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MORPHINE SULFATE

CLASS:

  • Narcotic (opiate) analgesic

  • (Controlled Substance Schedule II)

ACTIONS:

  • Anaglesic - An opioid agonist that binds with opioid receptors in the CNS

  • Reduces preload (increases venous capacitance) and reduces afterload (SVR) and decreases myocardial oxygen demand by reducing intramyocardial wall tension in pulmonary edema. It lowers blood pressure by releasing histamine, resulting in vasodilation, reduces peripheral resistance - thus reducing preload. Preload is reduced more effectively than afterload.

  • MS also blunts the reflex vasoconstriction caused by increased pCO2

  • Reduces the brainstem respiratory centers responsiveness to CO2, also depresses pontine and medullary centers involved in regulating respiratory rhythmicity thus produces respiratory depression

INDICATIONS

  • Pain of AMI, burns, kidney stones, fractures

  • Chest pain unresponsive to nitrates

  • Acute pulmonary edema

CONTRAINDICATIONS

  • Allergies to opiates / hypersensitivity

  • Hypovolemia/hypotension/shock

  • Head injury with increased ICP when it can mask neurological deterioration

  • Diminished LOC, coma

  • Abdominal pain, unknown etiology

  • Bronchial asthma

STANDARD PREP:

  • 10 mg/10cc

DOSAGE / ROUTE:

  • See Hawaii S.O.

  • Can be given IM if this route is ordered.

SIDE EFFECTS:

  • Respiratory depression

  • Hypotension

  • Decreased mental status

  • N/V, Constipation

  • Euphoria

  • Bradycardia (rare)

  • Bronchospasm (rare)

PRECAUTIONS:

  • Have resuscitation equipment & narcan available

  • Resp depression occurs before pt is aware of it

  • Potentiates action of ETOH & CNS depressants

  • Titrate to pt's decreased sensation of pain, not abolishment of pain

  • May worsen bradycardia or heart block in Inferior MI (vagotonic effect)