NATIVIDAD, JOSEPH P.

BSN 3A-3

Drug Name Dosage Action Indication Contraindication Adverse Effect Nursing consideration

Generic 15mg Morphine To relieve For all forms: CNS: Agitation, - Be aware that morphine can lead to abuse,
Name: IV, Q8 sulphate pain severe Acute or severe amnesia, anxiety, addiction, and misuse. To ensure that benefits of
morphine IV enough to bronchial asthma ataxia, chills, coma, morphine therapy outweigh risks, a Risk
sulfate ↓ require in an unmonitored confusion, Evaluation and Mitigation Strategy (REMS) is
Absorption in opioid setting or in the decreased required.
Brand the bloodstream treatment absence of concentration, - WARNING Know that chronic maternal use of
Name: ↓ and for resuscitative delirium, delusions, morphine during pregnancy can result in NOWS,
Arymo ER, distribution which equipment; depression, which may be life-threatening if not recognized
Astramorph ↓ alternative gastrointestinal dizziness, dream and treated appropriately. NOWS occurs when a
PF, binding to treatment obstruction, abnormalities, newborn has been exposed to opioid drugs like
Duramorph opioid receptors options such including paralytic drowsiness, edema, morphine for a prolonged period while in utero.
PF, ↓ as ileus; euphoria, fever, gait - WARNING Use extreme caution when
Infumorph, Mu receptor nonopioid hypersensitivity to disturbance, administering morphine to patients with
Kadian, M- activation analgesics morphine sulfate hallucinations, conditions accompanied by hypercapnia,
Eslon ↓ or opioid or its components; headache, increased hypoxia, or decreased respiratory reserve such as
(CAN), modulation of combination significant intracranial asthma, chronic obstructive pulmonary disease
MorphaBon neurotransmitter products are respiratory pressure, insomnia, (COPD), or cor pulmonale. This is because, even
d ER, MS ↓ inadequate depression; use of lethargy, light- with usual therapeutic doses, morphine may
Contin, tolerance and or not MAO inhibitors headedness, decrease respiratory drive while simultaneously
MSIR, dependence tolerated within past 14 malaise, mood increasing airway resistance to the point of
Statex ↓ days; For alterations, apnea. Monitor patient’s respiratory status
(CAN) metabolism and neuraxial psychosis, closely, especially during the initiation of therapy
excretion administration: restlessness, or following a dose increase.
Concomitant
Classificatio ↓ rigidity, sedation, - WARNING Use morphine with extreme caution
anticoagulant
n: duration of seizures, syncope, in patients who may be at risk for carbon dioxide
therapy, infection
Opioid action thinking retention (e.g., those with brain tumors or
at the injection
analgesic disturbances, increased intracranial pressure). Monitor for
microinfusion site,
tremor, signs of sedation and respiratory depression,
presence of any
Route: uncoordinated especially when initiating therapy. Morphine
other concomitant
IV muscle movements, may reduce respiratory drive, and the resultant
therapy or medical
condition which unresponsiveness, carbon dioxide retention can further increase
Form: would render vertigo, weakness intracranial pressure. Also know that opioids like
I.V. epidural or morphine may obscure signs and symptoms in a
INJECTION CV: Bradycardia, patient with a head injury.
intrathecal cardiac arrest, - WARNING Know that morphine should only be
administration of edema, used concomitantly with benzodiazepine and
morphine hypertension, other CNS depressant therapy in patients for
especially hypotension, whom other treatment options are inadequate. If
hazardous orthostatic prescribed together, expect dosing and duration
hypotension, of morphine to be limited. Monitor patient
palpitations, shock, closely for signs and symptoms of a decrease in
tachycardia, consciousness, including coma, profound
vasodilation sedation, and significant respiratory depression.
Notify prescriber immediately and provide
EENT: Amblyopia, emergency supportive care, as death may occur.
blurred vision, - Use cautiously in patients about to undergo
diplopia, dry surgery of the biliary tract and patients with
mouth, eye pain, acute pancreatitis secondary to biliary tract
hiccup, laryngeal disease because morphine may cause spasm of
edema or the sphincter of Oddi.
laryngospasm - Be aware that MorphaBond ER formulation has
(allergic), miosis, an added abuse deterrent property that makes it
nystagmus, rhinitis, difficult to break, crush, or cut the tablet. It also
taste or voice resists extraction and forms a viscous liquid
alteration when physically compromised and placed in a
liquid. This abuse deterrent helps prevent abuse
ENDO: Adrenal when attempts are made to administer it
insufficiency (rare), intranasally or by injection.
hypogonadism - Store morphine at room temperature.
- Ensure that before giving morphine, opioid
GI: Abdominal antagonist and equipment for oxygen delivery
cramps or pain, and respiration are available.
anorexia, biliary - Assess patient’s drug use, including all
tract spasm, prescription and OTC drugs before therapy
constipation, begins.
diarrhea, dysphagia, - Expect prescriber to usually start patient who has
elevated liver never received opioids on immediate-release
enzymes, form and then switch to E.R. form if therapy
gastroenteritis, must last longer than a few days.
gastroesophageal - Keep in mind that when morphine is given by
reflux, hiccups, epidural route, dosage must be individualized
ileus (in patients according to patient’s age, body mass, physical
with inflammatory status, previous experience with opioids, risk
bowel disease), factors for respiratory depression, and drugs to
toxic megacolon (in be coadministered before or during surgery.
patients with - Give oral form with food or milk to minimize
inflammatory bowel adverse GI reactions, if needed. Solution can be
disease), mixed with fruit juice to improve taste.
indigestion, - Open E.R. capsules and sprinkle contents on
intestinal applesauce (at room temperature or cooler) just
obstruction, nausea, before giving to patient, if needed. Make sure
vomiting patient doesn’t chew or crush capsules or
dissolve capsule’s pellets in his mouth.
GU: Decreased - Be aware that E.R. forms of morphine aren’t
ejaculate potency, interchangeable.
decreased libido, - Discard injection solution that is discolored or
difficult ejaculation, darker than pale yellow or that contains
dysuria, impotence, precipitates that don’t dissolve with shaking.
infertility, - WARNING Don’t use highly concentrated
menstrual solutions (such as 10 to 25 mg/ml) for single-
irregularities, dose I.V., I.M., or subcutaneous administration.
oliguria, prolonged These solutions are intended for use in
labor, urinary continuous, controlled microinfusion devices.
hesitancy, urine - For direct I.V. injection, dilute appropriate dose
retention with 4 to 5 ml of sterile water for injection. Inject
2.5 to 15 mg directly into tubing of free-flowing
HEME: Anemia, I.V. solution over 4 to 5 minutes. Rapid I.V.
leukopenia, injection may increase adverse reactions.
thrombocytopenia - For continuous I.V. infusion, dilute drug in D5W
and administer with infusion-control device.
MS: Arthralgia, Adjust dose and rate based on patient response,
decreased bone as prescribed.
mineral density, - Avoid I.M. route for long-term therapy because
skeletal muscle of injection-site irritation.
rigidity - During subcutaneous injection, take care to avoid
injecting drug intradermally. For intrathecal
RESP: Apnea, injection, expect prescriber to give no more than
asthma 2 ml of 0.5-mg/ml solution or 1 ml of 1-mg/ml
exacerbation, solution.
atelectasis, - Expect intrathecal dosage to be about one-tenth
bronchospasm, of epidural dosage.
depressed cough - Keep in mind if rectal suppository is too soft to
reflex, insert, refrigerate for 30 minutes or run wrapped
hypoventilation, suppository under cold tap water.
pulmonary edema, - WARNING Monitor circulatory and respiratory
respiratory arrest status carefully and frequently during morphine
and depression, therapy, especially when drug therapy is initiated
wheezing and when patient is being converted to morphine
because respiratory depression and severe
SKIN: Diaphoresis, hypotension can develop. Be especially vigilant
dryness, flushing, with cachectic, debilitated, and elderly patients
pallor, pruritus, who are at higher risk. Know that life-threatening
rash, urticaria depression can occur even when morphine is
taken as prescribed and is not misused or abused.
Other: Allergic - Monitor patient with seizure disorder for
reaction; increased seizure activity because morphine may
anaphylaxis; worsen the disorder.
angioedema; - Monitor patient for excessive or persistent
injection-site sedation; dosage may need to be adjusted.
edema, pain, rash, - Know that if patient is receiving a continuous
or redness; physical morphine infusion, watch for and notify
and psychological prescriber about new neurologic signs or
dependence; weight symptoms. Inflammatory masses (such as
loss; withdrawal granulomas) have caused serious neurologic
symptoms reactions, including paralysis.
- Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body aches,
diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
- Keep in mind if tolerance to morphine develops,
expect prescriber to increase dosage.
- Know that morphine may have a prolonged
duration and cumulative effect in patients with
impaired hepatic or renal function. It also may
prolong labor.
- WARNING Know that many drugs may interact
with opioids like morphine to cause serotonin
syndrome. Monitor patient closely for signs and
symptoms such as agitation, diaphoresis,
diarrhea, fever, hallucinations, labile blood
 pressure, muscle twitching or stiffness, nausea,
shakiness, shivering, tachycardia, trouble with
coordination, or vomiting. Notify prescriber at
once because serotonin syndrome may be life-
threatening. Be prepared to discontinue drug, if
possible and ordered, and provide supportive
care.
- Monitor patient for adrenal insufficiency.
Although rare, it can be life-threatening. Monitor
patient for anorexia, dizziness, fatigue,
hypotension, nausea, vomiting, and weakness.
Notify prescriber if adrenal insufficiency is
suspected and expect diagnostic testing to be
done. If confirmed, expect to administer
corticosteroids and wean patient off morphine, if
possible.
- Keep in mind when discontinuing morphine in
patients receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about one-half
for 2 days and then by 25% every 2 days
thereafter until total dose reaches initial amount
recommended for patients who haven’t received
opioids (15 to 30 mg daily). This regimen
minimizes the risk of withdrawal symptoms.