Morphine Sulfate

Question 1

Class

Answer 1

Narcotic (opiate) analgesic

Controlled substance schedule 2

Question 2

Actions

Answer 2

Lowers BP by releasing histamine, which causes vasodilation, decreased peripheral resistance, and decreased preload.
Decreases the brainstem’s reponsiveness to CO2 and depresses the pontine and medullary respiratory rhythmicity centers, causing respiratory depression.
Blunts reflex vasoconstriction caused by CO2.
Analgesia by binding to opiate receptors in the CNS as an agonist.
Reduces preload (by increasing venous capacitance) and reduces afterload (systemic vascular resistance) and reduces myocardial oxygen demand by reducing intramyocardial wall tension in pulmonary edema. Preload is reduced more effectively than afterload.

Question 3

Indications

Answer 3

Pain of AMI, burns, kidney stones, isolated extremity fractures.
Acute pulmonary edema.
CP unresponsive to nitrates.

Question 4

Contraindications

Answer 4

Allergy to opiates / hypersensitivity
Hypovolemia/hypotension/shock
Head injury with increase ICP when it can mask neurological deterioration (same for cvas)
Diminished LOC, coma
Abdominal pain of unknown etiology
Bronchial asthma

Question 5

Side effects

Answer 5

Respiratory depression.
bradycardia -rare
bronchospasm-rare
n/v
Decreased mental status
constipation
euphoria
Hypotension (pronounced in geriatrics, peds, debilitated pts).

Question 6

Precautions

Answer 6

Have resuscitation eqiupment and narcan available.
resp depression occurs before pt is aware of it.
potentiates the action of etoh and cns depressants
titrate to decreased sensation of pain, not abolishment
may worsen bradycardia or heart blocks in inferior mi pts via a vagotonic effect