DRUG STUDY

Name of Student Nurse: Carissa Mae T. Estrada Date: July 31, 2022
Level/Block/Group: 3BSN-13 Hospital/Area: PACU Clinical Instructor: Mrs. Maria Cecilita C.
Lusung, R.N. and Amelita Delos Santos
MORPHINE Dumaguin, R.N.

NAME OF DRUG MECHANISM OF CONTRAINDICATI SIDE ADVERSE NURSING RESPONSIBILITIES

ACTION ONS EFFECTS EFFECTS
GENERIC NAME PHARMACOKINETIC All Formulations: Possible Side CV:  ASSESSMENT
S Hypersensitivity to Effects: CONSIDERATIONS
morphine. Acute or hypotension -Assess level of consciousness,
Morphine (Sulphate)
severe
Absorption site: Ambulatory , BP, pulse, and respirations
asthma, GI
BRAND NAME Variably absorbed after obstruction, pts, pts notin bradycardia before and periodically during
oral administration; known or suspected severe pain Derm: flushi administration. If respiratory rate
Arymo, Avinza, Doloral, rapidly absorbed after paralytic ileus, may ng, itching, is <10/min, assess level of
Duramorph, Embeda, subcutaneous or severe experience sweating sedation
intramuscular hepatic/renal nausea, EENT: blurr
Infumorph, Kadian, M-ediat, M-
administration. impairment, vomiting more ed vision, -Assess type, location, and
eslon, MSIR, Mitigo, Ms Contin, severe respiratory
Statex frequently than diplopia, intensity of pain prior to and 1 hr
depression.
CLASSIFICATION Bioavailability: Extended-Release: pts in supine miosis following PO, subcut, IM, and 20
Morphine has GI obstruction, acute position or who min (peak) following IV
Pharmacologic Class: bioavailability of 50% ie postoperative pain, have severe Endo:  administration.
F =0.5. This means that hypercarbia pain
- Opioid agonists
only 50% of the oral Injection: adrenal -Assess geriatric patients
dose is absorbed and HF due to lung Frequent: insufficiency frequently; older adults are more
Therapeutic Class: disease;
- Opioid analgesics so the dose given must sensitive to the effects of opioid
arrhythmias, head
then be twice the SC/IV injury, Sedation GI:  analgesics and may experience
INDICATION dose Decreased side effects and respiratory
seizures, acute
- Severe pain (the 20 mg/mL alcoholism. B/P constipation complications more frequently.
oral solution concentration Distribution: Widely Labor when (including , nausea,
should only be used in opioid- distributed throughout premature orthostatic vomiting -Assess risk for opioid addiction,
tolerant patients). the body, mainly in the birth expected. abuse, or misuse prior to
hypotension)
Increased
kidneys, liver, lungs Diaphoresis GU: urinary administration. Abuse or misuse
intracranial pressure
- Pain severe enough to require and spleen; lower retention of extended-release
Immediate-Release: Facial
daily, around-the-clock long- concentrations appear Hypercarbia preparations by crushing,
flushing
term opioid treatment and for
which alternative treatment in the brain and Extreme Cautions: Constipation Neuro: chewing, snorting, or injecting
options are inadequate muscles. Morphine COPD, cor Dizziness dissolved product will result in
(extended-release). crosses the placenta pulmonale, confusion, s uncontrolled delivery of
Drowsiness
hypoxia,
- Pulmonary edema. and traces are secreted Nausea edation, morphine and can result in
hypercapnia,
in sweat and milk. preexisting Vomiting dizziness, overdose and death.
-Pain associated with MI. Protein binding-about respiratory dysphoria,
DOSAGE & FREQUENCY 35% bound to albumin depression, head Occasional: euphoria, IMPLEMENTATION
PO Rect:  (Adults and and to immunoglobulins injury, floating -Do not confuse MS Contin
Children  <50 kg): Usual at concentrations within increased ICP, severe feeling, (morphine sulfate) with
hypotension Allergic
starting dose for moderate to the therapeutic range. hallucinatio Oxycontin (oxycodone). Do not
All Formulations: reaction
severe pain in opioid-naive ns, confuse morphine with
(rash, pruritus)
patients– 0.3 mg/kg every 3–4 Peak: 20 minutes for IV headache, hydromorphone. Do not confuse
Hypersensitivity Dyspnea
hr initially. boluses unusual morphine (nonconcentrated oral
to morphine. Confusion
PO (Children  >1 mo): Prompt- dreams liquid) with morphine
Acute or Palpitations
release tablets and Half-life: Serum half- (concentrated oral liquid).
severeasthma, Tremors
solution– 0.2–0.5 mg/kg every life in the period ten Resp:
GI obstruction, Urinary
4–6 hr as needed.  Controlled- minutes to six hours -Use only preservative-free
known or retention
release tablet– 0.3–0.6 mg/kg following intravenous RESPIRAT formulations for neonates, and
suspected Abdominal
every 12 hr. administration-two to ORY for epidural and intrathecal
paralytic ileus, cramps
three hours; serum half- DEPRESSI routes in all patients.
severe Vision
IM IV Subcut (Adults  ≥50 life in the period six ON (includi
hepatic/renal changes
kg): Usual starting dose for hours onwards-10 to 44 ng central -Explain therapeutic value of
impairment, Dry mouth
moderate to severe pain in hours. sleep apnea medication prior to
severe
opioid-naive patients– 4–10 mg Headache and sleep- administration to enhance the
respiratory
every 3–4 hr.  MI– 8–15 mg, for Metabolism and Decreased related analgesic effect.
depression.
very severe pain additional excretion: Morphine is appetite hypoxemia)
smaller doses may be given 90% metabolized by Pain/burning Rect: MS Contin has been
Extended-Release:
every 3–4 hr. glucuronidation by at Misc:  administered rectally.
UGT2B7 and sulfation injection site IM Subcut: Use IM route for
GI obstruction,
IM IV Subcut (Adults and at positions 3 and 6.4 physical repeated doses, because
acute
Children  <50 kg): Usual Morphine can also be Rare: dependenc morphine is irritating to subcut
postoperative
starting dose for moderate to metabolized to codeine, e, tissues.
pain,
severe pain in opioid-naive normorphine, and Paralytic ileus psychologic Epidural: Administer undiluted.
hypercarbia
patients– 0.05–0.2 mg/kg every morphine ethereal al Do not use an in-line filter. Do
3–4 hr, maximum: 15 mg/dose. sulfate. After an oral dependenc not admix or administer other
Injection:
dose, about 60% is e, tolerance medications in epidural space for
IM IV Subcut (Neonates): 0.05 excreted in the urine in 48 hr after administration.
mg/kg every 4–8 hr, maximum 24 hours, with about HF due to lung Administer within 4 hr after
dose: 0.1 mg/kg. Use 3% excreted as free disease; removing from vial. Store in
preservative-free formulation. morphine in 48 hours. arrhythmias, refrigerator; do not freeze.
After a parental dose, head injury,
IV Subcut (Adults): Continuous about 90% is excreted seizures, acute PATIENT TEACHING:
infusion– 0.8–10 mg/hr; may be in 24 hours, with about alcoholism.Lab -Instruct patient on how and
preceded by a bolus of 15 mg 10% as free morphine, or when when to ask for and take pain
(infusion rates vary greatly; up 65 to 70% as premature birth medication.
to 80 mg/hr have been used). conjugated morphine, expected.
1% as normorphine and Increased -Instruct patient how and when
IV Subcut (Children  >1 3% as normorphine intracranial to ask for pain medication. Do
mo): Continuous infusion, glucuronide. After pressure not stop taking without
postoperative pain– 0.01–0.04 administration of large discussing with health care
mg/kg/hr.  Continuous infusion, doses to addicts about Immediate- professional; may cause
sickle cell or cancer pain– 0.02– 0.1% of a dose is Release: withdrawal symptoms if
2.6 mg/kg/hr. excreted as discontinued abruptly after
IV (Neonates): Continuous norcodeine. Urinary Hypercarbia prolonged use. Discuss safe
infusion– 0.01–0.03 mg/kg/hr. excretion of morphine use, risks, and proper storage
Epidural:  (Adults): Intermittent appears to be pH Extreme Cautions: and disposal of opioid
injection– 5 mg/day (initially); if dependent to some analgesics with patients and
relief is not obtained at 60 min, extent; as the urine COPD, cor caregivers with each Rx.
1–2 mg increments may be becomes more acidic pulmonale,
made (total dose not to exceed more free morphine is hypoxia, -Advise patient to notify health
10 mg/day).  Continuous excreted and as the hypercapnia, care professional if pain control
infusion– 2–4 mg/24 hr; may ↑ urine becomes more preexisting is not adequate or if severe or
by 1–2 mg/day (up to 30 alkaline more of the respiratory persistent side effects occur.
mg/day). glucuronide conjugate depression,
Epidural:  (Children >1 is excreted. Up to 10% head injury, -Advise patient to change
mo): 0.03–0.05 mg/kg, of a dose may be increased ICP, positions slowly to minimize
maximum dose: 0.1 mg/kg or 5 excreted in the bile. severe orthostatic hypotension.
mg/24 hr. Use preservative-free hypotension
formulation. -Explain to patient and family
Cautions: how and when to administer
morphine and how to care for
Biliary tract infusion equipment properly.
disease,
pancreatitis, -Teach parents or caregivers
Addison’s how to accurately measure liquid
disease, medication and to use only the
cardiovascular measuring device dispensed
disease, with the medication.
morbid obesity,
adrenal EVALUATION/ DESIRED
insufficiency, OUTCOMES:
elderly,
hypothyroidism, -Decrease in severity of pain
urethral without a significant alteration in
stricture, level of consciousness or
prostatichyperp respiratory status.
lasia,
debilitated pts, -Decrease in symptoms of
pts with CNS pulmonary edema.
depression,
toxic psychosis,
seizure
disorders,
alcoholism