DRUG STUDY

NAME OF ROUTE, DOSAGE AND MECHANISM SIDE EFFECTS/ NURSING

INDICATION CONTRAINDICATION
DRUG FREQUENCY OF ACTION ADVERSE EFFECTS CONSIDERATIONS
Generic Name: Angina: Binds with opioid Relief of moderate Contraindications: Possible Side Effects:  Observe the patient’s 10
Morphine PO (Immediate-Release): receptors within to severe, acute, or All Formulations: rights of medication
Ambulatory pts, pts not
(Sulphate) Adults, Elderly: 10–30 mg CNS, inhibiting chronic pain; Hypersensitivity to administration
in severe pain may
q4h as needed. (Solution): 10– ascending pain analgesia during morphine. Acute or severe
experience nausea,
Brand Name: 20 mg q4h as needed. pathways. labor, pain due to asthma, GI obstruction, Baseline Assessment:
vomiting more
Duramorph, (Tablet): 15–30 mg q4h as MI, dyspnea from known or suspected  Pt should be in recumbent
frequently than pts in
Infumorph, needed. Therapeutic pulmonary edema paralytic ileus, severe position before drug is given
supine position or who
Roxanol Children 6 Months of Age Effect: Alters not resulting from hepatic/renal impairment, by parenteral route.
have severe pain
and Older Weighing 50 kg or pain perception, chemical severe respiratory  Assess onset, type, location,
Classification: Greater: emotional respiratory irritant. depression. duration of pain.
Frequent:
Pharmaco- 15–20 mg q3–4h as needed. response to pain.  Obtain vital signs before
 Sedation
therapeutic: Children 6 Months of Age Infumorph: Use in Extended-Release: giving medication. If
Opioid and Older Weighing Less devices for GI obstruction, acute  Decreased B/P
(including orthostatic respirations are 12/min or
agonist Than 50 kg: managing postoperative pain, less (20/min or less in
(Schedule II). 0.2–0.5 mg/kg q3–4h as intractable chronic hypercarbia hypotension)
children), withhold
needed. pain.  Diaphoresis
medication, contact
Clinical: Children Younger Than 6 Injection:  Facial flushing
physician.
Opioid Months: Extended-release: HF due to lung disease;  Constipation
 Effect of medication is
analgesic. (Oral solution): 0.08–0.1 Use only when arrhythmias, head injury,  Dizziness reduced if full pain recurs
mg/kg q3–4h as needed repeated doses for seizures, acute alcoholism.  Drowsiness before next dose.
extended periods of Labor when premature  Nausea
PO (Extended-Release): time are required birth expected. Increased  Vomiting. Intervention:
Adults, Elderly: Dosage around the clock. intracranial pressure  Monitor vital signs 5–10 min
requirement should be after IV administration, 15–
established using prompt- Immediate-Release: Occasional:
 Allergic reaction 30 min after SQ, IM.
release formulations and is Hypercarbia
(rash, pruritus)  Be alert for decreased
based on total daily dose.
 Dyspnea respirations, B/P.
Avinza: AVINza is given once Extreme Cautions:
 Confusion  Check for adequate voiding.
daily only. COPD, cor pulmonale,
Kadian: Dose is given once hypoxia, hypercapnia,  Palpitations  Monitor daily pattern of
daily or divided and given preexisting respiratory  Tremors bowel activity, stool
q12h. depression, head injury,  Urinary retention consistency; avoid
constipation.
MS Contin: Daily dose is increased ICP, severe  Abdominal cramps
divided and given q8h or q12h. hypotension.  Initiate deep breathing,
 Vision changes
coughing exercises,
 Dry mouth
IV: Cautions: particularly in those with
Adults, Elderly: 2.5–5 mg q3–
4h as needed. Note: Repeated
doses (e.g., 1–2 mg) may be
given more frequently (e.g.,
every hr) if needed. Children
50 kg or Greater:
Initially, 2–5 mg q2–4h as
needed.
Children Weighing Less
Than 50 kg:
Initially, 0.05 mg/kg. Range:
0.1–0.2 mg/kg q2– 4h as
needed. Neonates: Initially,
0.05–0.1 mg/kg/dose q4–6h as
needed.
IV Continuous Infusion:
Adults, Elderly: 0.8–10
mg/hr. Range: Titrate up to 80
mg/hr.
Children Weighing 50 kg or
Greater:
1.5 mg/hr.
Children Weighing Less
Than 50 Kg:
Initially, 0.01 mg/kg/hr.
Range: 0.01–0.04 mg/kg/hr
(10–40 mcg/ kg/hr).
NEONATES: Initially, 0.01
mg/kg/hr (10 mcg/kg/hr).
Maximum: 0.015–0.02
mg/kg/hr. Note: IM injection
not recommended
IM:
Adults, Elderly: 5–10 mg q3–
4h as needed. Children: 0.1–
0.2 mg/kg q3–4h as needed.
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.
 Headache pulmonary impairment.
 Decreased appetite  Assess for clinical
 Pain/burning at improvement; record onset of
injection site pain relief.
 Consult physician if pain
Rare: relief is not adequate.
 Paralytic ileus
Patient/Family Teaching:
Adverse effect:  Discomfort may occur with
 Overdose results in: injection.
o Respiratory  Change positions slowly to
depression avoid orthostatic
o Skeletal muscle hypotension.
 Avoid tasks that require
flaccidity
alertness, motor skills until
o Cold/ clammy skin
o Cyanosis response to drug is
established.
o Extreme drowsiness
progressing to  Avoid alcohol, CNS
depressants.
seizures
o Stupor  Tolerance, dependence may
o Coma occur with prolonged use of
high doses.
 Tolerance to
analgesic effect  Report ineffective pain
(Physical dependence control, constipation,
may occur with urinary retention.
repeated use)
 Prolonged duration of
action, cumulative
effect may occur in
those with
hepatic/renal
impairment.
 Antidote: Naloxone
References:
Kizior, R. J. & Hodgson, K. J. (2019). Saunders Nursing Drug Handbook 2019. Elsevier Inc.