Morphine is U.S. FDA-approved for relief of obstetric pain, postoperative eye pain, preoperative sedation, and acute pulmonary edema.
The statement is false. Morphine is FDA-approved for relief of moderate/severe pain (acute or chronic), acute myocardial infarction (AMI) pain, obstetric pain, postoperative pain, patient-controlled analgesia, preoperative sedation, and acute pulmonary edema.
Morphine stimulates CNS opioid receptors, inhibiting transmission of pain impulses and altering the patient’s perception of and response to pain.
The statement is true. Morphine stimulates CNS opioid receptors, inhibiting transmission of pain impulses and altering the patient’s perception of and response to pain.
Morphine causes respiratory depression by suppressing diaphragmatic neurotransmission, slowing breathing rate.
Extended-release (ER)/sustained-release (SR) preparations are indicated for patients with moderate/severe pain needing long-term as-needed analgesia.
Extended-release (ER)/sustained-release (SR) preparations are indicated for patients with moderate/severe pain needing long-term as-needed analgesia.
The statement is false. ER/SR preparations are indicated for patients with moderate/severe pain needing long-termaround-the-clock analgesia; they are not intended for as-needed use.
Use morphine cautiously in patients who have received a monoamine oxidase inhibitor (MAOI) within the previous 14 days.
The statement is false. MAOIs are not recommended because of marked morphine potentiation; do not give morphine within 14 days of MAOIs except in an emergency.
Morphine’s most serious adverse effect is respiratory depression.
The statement is true. Morphine’s most serious adverse effect is respiratory depression. Other serious and/or potentially life-threatening adverse reactions include cardiac arrest, hypotension, orthostatic hypotension, palpitations, shock, biliary colic, anaphylaxis, ↑ intracranial pressure, seizures, and pulmonary edema.
Which of the following is/are not FDA-approved use(s) for morphine?
a.) Analgesia for ICU patients on mechanical ventilation (off label use)
b.) Preoperative sedation
c.) Acute pulmonary edema
Which of the following should be monitored in a patient receiving morphine?
Monitor for pain relief; monitor BP, I & O, respiratory function, mental status, and bowel movements(2,
A woman who has gone into labor at 34 weeks' gestation is asking for morphine for pain. How much should the nurse give her?
none
Contraindications for morphine rectal suppositories include
Rectal suppositories are contraindicated in patients with acute alcoholism, delirium tremens, brain tumor, head injuries, ↑ intracranial or cerebrospinal pressure, seizure disorders, severe CNS depression, dysrhythmias, heart failure secondary to chronic lung disease, suspected acute abdomen, surgical anastomosis, or after biliary tract surgery
Common adverse reactions to morphine include _____ and _____.
Common adverse reactions (≥ 5%) include peripheral edema, rash, hyperhidrosis, constipation, diarrhea, anorexia, nausea, vomiting, abdominal pain, xerostomia, backache, asthenia, dizziness, headache, insomnia, paresthesia, somnolence, anxiety, depression, urinary retention, dyspnea, fever, and drug tolerance/dependence with long-term use
Morphine's most serious adverse effect is
Morphine’s most serious adverse effect is respiratory depression. Other serious adverse reactions include cardiac arrest, hypotension, orthostatic hypotension, palpitations, shock, biliary colic, anaphylaxis (rare), seizures (rare), ↑ intracranial pressure, and pulmonary edema
Pruritus can occur in up to ____ of patients receiving intrathecal or epidural morphine.
Pruritus can occur in up to 80% of patients receiving intrathecal or epidural morphine
Concurrent use of morphine is contraindicated with
Naltrexone: Contraindicated in patients addicted to opioids; patient should be opioid-free for at least 7–10 days before naltrexone administration
Monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, linezolid): Not recommended ; marked morphine potentiation. Do not give morphine ≤ 14 days of MAOIs except in an emergency
Opioid partial agonists (e.g., butorphanol, nalbuphine, pentazocine) or antagonists (e.g., methylnaltrexone, nalorphine, naloxone): Not recommended ; possible ↓ analgesia, ↑ withdrawal symptoms in patients addicted to opioids; if medically necessary, use ↓ dose and monitor patient
A patient is being discharged from the hospital with a prescription for extended-release (ER) morphine for intractable pain. What educational information should the nurse provide?
Educate the patient that ER/SR capsules can be opened and contents mixed with a small amount of applesauce, but beads/pellets must not be chewed to avoid acute overdose
Oral morphine should be used cautiously in patients with
Use cautiously in older or debilitated patients, infants < 3 months, and in patients with abuse potential, alcoholism, acute abdominal conditions, adrenocortical insufficiency, biliary tract disease or surgery, dysphagia, impaired pulmonary function, chronic obstructive pulmonary disease (COPD), cor pulmonale, ↓ respiratory reserve, asthma, preexisting hypoxia/hypercapnia, circulatory shock, hypotension, CNS depression, delirium tremens, hypothermia, morbid obesity, gastrointestinal obstruction, severe hepatic impairment, hypothyroidism, myxedema, prostatic hypertrophy, severe renal impairment, seizure disorders, or hypersensitivity to other phenanthrenes (e.g., codeine, oxyCODONE)
Morphine is also contraindicated in patients with respiratory depression or severe/acute bronchial asthma in the absence of resuscitative equipment, hypercapnia, or known/suspected paralytic ileus or GI obstruction(2
IV morphine should be used with extreme caution in patients with
Use with extreme caution in patients with head injuries, intracranial lesions, or ↑ intracranial pressure(
Intrathecal/epidural morphine is contraindicated in patients with
Intrathecal or epidural administration is contraindicated in patients with uncontrolled bleeding diathesis, concurrent anticoagulant therapy, upper airway obstruction, or injection site infection
A patient with hepatic insufficiency is receiving morphine for pain. What sort of dosage adjustment should be made?
Morphine duration of action is ↑ in patients with hepatic insufficiency; consider ↑ dosing interval by 1.5–2 times normal
Which of the following statements is correct regarding morphine use during pregnancy?
Pregnancy: Either serious adverse effects in animals or insufficient human/animal research; use only if potential benefit outweighs risk(2)
- Prolonged maternal morphine use can produce potentially lethal neonatal abstinence syndrome; educate pregnant women about the risk, and have appropriate treatment materials available at delivery
Which of the following patient beliefs should the clinician identify and if possible, accommodate, to enhance care?
Identify and accommodate, if possible, any specific cultural and religious beliefs that may enhance care.