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Intravenous Dilution Guidelines

Morphine Sulfate

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

ICU's:
[50 mg] [50 ml] [As directed]
[100 mg] [100 ml] [As directed]


Usual concentration for continuous I.V. infusion: 0.1 to 1 mg/mL in D5W.

Parenteral drug products should be inspected for particulate matter and discoloration prior to administration, whenever solution and container permit. DO NOT USE IF COLOR IS DARKER THAN PALE YELLOW, IF IT IS DISCOLORED IN ANY OTHER WAY OR IF IT CONTAINS A PRECIPITATE.

Stability / Miscellaneous

Exp: 7 days (RT / REF).
Some studies indicate stability up to 30 days. Usual rate: 1 to 10 mg/hr.


DRUG ABUSE AND DEPENDENCE

Controlled Substance CII
Morphine sulfate is a Schedule II narcotic under the United States Controlled Substance Act (21 U.S.C. 801-886). Morphine is the most commonly cited prototype for narcotic substances that possess an addiction-forming or addiction-sustaining liability. As with all potent opioids which are µ-agonists, tolerance, psychological and physical dependence to morphine may develop. Individuals with a prior history of opioid or other substance abuse or dependence would be considered to be at greater risk. Care must be taken to avert withdrawal in patients who have been maintained on parenteral/oral narcotics. Withdrawal symptoms may occur when morphine is discontinued abruptly or upon administration of a narcotic antagonist.

Withdrawal symptoms in patients dependent on morphine begin shortly before the time of the next scheduled dose, reach a peak at 36 to 72 hours after the last dose, and then slowly subside over a period of 7 to 10 days. Symptoms include yawning, sweating, lacrimation. rhinorrhea, a restless, tossing sleep, dilated pupils, gooseflesh, irritability, tremor, nausea, vomiting, and diarrhea.

Treatment of the abstinence syndrome is primarily symptomatic and supportive, including maintenance of proper fluid and electrolyte balance.


OVERDOSAGE
Overdosage of morphine is characterized by respiratory depression, with or without concomitant CNS depression. Mild overdosage may be managed by continuous stimulation of the patient and/or frequent verbal instructions to "Wake-up" or "Take a deep breath". Serious overdose with morphine is characterized by profound respiratory depression (a decrease in respiratory rate/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, and sometimes bradycardia and hypotension. The triad of coma, pinpoint pupils and respiratory depression is strongly suggestive of opiate poisoning.

Primary attention should be given to the establishment of adequate respiratory exchange through maintenance of a patent airway and institution of assisted, or controlled, ventilation. The narcotic antagonist, naloxone, is a specific antidote. An initial dose of 0.4 to 2 mg of naloxone should be administered intravenously, simultaneously with respiratory resuscitation. If the desired degree of counteraction and improvement in respiratory function is not obtained, naloxone may be repeated at 2 to 3 minute intervals. If no response is observed after 10 mg of naloxone has been administered, the diagnosis of morphine-induced toxicity should be questioned. Intramuscular or subcutaneous administration of naloxone may be used if the intravenous route is not available. As the duration of effect of naloxone is considerably shorter than that of morphine, repeated administration may be necessary.

Dosing info....

Source: [package insert]
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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