CONTROLLED SUBSTANCES UNIT 2- NU
578 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS LATEST VERSION
2025/2026.
Morphine (standard) - ANS Relieve pain, causes drowsiness and mental clouding, reduces
anxiety and creates a sense of well-being
o Actions through CNS and peripherycan cause resp depression, constipation, urinary retention,
orthostatic hypotension, emesis, miosis (pinpoint pupils), cough
suppression, and biliary colic
o Relieves pain w/o affecting other senses or LOC
o Large doses affective against sharp pain
o ability to cause mental clouding, sedation, euphoria, and anxiety reduction can contribute to
pain relief.
Morphine actions: - ANS Analgesia, eurpohia, sedation, cough suppression, biliary colic,
emesis, elevated ICP, Miosis, Neurotoxicity, Hormonal changes w prolonged use.
Adverse affects of Morphine - ANS Resp Depression
Tolerance to resp depression-long term use
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,When to NOT give Morphine: - ANS 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: - ANS IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
Morphine S/E: Constipation tx - ANS 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 - ANS stimulant lax- senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
Morphine Side effect: Orthostatic hypotension - ANS 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 - ANS Increases tone in the bladder sphincter
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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 - ANS 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 - ANS Cough suppression
o Act at opioid receptors in the medulla
Morphine: side effect: Biliary colic - ANS 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? - ANS Demerol
Morphine side effect: emesis - ANS Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the medulla
ICP associated with Morphine admin? - ANS Increase ICP
o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the blood which dilates the
cerebral vasculature causing icp to rise
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
578 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS LATEST VERSION
2025/2026.
Morphine (standard) - ANS Relieve pain, causes drowsiness and mental clouding, reduces
anxiety and creates a sense of well-being
o Actions through CNS and peripherycan cause resp depression, constipation, urinary retention,
orthostatic hypotension, emesis, miosis (pinpoint pupils), cough
suppression, and biliary colic
o Relieves pain w/o affecting other senses or LOC
o Large doses affective against sharp pain
o ability to cause mental clouding, sedation, euphoria, and anxiety reduction can contribute to
pain relief.
Morphine actions: - ANS Analgesia, eurpohia, sedation, cough suppression, biliary colic,
emesis, elevated ICP, Miosis, Neurotoxicity, Hormonal changes w prolonged use.
Adverse affects of Morphine - ANS Resp Depression
Tolerance to resp depression-long term use
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,When to NOT give Morphine: - ANS 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: - ANS IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
Morphine S/E: Constipation tx - ANS 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 - ANS stimulant lax- senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
Morphine Side effect: Orthostatic hypotension - ANS 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 - ANS Increases tone in the bladder sphincter
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, 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 - ANS 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 - ANS Cough suppression
o Act at opioid receptors in the medulla
Morphine: side effect: Biliary colic - ANS 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? - ANS Demerol
Morphine side effect: emesis - ANS Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the medulla
ICP associated with Morphine admin? - ANS Increase ICP
o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the blood which dilates the
cerebral vasculature causing icp to rise
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
