Beruflich Dokumente
Kultur Dokumente
(mor'feen)
Astramorph PF, Avinza, DepoDur, Duramorph, Epimorph , Kadian, MSIR, MS Contin,
Oramorph SR, Roxanol, RMS, Statex
Classifications: central nervous system (cns) agent; analgesic; narcotic (opiate) agonist
Pregnancy Category: B (D in long-term use or high dose)
Controlled Substance: Schedule II
Availability
10 mg, 15 mg, 30 mg tablets/capsules; 15 mg, 20 mg, 30 mg, 60 mg, 100 mg, 120 mg,
200 mg controlled release tablets/capsules; 10 mg/2.5 mL, 10 mg/5 ml, 20 mg/mL, 20
mg/5 mL, 30 mg/1.5 mL, 100 mg/5 mL oral solution; 0.5 mg/mL, 1 mg/mL, 2 mg/mL, 4
mg/mL, 5 mg/mL, 8 mg/mL, 10 mg/mL, 15 mg/mL, 25 mg/mL, 50 mg/mL injection; 10
mg/mL, 15 mg/1.5 mL, 20 mg/2 mL extended-release lysosomal injection; 5 mg, 10 mg,
20 mg, 30 mg suppositories
Actions
Natural opium alkaloid with agonist activity by binding with the same receptors as
endogenous opioid peptides. Narcotic agonist effects are identified with 3 types of
receptors: Analgesia at supraspinal level, euphoria, respiratory depression and physical
dependence; analgesia at spinal level, sedation and miosis; and dysphoric, hallucinogenic
and cardiac stimulant effects.
Therapeutic Effects
Controls severe pain; also used as an adjunct to anesthesia.
Uses
Symptomatic relief of severe acute and chronic pain after nonnarcotic analgesics have
failed and as preanesthetic medication; also used to relieve dyspnea of acute left
ventricular failure and pulmonary edema and pain of MI.
Contraindications
Hypersensitivity to opiates; increased intracranial pressure; convulsive disorders; acute
alcoholism; acute bronchial asthma, chronic pulmonary diseases, severe respiratory
depression; chemical-irritant induced pulmonary edema; prostatic hypertrophy; diarrhea
caused by poisoning until the toxic material has been eliminated; undiagnosed acute
abdominal conditions; following biliary tract surgery and surgical anastomosis;
pancreatitis; acute ulcerative colitis; severe liver or renal insufficiency; Addison's disease;
hypothyroidism; during labor for delivery of a premature infant, in premature infants;
pregnancy (category B; D in long-term use or when high dose is used); lactation.
Cautious Use
Toxic psychosis; cardiac arrhythmias, cardiovascular disease; emphysema;
kyphoscoliosis; cor pulmonale; severe obesity; reduced blood volume; very old, very
young, or debilitated patients; labor.
Administration
Oral
Intravenous
ADMINISTER: Direct: Give a single dose over 4–5 min. Avoid rapid administration.
Interactions
Drug: cns depressants, sedatives, barbiturates, alcohol, benzodiazepines, and tricyclic
antidepressants potentiate CNS depressant effects. Use mao inhibitors cautiously; they
may precipitate hypertensive crisis. phenothiazines may antagonize analgesia. Herbal:
Kava-kava, valerian, St. John's wort may increase sedation.
Pharmacokinetics
Absorption: Variably absorbed from GI tract. Peak: 60 min PO; 20–60 min PR; 50–90
min SC; 30–60 min IM; 20 min IV. Duration: Up to 7 h. Distribution: Crosses blood–
brain barrier and placenta; distributed in breast milk. Metabolism: Metabolized primarily
in liver. Elimination: 90% of drug and metabolites excreted in urine in 24 h; 7%–10%
excreted in bile.
NURSING IMPLICATIONS
Assessment & Drug Effects
• Obtain baseline respiratory rate, depth, and rhythm and size of pupils before
administering the drug. Respirations of 12/min or below and miosis are signs of
toxicity. Withhold drug and report to physician.
• Observe patient closely to be certain pain relief is achieved. Record relief of pain
and duration of analgesia.
• Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or drawn
facial expression that may indicate need for analgesia.
• Differentiate among restlessness as a sign of pain and the need for medication,
restlessness associated with hypoxia, and restlessness caused by morphine-
induced CNS stimulation (a paradoxic reaction that is particularly common in
women and older adult patients).
• Monitor for respiratory depression; it can be severe for as long as 24 h after
epidural or intrathecal administration.
• Monitor carefully those at risk for severe respiratory depression after epidural or
intrathecal injection: Older adult or debilitated patients or those with decreased
respiratory reserve (e.g., emphysema, severe obesity, kyphoscoliosis).
• Continue monitoring for respiratory depression for at least 24 h after each
epidural or intrathecal dose.
• Assess vital signs at regular intervals. Morphine-induced respiratory depression
may occur even with small doses, and it increases progressively with higher doses
(generally max: 90 min after SC, 30 min after IM, and 7 min after IV).
• Encourage changes in position, deep breathing, and coughing (unless
contraindicated) at regularly scheduled intervals. Narcotic analgesics also depress
cough and sigh reflexes and thus may induce atelectasis, especially in
postoperative patients.
• Be alert for nausea and orthostatic hypotension (with light-headedness and
dizziness) in ambulatory patients or when a supine patient assumes the head-up
position or in patients not experiencing severe pain.
• Monitor I&O ratio and pattern. Report oliguria or urinary retention. Morphine
may dull perception of bladder stimuli; therefore, encourage the patient to void at
least q4h. Palpate lower abdomen to detect bladder distention.