ACTIVE LEARNING TEMPLATE:
Medication
STUDENT NAME______________________________________
Morphine Sulfate
MEDICATION___________________________________________________________________________
REVIEW MODULE CHAPTER____________
Agonists
CATEGORY CLASS__Opioid
_____________________________________________________________________
PURPOSE OF MEDICATION
Expected Pharmacological Action
MS mimics actions of naturally occurring
opioids (endorphins, enkephalins) by binding
with mu receptrs causeing analgesia,
sedation, euphoria, respiratory depression.
Therapeutic Use
MS - relief of moderate to severe pain,
sedation, reduction of bowel motility
Couph suppression (codeine)
Complications
Respiratory depression, sedation, dizziness, lightheadedness,
drowsiness, constipation, nausea, vomiting, orthostatic hypotension,
urinary retention, cough suppression, potential for abuse, tolerance
with continued use; cross tolerance with other opioids
Contraindications/Precautions
Contraindications: Pregnancy risk category D (long-term use, high
doses, near term; otherwise C); kidney failure; increased intracranial
pressure; biliary colic; biliary tract surgery; preterm labor.
Precautions: Schedule II controlled substance; older adults, infants;
reduced respiratory reserve; head injury; inflammatory bowel disease;
prostatic enlargement; hypotension; hepatic or kidney diseas
Interactions
CNS depressants (barbiturates, phenobarbital, benzodiazepines, alcohol) increase
CNS depression. Anticholinergic agents, such as antihistamines, and tricyclic
antidepressants increase anticholinergic effects (constipation, urinary retention).
MAOIs can cause hyperpyrexic coma (excitation, seizures, respiratory depression) with
meperidine (Demerol).
Antihypertensives increase hypotensive effects. St. John's wort medication can
increase sedation
Evaluation of Medication Effectiveness
Relief of moderate to severe pain
Cough suppression
resolution of diarrhea
ACTIVE LEARNING TEMPLATES
Medication Administration
Vital signs before administration and monitor
throughout therapy. Administer orally, IM, IV,
SC, rectally, or epidurally. Patient has to swallow
sustained-release forms whole and do not crush
or chew them. Administer IV opioids by diluting
as recommended and administering slowly over
4 to 5 min; have naloxone and resuscitation
equipment available.
Monitor PCA (patient-controlled analgesic pump)
use and pump settings carefully.
Administer to patients with cancer on a fixed,
around-the-clock dosing schedule, not PRN
Nursing Interventions
Vital signs and auscultate lungs. Respiratory
rates below 12 per min, withhold the drug,
stimulate breathing, and administer an opioid
antagonist if indicated; naloxone to restore
respiratory rate. Monitor patients when
ambulating to prevent injury. Encourage fiber
supplements, stool softeners. Monitor intake and
output, watching for signs of urinary retention
(bladder distention). Encourage patients to
urinate every 4 hr. Prepare to insert a urinary
catheter to drain the bladder
Client Education
Take the drug only when in need and for the
short-term. Do not take prior to driving or
activities requiring mental alertness. Sit or lie
down if feeling lightheaded. Change positions
gradually. Increase fluid and fiber intake; activity
and exercise. Take the drug with food or milk
(oral forms). Sit or lie down if feeling
lightheaded. Rise slowly from a reclining or
sitting position. Report any inability to urinate or
difficulty urinating. Cough regularly to clear
secretions from the throat and chest
Therapeutic Procedure
A7