Morphine sulfate

dr.joan

- Morphine sulfate :

Trade names: Roxanol

Class: Narcotic analgesic, morphine type.

Pregnancy: (Category C / D if used for prolonged periods or in high doses at term)

Action:

• Narcotic analgesics attach to specific receptor in the CNS resulting in analgesia- action
• Action exactly is unknown but may be by decreasing cell membrane permeability to sodium transmission of pain impulses.

Uses:

• Intrathecally, epidurally, orally or I.V. infusion for acute or chronic pain.
• Preoperative medication.
• To facilitate induction of anesthesia or to decrease the dose of anesthesia.

Dose:

§ acute pain, by intramuscular injection, 10 mg every 4 hours if necessary (15 mg for heavier well-muscled patients); CHILD up to 1 month 150 micrograms/kg, 1–12 months 200 micrograms/kg, 1–5 years 2.5–5 mg, 6–12 years 5–10 mg.By slow intravenous injection, quarter to half corresponding intramuscular dose

§ Premedication, by subcutaneous or intramuscular injection, up to 10 mg 60–90 minutes before operation; CHILD, by intramuscular injection, 150 micrograms/kg

§ Myocardial infarction, by slow intravenous injection (2 mg/minute), 10 mg followed by a further 5–10 mg if necessary; elderly or frail patients, reduce dose by half

§ Acute pulmonary edema, by slow intravenous injection (2 mg/minute) 5–10 mg

Contraindications:

· It is given epidural or intrathecal, if infection is present at injection site.

· In patients on anticoagulant therapy .

· Bleeding disorders.

· If patients have received parenteral corticosteroids within the past 2 weeks.

Side effects:

Respiratory depression , apnea, dizziness, euphoria headache, mental clouding, insomnia nausea, vomiting, constipation, dry mouth, skin rashes, laryngospasm, urinary retention, and decreased libido.

Nursing considerations:

• Use supportive nursing measures as relaxation techniques to relieve pain before using narcotics.
• Explore the source of pain, use non-narcotic analgesia if possible.
• Administer the medication when needed, prolonging the medication administration will decrease the effect of the medication.
• Monitor vital signs & mental status.
• Monitor Respiratory rate (drug may lead to respiratory depression).
• Monitor blood pressure ( hypotension may occur)
• Monitor pulse rare (if 60\m withhold the drug).
• Watch for constricted pupils. Document it and notify the physician.
• Monitor bowel function, since drug may cause constipation .
• Encourage client to empty bladder every 3-4 hrs (since drug may cause urinary retention).
• If client is bed ridden, use side rails.
• Inform the client\family that the drug may become habit forming and leading to addiction.
• Document any history of asthma or other contraindications.
• Have emergency equipment and narcotic antagonist available .