NU 578 Controlled Substances Exam
Questions and Answers | Verified | A+
• Morphine actions: -✓✓Analgesia, eurpohia, sedation, cough
suppression, biliary colic, emesis, elevated ICP, Miosis, Neurotoxicity,
Hormonal changes w prolonged use.
• Adverse affects of Morphine -✓✓Resp Depression
Tolerance to resp depression-long term use
• When to NOT give Morphine: -✓✓elderly/young (monitor)
Hx of Resp disease (COPD/Asthma)
Concurrent with CNS depressant
RR less than 12
*REVERSE WITH NARCAN*
• Morphine depression varies by route: -✓✓IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
• Morphine S/E: Constipation tx -✓✓Activation of mu receptors of the
gut, suppress propulsive intestinal contractions, intensify nonpropulsive
contractions, increase the tone of the anal sphincter,
inhibit secretion of fluid into the intestinal lumen
AEfecal impaction, bowel perf, rectal tearing, hemorrhoids
• Prophylactic drugs for constipation -✓✓stimulant lax- senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
,• Morphine Side effect: Orthostatic hypotension -✓✓o R/t the blunting
of the baroreceptor relex and dilating peripheral arterioles and veins.
Causes the release of histamine
• Morphine: urinary retention-- 3 mechanisms -✓✓Increases tone in the
bladder sphincter
Increases tone in the detrusor muscle thereby elevating pressure within
the bladder causing a sense of urinary urgency
Interfere w voiding by suppressing awareness of bladder stimuli
• Tx of urinary retention with morphine -✓✓encourage urination q 4
hours
Hesitancy and retention esp likely in pt w BPH and drugs with
anticholinergic properties (tricyclic antidepressants, antihistamines) can
exacerbate the
prob
• Morphine also used as -✓✓Cough suppression
o Act at opioid receptors in the medulla
• Morphine: side effect: Biliary colic -✓✓Biliary Colic
o Induce spasm of the common bile duct, causing pressure w/in the
biliary tract to rise dramatically
Symptoms epigastric distress to biliary colic
• Certain opioids cause less smooth muscle spam r/t morhpine admin? -
✓✓Demerol
• Morphine side effect: emesis -✓✓Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the
medulla
• ICP associated with Morphine admin? -✓✓Increase ICP
, o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the
blood which dilates the cerebral vasculature causing icp to rise
• Birth defects of morphine during preg? -✓✓o When taken before
conception or during early pregnancy can cause heart defects (AV septal
defect, HLHS, conoventricular septal defects), spina bifida,
gastroschisis
• Neurotoxicity of morphine admin? -✓✓o Delirium, agitation,
myoclonus, hyperalgesia
Primary risk factors renal impairment, preexisting cognitive
impairment..
• Tx of neurotoxicity -✓✓hydration, dose reduction. LT use alternate
opioids.
• Prolonged use of Morphine -✓✓o Hormonal changes
Decline in cortisol levels, increase in prolactin levels, decrease in
luteinizing hormone, follicle-stimulating hormone, testosterone, and
estrogen
o Immune function
• Tolerance -✓✓can be defined as a state in which a larger dose is
required to produce
the same response that formerly could be produced with a smaller dose.
• Cross-tolerance -✓✓exists among the various opioid agonists but not
between opioid agonists and general CNS depressants.
• Physical dependence is a state in which an abstinence syndrome occurs
if drug use is abruptly stopped. The intensity and duration of the opioid
abstinence
Questions and Answers | Verified | A+
• Morphine actions: -✓✓Analgesia, eurpohia, sedation, cough
suppression, biliary colic, emesis, elevated ICP, Miosis, Neurotoxicity,
Hormonal changes w prolonged use.
• Adverse affects of Morphine -✓✓Resp Depression
Tolerance to resp depression-long term use
• When to NOT give Morphine: -✓✓elderly/young (monitor)
Hx of Resp disease (COPD/Asthma)
Concurrent with CNS depressant
RR less than 12
*REVERSE WITH NARCAN*
• Morphine depression varies by route: -✓✓IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
• Morphine S/E: Constipation tx -✓✓Activation of mu receptors of the
gut, suppress propulsive intestinal contractions, intensify nonpropulsive
contractions, increase the tone of the anal sphincter,
inhibit secretion of fluid into the intestinal lumen
AEfecal impaction, bowel perf, rectal tearing, hemorrhoids
• Prophylactic drugs for constipation -✓✓stimulant lax- senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
,• Morphine Side effect: Orthostatic hypotension -✓✓o R/t the blunting
of the baroreceptor relex and dilating peripheral arterioles and veins.
Causes the release of histamine
• Morphine: urinary retention-- 3 mechanisms -✓✓Increases tone in the
bladder sphincter
Increases tone in the detrusor muscle thereby elevating pressure within
the bladder causing a sense of urinary urgency
Interfere w voiding by suppressing awareness of bladder stimuli
• Tx of urinary retention with morphine -✓✓encourage urination q 4
hours
Hesitancy and retention esp likely in pt w BPH and drugs with
anticholinergic properties (tricyclic antidepressants, antihistamines) can
exacerbate the
prob
• Morphine also used as -✓✓Cough suppression
o Act at opioid receptors in the medulla
• Morphine: side effect: Biliary colic -✓✓Biliary Colic
o Induce spasm of the common bile duct, causing pressure w/in the
biliary tract to rise dramatically
Symptoms epigastric distress to biliary colic
• Certain opioids cause less smooth muscle spam r/t morhpine admin? -
✓✓Demerol
• Morphine side effect: emesis -✓✓Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the
medulla
• ICP associated with Morphine admin? -✓✓Increase ICP
, o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the
blood which dilates the cerebral vasculature causing icp to rise
• Birth defects of morphine during preg? -✓✓o When taken before
conception or during early pregnancy can cause heart defects (AV septal
defect, HLHS, conoventricular septal defects), spina bifida,
gastroschisis
• Neurotoxicity of morphine admin? -✓✓o Delirium, agitation,
myoclonus, hyperalgesia
Primary risk factors renal impairment, preexisting cognitive
impairment..
• Tx of neurotoxicity -✓✓hydration, dose reduction. LT use alternate
opioids.
• Prolonged use of Morphine -✓✓o Hormonal changes
Decline in cortisol levels, increase in prolactin levels, decrease in
luteinizing hormone, follicle-stimulating hormone, testosterone, and
estrogen
o Immune function
• Tolerance -✓✓can be defined as a state in which a larger dose is
required to produce
the same response that formerly could be produced with a smaller dose.
• Cross-tolerance -✓✓exists among the various opioid agonists but not
between opioid agonists and general CNS depressants.
• Physical dependence is a state in which an abstinence syndrome occurs
if drug use is abruptly stopped. The intensity and duration of the opioid
abstinence
