DRUG STUDY: MORPHINE SULFATE

Drug Name Drug Classification Mechanism of Action and Drug Action Drug Effects Interactions
Indications (Serious/Common)
Generic Name: Pharmacologic: Mechanism of Action: Pharmacokinetics Side effects (common by Drug – Drug
A: Variably absorbed (about system):
Morphine. Opioid agonists Binds with and activates opioid 30%) following oral Use with extreme caution in
receptors (mainly mu receptors) administration. More reliably CNS: confusion, sedation, patients receiving MAO
in brain and spinal cord to
absorbed from rectal, subcut, dizziness, dysphoria, inhibitors within 14 days prior
produce analgesia and euphoria.
and IM sites. Following euphoria, floating feeling, (may result in unpredictable,
Trade Name: epidural administration, hallucinations, headache, severe reactions— decrease
Therapeutic: systemic absorption and unusual dreams. initial dose of morphine to 25%
Arymo ER absorption into the intrathecal of usual dose).
Astramorph Opioid Analgesic Indication(s): space via the meninges occurs. EENT: blurred vision,
AVINza diplopia, miosis. Use with benzodiazepines or
To relieve acute or chronic
D: Widely distributed. Crosses other CNS depressants
moderate to severe pain; as
Dosage: the placenta; enters breast milk CV: hypotension, including otheropioids, non-
adjunct to treat pulmonary edema
in small amounts. Protein bradycardia. benzodiazepine
caused by left-sided heart failure;
Recommended: Binding: Premature infants: sedative/hypnotics, anxiolytics,
to supplement general, local, or
P.O. - Initial: 10 to 30 mg _20%; Adults: 35%. Endo: adrenal general anesthetics, muscle
regional anesthesia.
every 4 hr, p.r.n. insufficiency. relaxants, antipsychotics, and
I.V. Infusion - Initial: 15 mg M: Mostly metabolized GI: constipation, nausea, alcohol may cause profound
by the liver. Half-life: Adults:
(or more) followed by 0.8 to vomiting. sedation, respiratory depression,
2–4 hr.
10 mg/hr, increased as coma, and death; reserve
needed for effectiveness. E: Active metabolites excreted GU: urinary retention. concurrent use for when
Maintenance: 0.8 to 80 renally. alternative treatment options are
mg/hr. Derm: flushing, itching, inadequate.
I.V. Injection - 2.5 to 15 mg sweating.
injected slowly.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 1
 I.M. or subQ- Initial: 10 mg
(based on 70-kg [154-lb]
adult) every 4 hr.
Maintenance:
5 to 20 mg.
Epidural Infusion - Initial:
2 to 4 mg/24 hr, increased by
1 to 2 mg/24 hr, as directed.
Epidural Injection - Initial:
5 mg into lumbar region. If
pain isn’t relieved after 1 hr,
1- to 2-mg doses given at
appropriate intervals to
relieve pain. Maximum: 10
mg/24 hr
Intrathecal Injection - 0.2
to 1 mg as a single dose.
P.R. - 10 to 30 mg every 4
hr, p.r.n.
Janeirah Q. Manalundong
Faculty, College of Health Sciences
Pharmacodynamics Misc: physical dependence,
Route: P.O psychological dependence,
Onset: Unknown tolerance.
Peak: 1- 2 hr
Duration: 4- 5 hr
Adverse Reactions
Route: P.O – E.R (Serious, life-threatening)
Onset: Unknown Life-threatening:
Peak: 3 - 4 hr Resp: RESPIRATORY
Duration: 8 - 24 hr DEPRESSION.
Route: I.V.
Onset: Rapid Contraindication
Peak: 20 min Contraindicated in:
Duration: 4 – 5 hr Hypersensitivity; Some
products contain tartrazine,
Route: I.M. bisulfites, or alcohol and
Onset: 10 – 30 min should be avoided in
Peak: 30 – 60 min
patients with known
Duration: 4- 5 hr
hypersensitivity; Acute,
Route: subQ mild, intermittent, or
Onset: 20 min postoperative pain
Peak: 50 – 90 min (extended/ sustained-
Duration: 4- 5 hr release); Significant
respiratory depression
Route: Epidural
Onset: 6 – 30 min (extended-release); Acute
Peak: 1 hr or severe bronchial asthma
Duration: Up to 24 hr (extended-release);
Paralytic ileus (extended
release)
NSG 105: PHARMACOLOGY DRUG STUDY 2
Buprenorphine, nalbuphine,
butorphanol, or pentazocine
may decrease analgesia. May
increase the anticoagulant effect
of warfarin.
Cimetidine decrease
metabolism and may increase
effects.
Drug – Food
Drug – Laboratory
May increase plasma amylase
and lipase levels.
Treatment of Overdose/
Antidote (if any)
Toxicity and Overdose: If an
opioid antagonist is required to
reverse respiratory depression or
coma, naloxone is the antidote.
Dilute the 0.4-mg ampule
of naloxone in 10 mL of 0.9%
NaCl and administer 0.5 mL
(0.02 mg) by IV push every 2
min. For children and adults
weighing _40 kg, dilute 0.1 mg
of naloxone in 10 mL of 0.9%
 Route: Intrathecal NaCl for a concentration of 10
Onset: 15 – 60 min mcg/mL and administer 0.5
Peak: Unknown mcg/kg every 2 min. Titrate
Duration: Up to 24 hr
dose to avoid withdrawal,
Route: Rect seizures, and severe pain.
Onset: unknown
Peak: 20 – 60 min
Duration: 3 – 7 hr

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 3
Nursing Process: Morphine Sulfate
Assessment
▪ Assess type, location,
and intensity of pain
prior to and 1 hr
following PO, subcut,
IM, and 20 min (peak)
following IV
administration. When
titrating opioid doses,
increases of 25–50%
should be administered
until there is either a
50% reduction in the
patient’s pain rating on
a numerical or visual
analogue scale or the
patient reports
satisfactory pain relief.
When titrating doses of
short-acting morphine,
a repeat dose can be
safely administered at
the time of the peak if
previous dose is
Janeirah Q. Manalundong
Faculty, College of Health Sciences
Nursing Diagnoses Planning Nursing Interventions with Appropriate Patient Evaluation/ Expected
(Priority Problems) Rationale (Italic) Teaching/Education Outcomes of Care
General
▪ Acute pain The patient will: ▪ Monitor vital signs. ▪ Decrease in severity
▪ Chronic pain ▪ Report pain relief or a Cardiac output and ▪ Instruct patient how and of pain without a
▪ Risk for injury central venous pressure significant alteration
reduction in pain when to ask for pain
may be needed.
intensity medication. in level of
▪ Assist with monitoring
▪ Demonstrate according to cardiac care consciousness or
understanding of the unit (CCU) or emergency ▪ May cause drowsiness or respiratory status.
drug’s action by department (ED) dizziness. Caution patient to
accurately describing protocols. call for assistance when ▪ Decrease in symptoms
drug side effects and ▪ Monitor vital signs, ambulating or smoking and of pulmonary edema.
especially depth and rate
precautions to avoid driving or other
of respirations and pulse
▪ Maintain respiratory rate oximetry. Opioids activities requiring alertness
at least twelve beats per interact with receptors in until response to medication
minute. the brain; respiratory is known.
▪ Immediately report effect depression and cardiac
such as untoward or arrest may occur. ▪ Advise patient that
rebound pain, ▪ Monitor liver enzymes morphine is a drug with
and observe the patient known abuse potential.
restlessness, anxiety,
for abdominal distention,
depression, Protect it from theft, and
tenderness and rigidity.
hallucination, nausea, Morphine may intensify never give to anyone other
dizziness, and itching. or mask the pain of than the individual for
▪ Maintain bowel function. gallbladder disease. whom it was prescribed.
Morphine can cause
anorexia, nausea and
vomiting, and may
NSG 105: PHARMACOLOGY DRUG STUDY 4
 ineffective and side
effects are minimal.
▪ Patients on a
continuous infusion
should have additional
bolus doses provided
every 15–30 min, as
needed, for
breakthrough pain. The
bolus dose is usually
set to the amount of
drug infused each hour
by continuous infusion.
▪ Patients taking
extended-release
morphine may require
additional short-acting
opioid doses for
breakthrough pain.
Doses of short-acting
opioids should be
equivalent to 10–20%
of 24 hr total and given
every 2 hr as needed.
Janeirah Q. Manalundong
Faculty, College of Health Sciences
trigger biliary tract ▪ Advise patient to change
spasm. Morphine also positions slowly to
raises serum amylase minimize orthostatic
levels.
hypotension.
▪ Keep resuscitative
equipment and narcotic-
▪ Caution patient to avoid
agonist (naloxone)
concurrent use of alcohol or
medication at hand.
Withhold the drug if the other CNS depressants with
patient's respiratory rate this medication.
below 12.
▪ Monitor neurological ▪ Encourage patients who are
status. Perform neuro- immobilized or on
checks regularly. prolonged bedrest to turn,
Decreased LOC and cough, and breathe deeply
sluggish pupillary every 2 hr to prevent
response may occur with atelectasis.
high doses. May cause
increased CO2 content ▪ Advise patient to notify
of blood, dilating health care professional if
cerebral vessels causing pregnancy is planned or
ICP. Observe for suspected, or if breast
seizures.
feeding.
▪ Interview patient
regarding the location,
quality, intensity, and Side Effects
frequency or duration of
pain; use a nominal scale ▪ Explain to patient and
to determine intensity. family how and when to
Administer medication administer morphine and
NSG 105: PHARMACOLOGY DRUG STUDY 5
▪ An equianalgesic chart
should be used when
changing routes or
when changing from
one opioid to another.
▪ Assess level of
consciousness, BP,
pulse, and respirations
before and periodically
during administration.
If respiratory rate is
_10/min, assess level of
sedation. Physical
stimulation may be
sufficient to prevent
significant
hypoventilation.
Subsequent doses may
need to be decreased by
25- 50%. Initial
drowsiness will
diminish with
continued use.
▪ Assess geriatric
patients frequently;
older adults are more
Janeirah Q. Manalundong
Faculty, College of Health Sciences
before pain becomes how to care for infusion
intense to help keep pain equipment properly.
under control.
▪ Monitor renal status and ▪ Emphasize the importance
urinary output. May of aggressive prevention of
cause urinary retention constipation with the use of
due to muscle relaxation
morphine.
in urinary tract. Opiates
are excreted through the
kidneys. Impaired kidney
function may result in
reduced medication
clearance and increased
serum drug levels.
Urinary retention may
exacerbate existing
symptoms of prostatic
hypertrophy.
▪ Monitor for side effects
such as restlessness,
dizziness, anxiety,
depression,
hallucinations. Opiates
bind mu and kappa
receptors in the brain
and spinal cord.
Stimulation of
chemoreceptors in the
GI tract may produce
nausea and vomiting.
NSG 105: PHARMACOLOGY DRUG STUDY 6
 sensitive to the effects
of opioid analgesics
and may experience
side effects and
respiratory
complications more
frequently.
▪ Assess bowel function
routinely. Institute
prevention of
constipation with
increased intake of
fluids and bulk and
with laxatives to
minimize constipating
effects. Administer
stimulant laxatives
routinely if opioid use
exceeds 2–3 days,
unless contraindicated.
▪ Assess risk for opioid
addiction, abuse, or
misuse prior to
administration. Abuse
or misuse of extended-
release preparations by
Janeirah Q. Manalundong
Faculty, College of Health Sciences
▪ Monitor for hives or
itching. These symptoms
may indicate an allergic
reaction due to the
production of histamine.
▪ Monitor for constipation.
Opioids have an
antispasmodic effect on
the GI tract, which
decreases peristaltic
activity. May need to
increase dietary fiber or
administer laxatives.
▪ Ensure patient safety.
Raise bed rails and place
call bell within patient's
reach and monitor
ambulation
▪ Monitor for
tolerance/dependence.
Continued long-term use
of opioids results in
tolerance to the drug's
desired effect and
physical dependence on
the drug itself. Increased
dosing or administration
route changes may be
required to maintain
analgesia.
Crosstolerance may also
NSG 105: PHARMACOLOGY DRUG STUDY 7
 crushing, chewing, develop to other
snorting, or injecting narcotics such as
dissolved product will methadone, meperidine
and heroin.
result in uncontrolled
delivery of morphine
and can result in
overdose and death.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 8