Morphine

Question 1

Morphine Indications

Answer 1

Moderate to severe pain.
Cardiogenic pulmonary oedema with severe anxiety.
Sedation post intubation.
Symptom control during end of life care

Question 2

Morphine Mechanism of action

Answer 2

Morphine is an opiate analgesic. It is an opiate agonist (or stimulator) that binds to opiate receptors in the brain and spinal cord causing analgesia.

Question 3

Morphine Contraindications

Answer 3

Known severe allergy.
Unable to obey commands (exceptions: End of life care and post intubation).
Respiratory depression

Question 4

Morphine Cautions (6)

Answer 4

-Aged less than one year. Children under the age of one year are at increased
risk of respiratory depression following opiate administration.
-At high risk of respiratory depression. For example, severe COPD, morbid
obesity or on home BiPAP. Such patients may develop respiratory depression following opiate administration.
-Labour. Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby, particularly when administered within an hour or two of birth. Discuss administration with the lead maternity carer if possible. —-Following birth, close observation of the baby is required and
personnel must be prepared to treat respiratory depression.
-Concurrent administration of other opiates, ketamine or midazolam. This will
increase and prolong the effects.
-Elderly and/or frail. These will increase and prolong the effects.
-Signs of shock. Fentanyl may make shock worse.

Question 5

Morphine Use in pregnancy/breastfeeding

Answer 5

• Safety has not been demonstrated in pregnancy, but morphine should be administered if indicated.
• May be administered if the patient is breastfeeding. Advise the patient to stop
breastfeeding and seek further advice from their lead maternity carer or GP.

Question 6

Morphine Common interactions

Answer 6

• The effects will be increased in the presence of other opiates and sedatives, for example benzodiazepines or alcohol.

Question 7

Morphine Adverse effects

Answer 7

• Respiratory depression.
• Bradycardia.
• Hypotension.
• Sedation.
• Nausea and vomiting.
• Itch.
• Euphoria.

Question 8

Morphine Onset of effect

Answer 8

• IV: 2-5 minutes. The maximal analgesic and respiratory depressant effects may
not occur until 10-15 minutes and this may be longer in the elderly.
• IM: 5-10 minutes.

Question 9

Morphine Duration of effect

Answer 9

• 30-60 minutes.

* The effect on respiration may last for several hours.

Question 10

Morphine Preparation

Answer 10

10mg/1ml

Question 11

Morphine Histamine release

Answer 11

Histamine release and itch are common. Not an allergy so long as confined to skin involvement.
True allergy is rare, severe side effects i.e. severe nausea/vomiting may have been experienced - consider Fentanyl.

Question 12

Morphine and Fentanyl together

Answer 12

Should be rare, however is permissible if appropriate (Fent for intense pain relief, morphine as follow up. Give all of the fentanyl amp before switching.

Question 13

Morphine additional information

Answer 13

Morphine is not contraindicated in a patient with abdo pain.

Reported to cause spasm of the sphincter of Oddi, not contraindicated in a patient with cholecystitis or biliary collic