Critical Care Trauma Centre

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-morphR)
  • 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.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 20, 2018