Action: Narcotic agonistanalgesic of opiate receptors;
inhibits ascending pain
pathways, altering response to
pain; produces analgesia,
respiratory depression, &
sedation; suppresses cough by
acting centrally in medulla
Routes: Injection
IM
Oral
IV
Intrathecal
Rectal
Uses: Pain, chronic (Severe), in
patients requiring a long-term
daily around-the-clock opioid
analgesic; Pain (Moderate to
Severe), Not responsive to nonnarcotic analgesics
Morphine Sulfate
AVINza, Kadian, MS Contin, MSIR, Oramorph SR
Roxanol, Roxanol-T, Rms
Analgesic, Analgesic Combination, Opioid, CNS Agent, Opioid
Dosages:
A:
Adult: Opioid naïve pt
PO: 10-30 mg q4hr PRN
SC/IM: 5-20 mg q4hr PRN
IV: 4-10 mg q3-4hr PRN ,
infused over 4-5 minutes
Onset: PO: 15-30min
IV: < 5min
Peak: 30-90 min
D: Protein 36%
M: liver
Duration: 4 hr immediate
release
E: Urine 2-12%
Feces 7-10%
Half-life: 2-4 hr;
extended release: 11-13hr
Common Side Effects: Dermatologic: Pruritus; Gastrointestinal: Constipation, N/V; Neurologic: Dizziness,
Headache, Lightheadedness, Somnolence, Ophthalmic: Miosis; Renal: Urinary retention
Adverse Effects: Cardiovascular: Cardiac arrest, Disorder of cardiovascular system, circulatory depression,
Orthostatic hypotension, Shock, Syncope; Immunologic: Anaphylaxis; Musculoskeletal: Myoclonus;
Neurologic: Coma, Raised intracranial pressure, Seizure; Respiratory: Dyspnea, Respiratory depression;
Other: Drug dependence, Drug withdrawal
Contraindications: hypersensitivity to drug/class/components; acute alcoholism & delirium tremens; acute
or severe bronchial asthma; biliary tract surgery, post-procedure; brain tumor ; cardiac arrhythmias; CNS
depression, severe; compromised BP; convulsive disorders ; concomitant use w/MAOIs, use of MAOIs w/in 14
days; head injuries; heart failure, secondary to chronic lung disease; hypercarbia; ↑ intracranial or cerebrospinal
pressure; neuraxial analgesia contraindications ; paralytic ileus; respiratory depression; surgical abdomen,
suspected; surgical anastomosis; upper airway obstruction
Interactions: alvimopan, artemether/lumrfantrine, drugs ending in “azid”, “ine”,
Nursing Considerations:Monitor: adequate analgesia is indicative of clinical efficacy; continually reassess
the maintenance of pain control & the need for continued opioid use; S & S of addiction, abuse, or misuse; S &
S respiratory depression; especially w/in 24-72 hrs following treatment initiation & after dose ↑; S & S of
hypotension; in ambulatory patients; on initiation & w/dose titration; exacerbation of biliary tract disease;
worsened seizure control; in patients w/hx of seizure disorders; Teaching: Advise against sudden
discontinuation of drug; Patient should not drink alcohol while taking this drug; avoid activities requiring
mental alertness or coordination until drug effects are realized;
Pregnancy: C; Breastfeeding: infant risk minimal