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