MORPHINE

Generic Name Morphine

Brand Name Astramorph PF,

Avinza, DepoDur,
Duramorph,
Epimorph , Kadian,
MSIR, MS Contin,
Oramorph SR,
Roxanol, RMS,
Statex

Classification CENTRAL NERVOUS SYSTEM (CNS) AGENT; ANALGESIC;

NARCOTIC (OPIATE) AGONIST
General Action Natural opium alkaloid with agonist activity by binding with the same
receptors as endogenous opioid peptides. Narcotic agonist effects are
identified with 3 types of receptors: Analgesia at supraspinal level,
euphoria, respiratory depression and physical dependence; analgesia at
spinal level, sedation and miosis; and dysphoric, hallucinogenic and
cardiac stimulant effects.
Dose and Route 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; (Avinza) dose
q24h IV 2.5–15 mg q4h or 0.8–10 mg/h by continuous infusion, 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 prn
Child: 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 sustained release q12h
Neonate: IV/IM/SC 0.05 mg/kg q4–8h (max: 0.1 mg/kg) or 0.01–0.02
mg/kg/h
Indications or Symptomatic relief of severe acute and chronic pain after nonnarcotic
Purposes analgesics have failed and as preanesthetic medication; also used to relieve
dyspnea of acute left ventricular failure and pulmonary edema and pain of
MI.
Side effects Body as a Whole: Hypersensitivity [Pruritus, rash, urticaria, edema,
hemorrhagic urticaria (rare), anaphylactoid reaction (rare)], sweating,
skeletal muscle flaccidity; cold, clammy skin, hypothermia.
 CNS: Euphoria, insomnia, disorientation, visual disturbances, dysphoria,
paradoxic CNS stimulation (restlessness, tremor, delirium, insomnia),
convulsions (infants and children); decreased cough reflex, drowsiness,
dizziness, deep sleep, 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, dry mouth, biliary colic, nausea, vomiting,
elevated transaminase levels.
Urogenital: Urinary retention 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.
Contraindications Hypersensitivity to opiates; increased intracranial pressure; convulsive
disorders; acute alcoholism; acute bronchial asthma, chronic pulmonary
diseases, severe respiratory depression; chemical-irritant induced
pulmonary edema; prostatic hypertrophy; diarrhea caused 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.
Nursing Assessment & Drug Effects
Responsibilities
 Obtain baseline respiratory rate, depth, and rhythm and size of
pupils before administering the drug. Respirations of 12/min or
below and miosis are signs of toxicity. Withhold drug and report to
physician.
 Observe patient closely to be certain pain relief is achieved. Record
relief of pain and duration of analgesia.
 Be alert to elevated pulse or respiratory rate, restlessness, anorexia,
or drawn facial expression that may indicate need for analgesia.
 Differentiate among restlessness as a sign of pain and the need for
medication, restlessness associated with hypoxia, and restlessness
caused by morphine-induced CNS stimulation (a paradoxic reaction
that is particularly common in women and older adult patients).
 Monitor for respiratory depression; it can be severe for as long as
24 h after epidural or intrathecal administration.
 Monitor carefully those at risk for severe respiratory depression
after epidural or intrathecal injection: Older adult or debilitated
patients or those with decreased respiratory reserve (e.g.,
emphysema, severe obesity, kyphoscoliosis).
 Continue monitoring for respiratory depression for at least 24 h
after each epidural or intrathecal dose.
  Assess vital signs at regular intervals. Morphine-induced
respiratory depression may occur even with small doses, and it
increases progressively with higher doses (generally max: 90 min
after SC, 30 min after IM, and 7 min after IV).
 Encourage changes in position, deep breathing, and coughing
(unless contraindicated) at regularly scheduled intervals. Narcotic
analgesics also depress cough and sigh reflexes and thus may
induce atelectasis, especially in postoperative patients.
 Be alert for nausea and orthostatic hypotension (with light-
headedness and dizziness) in ambulatory patients or when a supine
patient assumes the head-up position or in patients not experiencing
severe pain.
 Monitor I&O ratio and pattern. Report oliguria or urinary retention.
Morphine may dull perception of bladder stimuli; therefore,
encourage the patient to void at least q4h. Palpate lower abdomen
to detect bladder distention.

Patient & Family Education

 Avoid alcohol and other CNS depressants while receiving

morphine.
 Do not use of any OTC drug unless approved by physician.
 Do not smoke or ambulate without assistance after receiving drug.
Bedside rails are advised.
 Use caution or avoid tasks requiring alertness (e.g., driving a car)
until response to drug is known since morphine may cause
drowsiness, dizziness, or blurred vision.
 Do not breast feed while taking this drug.