DRUG STUDY

Name of Student Nurse: Carissa Mae T. Estrada Date: July 31, 2022
Level/Block/Group: 3BSN-13 Hospital/Area: Clinical Instructor:

MORPHINE

NAME OF DRUG MECHANISM OF CONTRAINDICATIONS SIDE EFFECTS ADVERSE NURSING

ACTION EFFECTS RESPONSIBILITIES
GENERIC NAME All Formulations: Possible Side Adverse effect: ASSESSMENT
PHARMACOKINETICS Hypersensitivity to Effects: CONSIDERATIONS
morphine. Acute or severe Adverse effect:
Morphine (Sulphate)
asthma, GI obstruction,
Absorption site: Ambulatory pts, Overdose results IMPLEMENTATION
known or suspected
BRAND NAME Variably absorbed after paralytic ileus, severe pts notin severe in:
oral administration; hepatic/renal impairment, pain may -Respiratory
Arymo, Avinza, Doloral, rapidly absorbed after severe respiratory experience depression PATIENT TEACHING
Duramorph, Embeda, subcutaneous or depression. nausea, -Skeletal muscle
intramuscular Extended-Release: vomiting more flaccidity EVALUATION
Infumorph, Kadian, M-
administration. GI obstruction, acute frequently than -Cold/ clammy skin
ediat, M-eslon, MSIR, postoperative pain,
Mitigo, Ms Contin, pts in supine -Cyanosis DESIRED OUTCOMES
hypercarbia
Statex Bioavailability: Injection: position or who -Extreme
CLASSIFICATION HF due to lung disease; have severe drowsiness
Distribution: Widely arrhythmias, head injury, pain progressing to
distributed throughout the seizures, acute alcoholism. seizures
Pharmacologic Class:
body, mainly in the Labor when premature Frequent: -Stupor
- Opioid agonists birth expected. Increased
kidneys, liver, lungs and -Coma
intracranial pressure
Therapeutic Class: spleen; lower Sedation
Immediate-Release:
- Opioid analgesics concentrations appear in Hypercarbia Decreased B/P Tolerance to
the brain and muscles. Extreme Cautions: (including analgesic effect
INDICATION Morphine crosses the COPD, cor pulmonale, orthostatic (Physical
- Severe pain (the 20 placenta and traces are hypoxia, hypercapnia, hypotension) dependence
mg/mL oral solution secreted in sweat and preexisting respiratory may occur with
Diaphoresis
concentration should milk. Protein binding- depression, head injury,
Facial flushing repeated use)
only be used in opioid- increased ICP, severe
about 35% bound to Constipation
hypotension
tolerant patients). albumin and to Prolonged
All Formulations: Dizziness
immunoglobulins at duration of
Drowsiness
- Pain severe enough to
require daily, around- concentrations within the Hypersensitivity to Nausea action, cumulative
the-clock long-term therapeutic range. morphine. Acute or Vomiting effect may occur in
opioid treatment and for severeasthma, GI those with
which alternative Peak: 20 minutes for IV obstruction, known Occasional: hepatic/renal
treatment options are boluses or suspected impairment.
inadequate (extended- paralytic ileus, Allergic
release). Half-life: Serum half-life severe hepatic/renal reaction
- Pulmonary edema. in the period ten minutes impairment, severe (rash, pruritus)
to six hours following respiratory Dyspnea
-Pain associated with intravenous depression. Confusion
MI. administration-two to
Palpitations
DOSAGE & three hours; serum half- Extended-Release:
Tremors
FREQUENCY life in the period six hours
Urinary
onwards-10 to 44 hours. GI obstruction, acute
retention
postoperative pain,
Abdominal
Metabolism and hypercarbia
cramps
excretion: Morphine is
90% metabolized by Injection: Vision changes
glucuronidation by Dry mouth
UGT2B7 and sulfation at HF due to lung Headache
positions 3 and 6.4 disease; Decreased
Morphine can also be arrhythmias, head appetite
metabolized to codeine, injury, seizures, Pain/burning at
normorphine, and acute injection site
morphine ethereal alcoholism.Labor
sulfate. After an oral when premature birth Rare:
dose, about 60% is expected. Increased
excreted in the urine in intracranial pressure Paralytic ileus
24 hours, with about 3%
excreted as free Immediate-Release:
morphine in 48 hours.
After a parental dose, Hypercarbia
about 90% is excreted in
24 hours, with about 10% Extreme Cautions:
as free morphine, 65 to
70% as conjugated COPD, cor
morphine, 1% as pulmonale, hypoxia,
normorphine and 3% as
normorphine glucuronide.
After administration of
large doses to addicts
about 0.1% of a dose is
excreted as norcodeine.
Urinary excretion of
morphine appears to be Cautions:
pH dependent to some
extent; as the urine
becomes more acidic
more free morphine is
excreted and as the urine
becomes more alkaline
more of the glucuronide
conjugate is excreted.
Up to 10% of a dose may
be excreted in the bile.
hypercapnia,
preexisting
respiratory
depression, head
injury, increased
ICP, severe
hypotension
Biliary tract disease,
pancreatitis,
Addison’s disease,
cardiovascular
disease, morbid
obesity, adrenal
insufficiency, elderly,
hypothyroidism,
urethral stricture,
prostatichyperplasia,
debilitated pts, pts
with CNS
depression, toxic
psychosis, seizure
disorders, alcoholism