NU 578 Controlled Substances Question and
Answer 2026 | Complete Study Guide with
Practice Questions | A+ Verified
• 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
Answer 2026 | Complete Study Guide with
Practice Questions | A+ Verified
• 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
