/hour (this is the lowest dose of fentanyl, and doses titrated up by 12-25 micrograms)