MorphineNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6]

Blood pressure

Why

Severe hypotension

When

During initiation and titration

Act on

Avoid in circulatory shock

Normal

Below 120/80 mm Hg.

Sources: [1][2]

Respiratory rate

Why

Opioid respiratory depression

When

Closely at initiation and after each dose increase; IV peak effect is about 30 minutes after a dose

Act on

Give naloxone for clinically significant respiratory depression

Normal

12 to 18 breaths per minute in adults.

Sources: [1][2][3]

High-alert status

High-alert medication. Opioids, including IV and oral forms, are on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1][2]

Boxed warning

Serious and life-threatening risks: addiction, abuse, and misuse that can lead to overdose and death; life-threatening respiratory depression, highest at the start and after dose increases; profound sedation, respiratory depression, coma, and death with benzodiazepines, alcohol, or other CNS depressants; and neonatal opioid withdrawal syndrome after prolonged use in pregnancy.

Sources: [1][2]

Antidote or reversal

Naloxone (or nalmefene) for significant respiratory or circulatory depression, after securing the airway and breathing. Reversal wears off before morphine does, so keep monitoring and redose as needed. In opioid-dependent patients, titrate small doses to avoid precipitating severe withdrawal.

Sources: [1]

Patient teaching

• It can cause addiction even at prescribed doses; never share it, and store it locked away from children and visitors
• Learn the signs of overdose and slowed breathing; call 911 for any suspected overdose, even after naloxone
• Keep naloxone or nalmefene available and show family where it is
• Do not combine with alcohol, benzodiazepines, or other sedatives unless a provider supervises
• Do not change the dose or stop without a tapering plan
• Avoid driving until you know how it affects you
• Expect constipation and follow a plan to manage it
• Dispose of unused tablets promptly, by flushing if no take-back program is available

Sources: [1]

Sound-alike and look-alike names

• morphine and HYDROmorphone
• morphine - non-concentrated oral liquid and morphine - oral liquid concentrate

Sources: [1]

Adult dose

IV, opioid-naive adult

0.1 to 0.2 mg/kg every 4 hours as needed, at the lowest effective dose, injected slowly.

IM

10 mg every 4 hours as needed (based on a 70 kg adult).

Oral immediate-release tablets, opioid-naive adult

15 to 30 mg every 4 hours as needed, then titrate to response.

Sources: [1][2]

Renal adjustment

Pharmacokinetics change in renal failure. Start lower than usual and titrate slowly, watching for respiratory depression, sedation, and hypotension.

Sources: [1][2]

Hepatic adjustment

Pharmacokinetics change significantly in cirrhosis. Start lower than usual and titrate slowly, watching for respiratory depression, sedation, and hypotension.

Sources: [1][2]

Mechanism

A full opioid agonist, relatively selective for mu receptors. It has no ceiling for pain relief; dose is limited by respiratory and CNS depression. After an IV dose, the peak CNS effect lags about 30 minutes.

Sources: [1][2]