Page 150 - 2026 SMOG

MORPHINE
Class/Mechanism of Action
• Opioid Analgesic
Binds to opioid receptors within the CNS, causing inhibition of ascending pain pathways (blocking
painful stimuli), altering the perception of and response to pain; produces generalized CNS depression.
˚ Onset of action—IV: 5–10min
Indications
• Labeled Indications
˚ Moderate to severe acute and chronic pain; pain of myocardial infarction; preanesthetic medication
• Off-Label Indications
˚ Critically ill patients in the ICU (analgesia and sedation)
Contraindications
• Hypersensitivity to morphine sulfate or any component of the formulation
• Severe respiratory depression
• Acute or severe asthma (in an unmonitored setting or without resuscitative equipment)
• GI obstruction, including known or suspected paralytic ileus
Adverse Reactions/Precautions
• Always be prepared for the use of paralytics and intubation (maintain positive control of airway)
• Head trauma: Use with extreme caution in head injury or suspected increased ICP; an
exaggerated increase in ICP may occur. Some formulations are specifically contraindicated.
• May cause Hypotension. Use with caution in hypovolemic patients
• May worsen Bradycardia
• May cause life-threatening hypoventilation and respiratory depression
• CNS depression: Impairs physical and mental abilities
• IM, SubQ: The use of IM/SubQ injections is no longer recommended, especially for repeated
administration, due to painful administration, variable absorption, and lag time to peak effect
• Pregnancy: Use with caution
• Lactation: Nonopioid analgesia is recommended for lactating patients peripartum
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Chest Pain/AMI Acute Pain (Moderate-to-Severe)
• IV/IO • IV (SLOW)
˚ 1–5mg only if discomfort is not relieved by ˚ Infants ≤6mo: 0.025–0.05mg/kg/dose
q2–4hr
nitroglycerin
Acute Pain (Moderate-to-Severe) ˚ Infants >6mo/<50kg: 0.05–0.1mg/kg/dose
• IV/IO (SLOW) q2–4hr; titrate based on patient response
˚ 2.5–10mg q1–4hr prn ˚ >50kg: 2–5mg q2–4hr prn. Use the lower
end of the dosing range in opioid naive
patients
• Continuous infusion
˚ Infants >6mo/<50kg: 10–40mcg/kg/hr;
titrate prn for pain
˚ >50kg: 1.5mg/hr; titrate carefully to effect;
usual maintenance dose: 0.8–3mg/hr

142 • MEDICATIONS