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
