Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph 200, Kadian, MS Contin,

Oramorph SR, RMS, Roxanol, Roxanol Rescuedose, Roxanol-T, MSIR, MSO OMS
Concentrate (morphine sulfate)

Classification: Therapeutic: opioid analgesic, Pharmacologic: opioid agonist Control Substance

Cat. Schedule II

Indication (Use): Sever pain, Sever pain from terminal cancer, pain after major
surgery(DepoDur), Pulmonary edema, pain associated with MI

Normal dosage: Adult ~ 5-20mg/70kg SubQ or IM qid, prn

30mg CR (controlled release) tabs PO q 8-12 hrs

5mg Epidural and increase by 1-2mg doses if pain isn’t adequately

relieved within 1hr (60min), max Epidural dose 15mg

Loading dose of 15mg or more by IV then continuous infusion of 0.8 to

80mg/hour, 10-15mg (max 20mg) by Lumbar route before surgery, or after umbilical cord
clamped in C-section

Children~ 0.1 to 0.2mg/kg SubQ qid, max single dose 15mg (severe pain from
terminal cancer), 0.025 to 2.6mg/kg/hr IV infusion

Side Effects: CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling,
hallucinations, h/a, unusual dreams, seizures(with large doses EENT: blurred vision, diplopia,
miosis. RESP: RESPIRATORY DEPRESSION, CV: hypotension, bradycardia, GI: N/V,
constipation. GU: urinary retention Derm: flushing, itching, sweating Misc: physical
dependence, psych. Dependence, tolerance.

Nursing implications: Assess LOC, B/P, Pulse, RR before and after administration. Geri/Peds:
assess for resp. complications. Assess for pain /p administration prior to 1hr (60 min) following
PO, SubQ, IM and 20min (peak) following IV admin. Assess bowel function, institute
prevention of constipation..increase fluid intake and bulk /c laxatives to decrease likelihood of
constipation

Patient teaching: Explain the purpose of the medication, possible side effects and what adverse
reaction to look for. How to ask for pain meds, not to drink alcohol with this med or operate any
machinery. Advise the family not to give pain meds via PCA while the pt. is sleeping, for Peds:
teach the parents how to properly measure the med prior to admin. Teach the patients the
importance of high fluid intake to prevent constipation and the use of laxatives. Immobilized Pts.
Iterate the importance for them to cough and to take deep breaths to prevent lung damage about
every 2 (two) hours.

Administration Principles: PO doses can be given with food or milk to minimize GI irritation,
oral solution may be diluted in glass of fruit juice, ER/CR tabs should be swallowed whole;
Kadian/Avinza may be opened up and sprinkled over applesauce (pt. should rinse mouth and
swallow to ensure all medication is ingested. MS Contin/ Oramorph SR have been administered
rectally.IM& SubQ~ use IM because it irritates the subcutaneous tissue. IV solution is colorless
and a discolored solution should not be administered. Direct IV: Dilute with at LEAST 5ml of
sterile water or 0.9%NaCl for injection, Concentration: 0.1-5mg/ml HIGH ALERT : Administer
2.5-5mg over 5 min; Concentration: 0.1-1mg/ml or greater for continuous infusion. RATE: via
infusion pump to control the rate (should relieve pain without excessive sedation, hypotension or
resp. depression; may be administered via PCA pump at low dose infusion, In pregnant women it
must be used cautiously.