morphine sulfate (ANALGESIC DRUG) Flashcards
how is morphine sulfate presented on the road
Injection: morphine sulfate 10mg/ml (morphine sulfate 10mg per 1 ml)
Oral: morphine sulfate 10mg/5ml (morphine sulfate 2mg per 1ml)
what are the indications for morphine sulfate
pain associated with suspected MI (morphine should be the first drug to be given)
severe pain- as part of an analgesic plan like with paracetamol
pt with continuous severe musculoskeletal and soft tissue pain.
oral morphine= helps with moderate pain
what are the indications for end of life adults
if pt own medication for pain/breathlessness hasn’t been prescribed
pt own medication isnt availaible/run out
medicines are in place without a patient-specific document signed by independent prescriber
Breathlessness: pt is at end of life care and is distressed and breathless
if unable to access rapid community/palliative care
Pain: pt is at end of life care and is in pain
what is morphine sulfate classed as
strong opioid analgesic
morphine produces sedation, euphoria (happiness), and analgesia (can reduce rr and cause hypotension)
histamine is released causing vasodilatory effects. May also cause urticaria and bronchoconstriction.
what are the pharmacokinetics of morphine sulfate
administration: parental/ enteral (including orally and IV)
distribution: plasma proteins
Metabolism: Liver
Excretion: Urine
what are the pharmacodynamics for morphine sulfate
Morphine binding to opioid receptors blocks the transmission of nociceptive signals.
Signals pain- modulating neurons in spinal cord
inhibits primary afferent nociceptors to dorsal horn sensory projection cells
possible adverse effects of morphine sulfate
reduced rr
reduced hr
nausea/vomiting
drowsiness
pupillary constriction
itching due to histamine being released
contra-indications for morphine sulfate
children under 1
rr under 10 for adults
rr under 20 for children
hypotension ( systolic bp below 90mmHg)
head injury (with only responsive to pain or unresponsive or below a 9 for GCS)
known hypersensitivity to morphine sulfate
what are the contraindications for morphine sulfate in adult end of life care
cautions and contra-indications don’t generally apply due to the focus being on minimizing pain and breathlessness.
what factors need to be taken into account for dosage of morphine sulfate for adults
weight
age
route of administration
what is the maximum dose of morphine sulfate for adults weighing over 50kg
20mg
how long does IV morphine take to work? and when does it reach its peak time
minimum of 2-3mins and reaches its peal at 10-20 mins
should morphine be diluted? if so what with
should be diluyed with sodium chloride 0.9% to make concentration of 10mg in 10ml UNLESS being administered IM or subcutaneous
when should morphine NOT be diluted
when being given IM or subcutaneous
If pain isnt reduced to a tolerable level after 10mg of IV/IO morphine then how many mg of morphine should be administered
2 mg slowly via IV/IO every 5 mins to a maximum of 20mg.