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Morphine Sulfate

Morphine Sulfate

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Published by Cay Sevilla

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Published by: Cay Sevilla on Nov 16, 2010
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MORPHINE SULFATE(mor'feen)Astramorph PF, Avinza, DepoDur, Duramorph, Epimorph , Kadian, MSIR, MS Contin,Oramorph SR, Roxanol, RMS, Statex
Classifications:
central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Pregnancy Category:
B (D in long-term use or high dose)
Controlled Substance:
Schedule II
Availability
10 mg, 15 mg, 30 mg tablets/capsules; 15 mg, 20 mg, 30 mg, 60 mg, 100 mg, 120 mg,200 mg controlled release tablets/capsules; 10 mg/2.5 mL, 10 mg/5 ml, 20 mg/mL, 20mg/5 mL, 30 mg/1.5 mL, 100 mg/5 mL oral solution; 0.5 mg/mL, 1 mg/mL, 2 mg/mL, 4mg/mL, 5 mg/mL, 8 mg/mL, 10 mg/mL, 15 mg/mL, 25 mg/mL, 50 mg/mL injection; 10mg/mL, 15 mg/1.5 mL, 20 mg/2 mL extended-release lysosomal injection; 5 mg, 10 mg,20 mg, 30 mg suppositories
Actions
 Natural opium alkaloid with agonist activity by binding with the same receptors asendogenous opioid peptides. Narcotic agonist effects are identified with 3 types of receptors: Analgesia at supraspinal level, euphoria, respiratory depression and physicaldependence; analgesia at spinal level, sedation and miosis; and dysphoric, hallucinogenicand cardiac stimulant effects.
Therapeutic Effects
Controls severe pain; also used as an adjunct to anesthesia.
Uses
Symptomatic relief of severe acute and chronic pain after nonnarcotic analgesics havefailed and as preanesthetic medication; also used to relieve dyspnea of acute leftventricular failure and pulmonary edema and pain of MI.
Contraindications
Hypersensitivity to opiates; increased intracranial pressure; convulsive disorders; acutealcoholism; acute bronchial asthma, chronic pulmonary diseases, severe respiratorydepression; chemical-irritant induced pulmonary edema; prostatic hypertrophy; diarrheacaused by poisoning until the toxic material has been eliminated; undiagnosed acute
 
abdominal conditions; following biliary tract surgery and surgical anastomosis; pancreatitis; acute ulcerative colitis; severe liver or renal insufficiency; Addison's disease;hypothyroidism; during labor for delivery of a premature infant, in premature infants; pregnancy (category B; D in long-term use or when high dose is used); lactation.
Cautious Use
Toxic psychosis; cardiac arrhythmias, cardiovascular disease; emphysema;kyphoscoliosis; cor pulmonale; severe obesity; reduced blood volume; very old, veryyoung, or debilitated patients; labor.
Route & Dosage
Pain Relief Adult: PO 10–30 mg q4h prn or 15–30 mg sustained release q8–12h; (Kadian) dose q12– 24h, increase dose prn for pain relief IV 2.5–15 mg q4h or 0.8–10 mg/h by continuousinfusion, may increase prn to control pain or 5–10 mg given epidurally q24h Epidural(DepoDur only) 10–15 mg as single dose 30 min before surgery (max: 20 mg) IM/SC 5– 20 mg q4h PR 10–20 mg q4h prnChild: IV 0.05–0.1 mg/kg q4h or 0.025–2.6 mg/kg/h by continuous infusion IM/SC 0.1– 0.2 mg/kg q4h (max: 15 mg/dose) PO 0.2–0.5 mg/kg q4–6h; 0.3–0.6 mg/kg sustainedrelease q12h Neonate: IV/IM/SC 0.05 mg/kg q4–8h (max: 0.1 mg/kg) or 0.01–0.02 mg/kg/h
Administration
Oral
Use a fixed, individualized schedule when narcotic analgesic therapy is started to provide effective management; blood levels can be maintained and peaks of paincan be prevented (usually a 4-h interval is adequate).
Use lower dosage for older adult or debilitated patients than for adults.
Do not break in half, crush, or allow sustained release tablet to be chewed.
Do not give patient sustained release tablet within 24 h of surgery.
Dilute oral solution in approximately 30 mL or more of fluid or semisolid food. Acalibrated dropper comes with the bottle. Read labels carefully when using liquid preparation; available solutions: 20 mg/mL; 100 mg/mL.Intravenous
 Note: Verify correct IV concentration and rate of infusion/injection for 
 
administration to neonates, infants, or children with physician.PREPARE: Direct: Dilute 2–10 mg in at least 5 mL of sterile water for injection.ADMINISTER: Direct: Give a single dose over 4–5 min. Avoid rapid administration.INCOMPATIBILITIES Solution/additive:
Aminophylline,
 
amobarbital,chlorothiazide,
 
floxacillin,
 
fluorouracil,
 
haloperidol,
 
heparin,
 
meperidine,pentobarbital,
 
phenobarbital,
 
phenytoin,
 
sodium bicarbonate,
 
thiopental.
Y-site:
Amphotericin B cholesteryl complex,
 
cefepime,
 
doxorubicin liposome,
 
minocycline,sargramostim,
 
tetracycline.
 
Store at 15°–30° C (59°–86° F). Avoid freezing. Refrigerate suppositories. Protectall formulations from light.
Adverse Effects ( 1%)
Body as a Whole: Hypersensitivity [Pruritus, rash, urticaria, edema, hemorrhagic urticaria(rare), anaphylactoid reaction (rare)], sweating, skeletal muscle flaccidity; cold, clammyskin, hypothermia. CNS: Euphoria, insomnia, disorientation, visual disturbances,dysphoria, paradoxic CNS stimulation (restlessness, tremor, delirium, insomnia),convulsions (infants and children); decreased cough reflex, drowsiness, dizziness, deepsleep, coma, continuous intrathecal infusion may cause granulomas leading to paralysis.Special Senses: Miosis. CV: Bradycardia, palpitations, syncope; flushing of face, neck,and upper thorax; orthostatic hypotension, cardiac arrest. GI: Constipation, anorexia, drymouth, biliary colic, nausea, vomiting, elevated transaminase levels. Urogenital: Urinaryretention or urgency, dysuria, oliguria, reduced libido or potency (prolonged use). Other:Prolonged labor and respiratory depression of newborn. Hematologic: Precipitation of  porphyria. Respiratory: Severe respiratory depression (as low as 2–4/min) or arrest; pulmonary edema.
Diagnostic Test Interference
False-positive urine glucose determinations may occur using Benedict's solution. Plasmaamylase and lipase determinations may be falsely positive for 24 h after use of morphine;transaminase levels may be elevated.
Interactions
Drug: cns depressants, sedatives, barbiturates,
alcohol,
benzodiazepines, and tricyclicantidepressants potentiate CNS depressant effects. Use mao inhibitors cautiously; they

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