morphine sulfate (ANALGESIC DRUG)

Question 1

how is morphine sulfate presented on the road

Answer 1

Injection: morphine sulfate 10mg/ml (morphine sulfate 10mg per 1 ml)

Oral: morphine sulfate 10mg/5ml (morphine sulfate 2mg per 1ml)

Question 2

what are the indications for morphine sulfate

Answer 2

pain associated with suspected MI (morphine should be the first drug to be given)

severe pain- as part of an analgesic plan like with paracetamol

pt with continuous severe musculoskeletal and soft tissue pain.

oral morphine= helps with moderate pain

Question 3

what are the indications for end of life adults

Answer 3

if pt own medication for pain/breathlessness hasn’t been prescribed

pt own medication isnt availaible/run out

medicines are in place without a patient-specific document signed by independent prescriber

Breathlessness: pt is at end of life care and is distressed and breathless

if unable to access rapid community/palliative care

Pain: pt is at end of life care and is in pain

Question 4

what is morphine sulfate classed as

Answer 4

strong opioid analgesic

morphine produces sedation, euphoria (happiness), and analgesia (can reduce rr and cause hypotension)

histamine is released causing vasodilatory effects. May also cause urticaria and bronchoconstriction.

Question 5

what are the pharmacokinetics of morphine sulfate

Answer 5

administration: parental/ enteral (including orally and IV)
distribution: plasma proteins
Metabolism: Liver
Excretion: Urine

Question 6

what are the pharmacodynamics for morphine sulfate

Answer 6

Morphine binding to opioid receptors blocks the transmission of nociceptive signals.
Signals pain- modulating neurons in spinal cord
inhibits primary afferent nociceptors to dorsal horn sensory projection cells

Question 7

possible adverse effects of morphine sulfate

Answer 7

reduced rr
reduced hr
nausea/vomiting
drowsiness
pupillary constriction
itching due to histamine being released

Question 8

contra-indications for morphine sulfate

Answer 8

children under 1
rr under 10 for adults
rr under 20 for children
hypotension ( systolic bp below 90mmHg)
head injury (with only responsive to pain or unresponsive or below a 9 for GCS)
known hypersensitivity to morphine sulfate

Question 9

what are the contraindications for morphine sulfate in adult end of life care

Answer 9

cautions and contra-indications don’t generally apply due to the focus being on minimizing pain and breathlessness.

Question 10

what factors need to be taken into account for dosage of morphine sulfate for adults

Answer 10

weight
age
route of administration

Question 11

what is the maximum dose of morphine sulfate for adults weighing over 50kg

Answer 11

20mg

Question 12

how long does IV morphine take to work? and when does it reach its peak time

Answer 12

minimum of 2-3mins and reaches its peal at 10-20 mins

Question 13

should morphine be diluted? if so what with

Answer 13

should be diluyed with sodium chloride 0.9% to make concentration of 10mg in 10ml UNLESS being administered IM or subcutaneous

Question 14

when should morphine NOT be diluted

Answer 14

when being given IM or subcutaneous

Question 15

If pain isnt reduced to a tolerable level after 10mg of IV/IO morphine then how many mg of morphine should be administered

Answer 15

2 mg slowly via IV/IO every 5 mins to a maximum of 20mg.

Question 16

For end of life care in adults, what is the correct dosage for sub or oral use of morphine when they are currently on morphine

Answer 16

administer their prescribed dose.
if dose range given, administer lowest dose. in line with previous dose

Question 17

if end of life adult pt isnt on morphine whats the dosage for morphine orally

Answer 17

oral morphine should be given as 2.5mg—-> 5mg. only given once

Question 18

if end of life adult pt isnt on morphine whats the dosage for morphine IM//SUB

Answer 18

1mg—->2.5mg. only given once