Generic Drug Name: Morphine
Brand Names: MS Cotin, Roxanol (discontinued)
Classification: Schedule II drug
Therapeutic: Opioid analgesics
Pharmacologic: Opioid agonists
Indications:
- Severe pain
- Chronic, round-the-clock pain for which other extended release medications have failed
- Pulmonary edema
- Pain associated with an myocardial infarction
Mechanism of Action:
Binds to opiate receptors in the central nervous system. Alters the perception of and the response to painful stimuli while depressing the central nervous system.
Expected Response: decrease in severity of pain.
Common Adult Doses in opioid-naive patients: (ALWAYS CHECK YOUR ORDERS)
Oral or Rectal max dose 1600 mg/day
(adults over 50 kg)
Instant release 30 mg every 3-4 hours initially. Once the dosage is established for comfort, conversion can be made to extended-release given once every 24 hours.
(adults under 50 kg
Initial dose should be 0.3 mg/kg every 3-4 hours.
IM, IV, or SubQ
(adults over 50 kg)
For moderate to severe pain, initially 4-10 mg every 3-4 hours as needed. For MI pain, 8-15 mg every 3-4 hours as needed.
(adults under 50 kg) max dose 15mg
For pain, initially 0.05-0.2 mg/kg every 3-4 hours
IV or SubQ Continuous Infusions
Bolus dose 15mg; Continuous rate of 0.8-10 mg/hr; max dose 0.4 mg/kg/hr.
Epidural
Intermittent injections
5mg/day initially. If relief not obtained in 1 hour, an extra 1-2 mg dose can be given. Max dose 10 mg/day.
Continuous infusions
2-4 mg/day. May be increased 1-2 mg/day. Max dose 30 mg/day.
Contraindications:
- Hypersensitivity to morphine products
- Acute, mild, or intermittent post-operative pain
- Significant respiratory depression
- Acute or severe bronchial asthma
- Paralytic ileus
Side Effects:
Common
- Confusion
- Sedation
- Hypotension
- Constipation
Life-Threatening
- Respiratory depression
Nursing Considerations:
Assessment
- Assess type, location, and intensity of pain before administration and 1 hour after for PO, subQ, or IM route and 20 minutes after for IV route.
- Patients on a continuous infusion should have bolus doses available for breakthrough pain.
- Patients taking an extended-release dose may need an instant-release dose to manage breakthrough pain.
- Assess BP, respiratory rate, and pulse before, during, and after drug administration. If RR is less than 10/min, assess level of consciousness and provide stimulation as needed to avoid hypoventilation. If the patient is decompensating from decreased respirations (low oxygen, HR, or BP), administer naloxone (antidote). A typical dose is 0.4 mg of naloxone diluted in 10 ml of 0.9% of normal saline with 0.5 ml (0.02 mg) given as an IV dose every 2 minutes until the patient becomes more alert and responsive.
- Assess bowel function routinely and institute prevention measures, such as fluids, bulk foods, and laxatives or stool softeners.
- Prolonged use may lead to physiological and psychological dependence. Assess risk for opioid addiction, abuse, or misuse prior to administration. Abuse or misuse by incorrectly taking an extended-release tablet by either crushing, chewing, snorting, or injecting dissolved tablets can result in overdose or death.
Nursing Diagnoses
- Acute pain (indications)
- Chronic pain (indications)
- Risk for injury (side effects)
Implementation
- Do not confuse MS Contin with Oxycontin; Do not confuse morphine with hydromorphone; Do not confuse concentrated liquid morphine with non-concentrated liquid morphine.
- Regularly administered doses may be more effective than PRN doses. Morphine is more effective if given before the pain becomes too severe.
- Morphine should be discontinued gradually to prevent withdrawal symptoms after long-term use.
- PO doses should be given with food or milk to prevent GI irritation.
- For IV push doses, dilute with 5 ml of normal saline and give over 5 minutes to prevent rapid respiratory depression, hypotension, and circulatory collapse.
- Educate patient to
- instruct patient when to ask for medication
- take with meals or soon after
- instruct patient that this medication is high potential for abuse; protect it from theft and do not give to anyone it was not prescribed to
- do not drink alcohol with this medication
- change positions slowly as their blood pressure may drop more easily
- inform their provider if they are pregnant, plan to become pregnant, or are breastfeeding
- teach family members how to properly administer doses
- instruct to stay on top of bowel program to prevent constipation
Expected Outcomes
- Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status
- Decrease in symptoms of pulmonary edema
Reference
Vallerand, A. H. & Sanoski, C. A. (2019). Davis’s drug guide for nurses. (16th ed., pp. 875-879). F.A. Davis Company.
