MORPHINE SULFATE

Name:	MORPHINE SULFATE
Classification:	*narcotic analgesic* acute and chronic severe pain anginal pain and pain post myocardial infarction decreases preload decreases afterload dilates coronary vessels adjunctive treatment in acute pulmonary edema
Dose:	Bolus dose: analgesic: 2-5 mg IV direct; repeat prn pulmonary edema: 10mg IV direct Infusion: administer IV bolus doses prn until pain control is achieved, then start infusion to maintain pain control starting rate of 1-5 mg/hr; titrate to pain score and VAMAAS
Administration:	IV Direct: inject slowly as rapid injection may result in increased frequency of adverse effects Infusion: 100mg/50mL dextrose 5% or sodium chloride 0.9% by syringe pump infusion NOTE: Special preservative-free preparation is used for epidural administration (Epi-morph^R) hypovolemia should be treated prior to/or concurrent with drug administration give analgesia before peak pain
Adverse Effects:	respiratory depression (maximum 7 minutes post IV dose) hypotension pinpoint pupils decreased gastrointestinal motility; constipation excessive sedation inhibition of voluntary cough reflex; increased secretion retention - patients must be encouraged to cough hallucinations tolerance to the analgesic, respiratory depressant and sedative effects may develop with prolonged therapy
Antidote:	naloxone: 0.1-0.4mg IV (see naloxone monograph)
Drug Interactions:	morphine + CNS depressants = increased CNS depressant effect morphine + antihypertensives = hypotensive effect morphine + metoclopramide = antagonism of metoclopramide effect on gastrointestinal motility
Monitoring Therapy:	blood pressure respiratory rate heart rate chest ausculation and chest xray if used chest pain or pulmonary edema dyspnea symptoms analgesic response bowel sounds
Adult Critical Care Protocol:	May be administed IV direct or by IV infusion by a nurse in Adult Critical Care Continuous infusions must be administered by infusion device with pump library enabled.