Morphine Flashcards
Presentation
10 mg in 1 mL
Pharmacology - CNS effects (DDDRS)
Depression (leading to analgesia) Depression of cough reflex Dependence (addiction) Respiratory depression Stimulation (mood changes, euphoria or dysphoria, vomiting, pin-point pupils)
Pharmacology - Cardiovascular effects
Vasodilatation
Decreases conduction velocity through AV node
Metabolism
Metabolised = liver Excreted = kidneys
Indications
Pain relief
Sedation to maintain intubation
Contras
Hypersensitivity
Renal impairment/failure
Late second stage labour
Precautions
Elderly/frail Hypotension (cardiovascular effects) Respiratory depression (CNS effects) Current asthma (CNS effects) Respiratory tract burns (CNS effects) Known addiction to opioids (CNS effects) Acute alcoholism Patients on monoamine oxidase inhibitors
Route of administration
IV
IM
Subcutaneous
Side effects - CNS
Drowsiness Respiratory depression Euphoria Nausea, vomiting Addiction Pin-point pupils
Side effects - Cardiovascular
Hypotension
Bradycardia
IV effects
Onset = 2-5 mins Peak = 10 mins Duration = 1-2 hrs
IM effects
Onset = 10-30 mins Peak = 30-60 mins Duration = 1-2 hrs
Moderate Pain - Adult
Up to 5mg IV Repeat up to 5mg IV @ 5min intervals Max dose 20mg IV Consult for more Consider Paracetamol as per mild pain in combination
Severe Pain - Adult
As per moderate pain
Consider IN Fentanyl or Methoxyflurane
Consult for IV Ketamine for extreme traumatic pain
Last resort elderly/frail/ <60kg - IM Morphine 0.1 mg/kg single dose
Last resort adult - IM Morphine, 10mg IM, repeat 5mg IM after 15mins, once only.
Paediatric pain relief
Last resort ONLY when unable to administer IN/IV Fentanyl
0.1mg/kg IM single dose only
Max dose should not exceed 5mg (unless pt heavier then age calculated weight).