Morphine sulfate

Question 1

What are some trade names for morphine sulfate?

Answer 1

Statex, MS Contin

Question 2

What is the drug classification of morphine sulfate?

Answer 2

Opioid analgesic

Question 3

How is morphine sulfate supplied?

Answer 3

10 mg/mL or 15mg/mL (ampule)

10mg/mL is commonly stocked in EMS. Draw up 1mL into a 10mL syringe and backfill with 9mL of normal saline. Now you have 1mg/mL.

Question 4

Describe the MOA (pharmacodynamics) of morphine sulfate.

Answer 4

Binds with opiate (MU) receptors within the CNS inhibiting ascending pathways; altering pain perception and emotional response to pain

Question 5

What are the indications for morphine administration?

Answer 5

• Pain control (moderate to severe)

- ACS when chest discomfort is unresponsive to nitrates

Question 6

What is the dosage of morphine for pain control in adults?

Answer 6

2.5 – 5 mg SIVP/IO/IM q 5-30 min prn; max 20mg

Question 7

What is the dose of morphine for use in ACS?

Answer 7

2.5mg SIVP prn q5 min until pain is relieved. Given only if unresponsive to nitrates.

Question 8

What is the pediatric dose of morphine for pain control?

Answer 8

0.05 to 0.1mg/kg slow IV/IO

Question 9

List the contraindications to morphine administration.

Answer 9

• Hypersensitivity
• Systolic BP <90mmHg
• Presence of MAO inhibitors, tricyclics, or phenothiazines within 14 days (greatly reduce dosage)

Question 10

Can you use morphine in a RV infarction?

Answer 10

Yes, but use EXTREME caution. Of course it would be contraindicated if Systolic BP <90mmHg.

Question 11

How do you set up a morphine infusion?

Answer 11

Mix 50mg into a 100ml NS bag, which makes a concentration of 0.5mg/mL. Infuse 5 - 20mg/hr. Used in long transports 30+ minutes.

Question 12

Why should you try to avoid using large amounts of morphine in a STEMI/NSTEMI?

Answer 12

Due to its association with increased mortality as it can decrease the effectiveness of Plavix and Ticagrelor

Question 13

Why should morphine be used cautiously in elderly or debilitated patients?

Answer 13

High risk of impaired renal or hepatic function.

Question 14

Why should morphine be used cautiously in breast feeing patients?

Answer 14

It can be passed through the milk causing infant drowsiness, and CNS depression.

Question 15

Can morphine affect preload?

Answer 15

Yes. It is a vasodilator and so can decrease preload. If hypotension develops, administer fluids as a first line therapy.

Question 16

Why can morphine be beneficial in treatment of ACS?

Answer 16

It produces CNS analgesia, which reduces the adverse effects of neurohumoral activation, catecholamine release, and heightened myocardial oxygen demand.