MORPHINE

SULPHATE
SUBMITTED BY:
M.Senbagam,
2nd yr B.Sc.Nursing,
Medical surgical nursing,
KMCH college of nursing
Coimbatore.
Definition

A drug used to treat moderate to severe pain. It

binds to opioid receptors in the central
nervous system and some other tissues.
Morphine sulfate is made from opium. It is a
type of opiate and a type of analgesic agent.
Group name: Narcotic analgesic
Drug name: Morphine sulphate
Trade name: MS continue, Roxanol, RMS
STRUCTURAL FORMULA
Available Dosage

Morphine sulphate used for pain relief may be injected

intramuscularly in doses of 100-150 much/kg every 2
hours as required. For operations and anesthesia, the dose
of morphine that needs to be administered depends on the
duration of surgery and the severity of pain anticipated.
Route of Administration
• Oral (Capsule, syrups, tablets)
• Intravenous
• Intramuscular
• Subcutaneous
• Epidural Administration
• Intrathecal Administration
Mechanism of action

Opioid drugs, typified by morphine, produce their

pharmacological actions, including analgesia, by acting
on receptors located on neuronal cell membranes. The
presynaptic action of opioid to inhibit neurotransmitter
release is considered to be their major effect in the
nervous system.
USES
• Morphine is used medicinally
• Relief moderate to severe pain in both acute and chronic
management.
• Pre-operative sedation and to facilitate the induction of
anesthesia.
• For long-term treatment of terminally ill, pain ridden patients.
Contraindication
• Respiratory depression,
• Hypersensitivity,
• Paralytic ileus, and delayed gastric emptying,
• Obstructive airway disease,
• Acute hepatic disease,
• MAO inhibitor administration,
• Pregnancy, lactation and in children.
Drug to Drug Intraction

Some products that may interact with this drug are:

Certain pain medication (mixed opioid
agonist/antagonists such as pentazocine, nalbuphine,
butorphanol, naltrexone.
Food Interaction

Avoid alcohol. Concomitant use may lead to

profound sedation, respiratory depression,
coma and death.
Pharmacokinetics

• Orally –absorbed very slowly,

• Extensive first pass metabolism -20% - 40% of bio-
availability.
• Duration of action – (3-6 hours)
• Distribution is wide; concentration in liver, spleen and
kidney is greater than plasma.
• Morphine freely crosses placenta.
• Plasma half life 3hours (1-5 hrs)
• 30% is plasma protein bound.
Side effects

• Nausea, vomiting and abdominal cramps

• Constipation
• Sedation and drowsiness
• Itching and allergic skin reactions causing warmth and
flushing.
• Shrinking of the pupils to pin points
• Respiratory depression or suppressed breathing
• Initial doses lead to euphoria but higher doses cause
unpleasant symptoms such as hallucinations, delirium,
dizziness and confusion.
• Formation of physical or psychological dependence and
development of withdrawal symptoms when use of the
drug is stopped.
• Development of tolerance and the need to increase dose
to achieve the same degree of effects as before
• Risk of overdose and poisoning.
Nurses responsibility

• Assess the source, quality, and severity of the patient’s

pain and keep in mind that pain is a subjective
experience. A patient’s report of pain should be
believed.
• Use non – opioid analgesics when possible.
• Monitor for decreased respiration.
• Giving an opioid along with a non-opioid may increase
analgesic effects and allow a lower dose of opioid to be given.
• Give the opioid drug at least 30-60 minutes prior to activities
or painful procedures.
• Monitor the patient closely when an opioid is given as
sedation for a painful procedure.
Patient teaching

• Instruct patient on how and when to ask for pain

medication.
• Advise patient to make position changes slowly to
minimize orthostatic hypotension.
• Encourage patient to turn, cough, and breath deeply
every 2hr to prevent atelectasis.