Morphine

Question 1

Presentation

Answer 1

10 mg in 1 mL

Question 2

Pharmacology - CNS effects (DDDRS)

Answer 2

Depression (leading to analgesia)
Depression of cough reflex
Dependence (addiction)
Respiratory depression
Stimulation (mood changes, euphoria or dysphoria, vomiting, pin-point pupils)

Question 3

Pharmacology - Cardiovascular effects

Answer 3

Vasodilatation

Decreases conduction velocity through AV node

Question 4

Metabolism

Answer 4

Metabolised = liver
Excreted = kidneys

Question 5

Indications

Answer 5

Pain relief

Sedation to maintain intubation

Question 6

Contras

Answer 6

Hypersensitivity
Renal impairment/failure
Late second stage labour

Question 7

Precautions

Answer 7

Elderly/frail
Hypotension (cardiovascular effects)
Respiratory depression (CNS effects)
Current asthma (CNS effects)
Respiratory tract burns (CNS effects)
Known addiction to opioids (CNS effects)
Acute alcoholism
Patients on monoamine oxidase inhibitors

Question 8

Route of administration

Answer 8

IV
IM
Subcutaneous

Question 9

Side effects - CNS

Answer 9

Drowsiness
Respiratory depression
Euphoria
Nausea, vomiting
Addiction
Pin-point pupils

Question 10

Side effects - Cardiovascular

Answer 10

Hypotension

Bradycardia

Question 11

IV effects

Answer 11

Onset = 2-5 mins
Peak = 10 mins
Duration = 1-2 hrs

Question 12

IM effects

Answer 12

Onset = 10-30 mins
Peak = 30-60 mins
Duration = 1-2 hrs

Question 13

Moderate Pain - Adult

Answer 13

Up to 5mg IV
Repeat up to 5mg IV @ 5min intervals
Max dose 20mg IV
Consult for more
Consider Paracetamol as per mild pain in combination

Question 14

Severe Pain - Adult

Answer 14

As per moderate pain
Consider IN Fentanyl or Methoxyflurane
Consult for IV Ketamine for extreme traumatic pain
Last resort elderly/frail/ <60kg - IM Morphine 0.1 mg/kg single dose
Last resort adult - IM Morphine, 10mg IM, repeat 5mg IM after 15mins, once only.

Question 15

Paediatric pain relief

Answer 15

Last resort ONLY when unable to administer IN/IV Fentanyl
0.1mg/kg IM single dose only
Max dose should not exceed 5mg (unless pt heavier then age calculated weight).

Question 16

Preparation for administration

Answer 16

10 mg in 1 mL
Dilute with 9 mL Normal Saline in a 10 mL syringe
= 1 mg in 1 mL