A Drug Study on Morphine

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A Drug Study Presented to 

The faculty of Nursing Department
Ma. Catherine Belarma, RN, MAN

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In Partial fulfilment of the

Requirements in NCM-212

By:

Karl Angelo Montano, Stn

BSN 4C

November 29, 2021

Generic Name: Morphine

Brand Name:  Arymo ER, Duramorph, Infumorph, Kadian, M-Eslon , Mitigo, MS

Contin, MS-IR

CLASSIFICATION: Opioid agonist

Mode of Action: Morphine binding to opioid receptors blocks transmission of

nociceptive signals, signals pain-modulating neurons in the spinal cord, and inhibits
primary afferent nociceptors to the dorsal horn sensory projection cells. Morphine
has a time to onset of 6-30 minutes.

INDICATION: Relief of moderate to severe, acute, or chronic pain; analgesia during

labor, pain due to MI, dyspnea from pulmonary edema not resulting from chemical
respiratory irritant. Infumorph: Use in devices for managing intractable chronic pain.
Extended-Release: Use only when repeated doses for extended periods of time are
required around the clock.

CONTRAINDICATION: Hypersensitivity to morphine. Acute or severe asthma, GI

obstruction, known or suspected paralytic ileus, concurrent use of MAOIs or use of
MAOIs within 14 days, severe respiratory depression. Extreme Caution: COPD,
morphine 797 Canadian trade name Non-Crushable Drug High Alert drug M cor
pulmonale, hypoxia, hypercapnia, preexisting respiratory depression, head injury,
increased ICP, severe hypotension.

Cautions: Biliary tract disease, pancreatitis, Addison’s disease, cardiovascular

disease, morbid obesity, adrenal insufficiency, elderly, hypothyroidism, urethral
stricture, prostatic hyperplasia, debilitated pts, pts with CNS depression, toxic
psychosis, seizure disorders, alcoholism

DOSAGE AND ROUTES:

Analgesia PO: (Immediate-Release):

ADULTS, ELDERLY: 10–30 mg q4h as needed.

CHILDREN 6 MOS AND OLDER WEIGHING 50 KG OR MORE: 15–20 mg q3–4h

as needed.

CHILDREN 6 MOS AND OLDER WEIGHING LESS THAN 50 KG: 0.2–0.5 mg/kg
q3–4h as needed.

CHILDREN YOUNGER THAN 6 MOS: (Oral Solution): 0.08–0.1 mg/kg q3–4h as

needed.
SIDE EFFECTS:

CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia,

seizures

CV: Palpitations, bradycardia, change in B/P, shock, cardiac arrest, chest pain,
hypo/hypertension, edema, tachycardia EENT: Blurred vision, miosis, diplopia

ENDO: Gynecomastia GI: Nausea, vomiting, anorexia, constipation, cramps, biliary

tract pressure

GU: Urinary retention, impotence, gonadal suppression

HEMA: Thrombocytopenia INTEG: Rash, urticaria, bruising, flushing, diaphoresis,

pruritus

INTERACTIONS:

Increase: serotonin syndrome risk—SSRIs, SNRIs, tricyclics, MAOIs, amoxapine,

dolasetron, palonosetron, antimigraine agents, linezolid, lithium, methylene blue,
trazodone; monitor for serotonin syndrome

Increase: effects with other CNS depressants—alcohol, opiates, sedative/hypnotics,

antipsychotics, skeletal muscle relaxants, general anesthetics, benzodiazepine;
avoid using together; increased respiratory depression

Decrease: morphine effect—butorphanol, nalbuphine, pentazocine; consider using

another product; withdrawal symptoms may occur

Decrease: morphine action—rifAMPin

Drug/Herb Increase: CNS depression—chamomile, hops, kava, St. John’s wort,

valerian

Drug/Lab Test Increase: amylase, lipase

NURSING RESPONSIBILITIES:

Assess:

• Pain: location, intensity, type, character; check for pain relief 20 min following IV, 1
hr following PO/IM/Subcut; titrate to relieve pain; give dose before pain becomes
severe

• Bowel status; constipation common, use stimulant laxative if needed; provide

increased bulk, fluids in diet
• I&O ratio; check for decreasing output; may indicate urinary retention; monitor
serum sodium

• B/P, pulse, respirations (character, depth, rate)

• CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction

• Abrupt discontinuation: gradually taper to prevent withdrawal symptoms; decrease

by 50% q1- 2days; avoid use of narcotic antagonists

• Allergic reactions: rash, urticarial

Evaluate:

• Therapeutic response: decrease in pain intensity

Teach patient/family:

• To avoid driving, hazardous activities until response is known

• To turn, cough and deep breathe if on bed rest

• To report constipation, as other products will need to be used

• To change position slowly; orthostatic hypotension may occur

• To report any symptoms of CNS changes, allergic reactions

• That physical dependency may result from long-term use

• To avoid use of alcohol, CNS depressants

• That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness,
anorexia

References

Vallerand, A.H. (2009). Davis’s Drug Guide for Nurses. F.A. Davis Company.
Philadelphia. (11th ed.)

Karch, A.M.(2011). Lippincott’s Nursing Drug Guide. Lippincott Williams Rwilkins.

Rochester, New York.
Hodgson, B.B.(2011).Saunders Nursing Drug Handbook. Elsevier Saunders. St.
Louis, Missouri.

Roth, Linda Skidmore.(2011). Mosby’s Nursing Drug Reference. Mosby’s Inc. St.
Louis, Missouri.