Page 36 - Learnwell EVS
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Notes on the use of morphine and derivatives:
– M o rp hine is an effective treatm ent fo r m any ty p es o f severe p ain. Its analgesic effect
is d o se-d ep end ent. I ts ad verse effects have o ften been exaggerated and sho uld no t be
an o bstacle to its use.
– T he m o st serio us ad verse effect o f m o rp hine is resp irato ry d ep ressio n, which m ay be
fatal. T his ad verse effect results fro m o verd o se. It is, therefo re, im p o rtant to increase
d o ses grad ually . R esp irato ry d ep ressio n is p reced ed by d ro w siness, w h ich is a
warning to m o nito r resp irato ry rate (R R ).
T he R R sho uld rem ain equal to o r greater than the thresho ld s ind icated belo w:
Neo nate R R ≥ 3 5 resp iratio ns/ m in
C hild ren 1 to 1 2 m o nths R R ≥ 2 5 resp iratio ns/ m in
C hild ren 1 to 2 y ears R R ≥ 2 0 resp iratio ns/ m in
C hild ren 2 to 5 y ears R R ≥ 1 5 resp iratio ns/ m in
C hild ren > 5 y ears and ad ults R R ≥ 1 0 resp iratio ns/ m in
R esp irato ry d ep ressio n m ust be id entified and treated quick ly : verbal and p hy sical
stim ulatio n o f the p atient; ad m inistratio n o f o xy gen; resp irato ry sup p o rt (bag and
m ask ) if necessary . If no im p ro vem ent, ad m inister nalo xo ne (antago nist o f m o rp hine)
in bo lus o f 1 to 3 m icro gram s/ k g as necessary until R R no rm alises and the excessive
d ro wsiness reso lves.
– M o rp hine and co d eine alway s cause co nstip atio n. A laxative sho uld be p rescribed if
the o p io id treatm ent co ntinues m o re than 4 8 ho urs. Lactulose P O is the d rug o f cho ice:
child ren < 1 y ear: 5 m l/ d ay ; child ren 1 -6 y ears: 5 to 1 0 m l/ d ay ; child ren 7 -1 4 y ears:
1 0 to 1 5 m l/ d ay ; ad ults: 1 5 to 4 5 m l/ d ay ).
I f the p atient‟s sto o ls are so ft, a stim ulant laxative ( bisacodyl P O : child ren > 3 y ears:
5 to 1 0 m g/ d ay ; ad ults: 1 0 to 1 5 m g/ d ay ) is p referred .
– Nausea and vo m iting are co m m o n at the beginning o f treatm ent.
A d ults:
haloperidol P O (2 m g/ m l o ral so lutio n): 1 to 2 m g to be rep eated up to 6 tim es d aily
o r metoclopramide P O : 1 5 to 3 0 m g/ d ay in 3 d ivid ed d o ses with an interval o f at least
6 ho urs between each d o se
D o no t co m bine halo p erid o l and m eto clo p ram id e.
C hild ren:
ondansetron P O : 0 .1 5 m g/ k g to be rep eated up to 3 tim es d aily . D o no t exceed
4 m g/ d o se.
D o no t use m eto clo p ram id e in child ren.
– F o r chro nic p ain in late stage d isease (cancer, A ID S etc.), m o rp hine P O is the d rug o f
cho ice. I t m ay be necessary to increase d o ses o ver tim e acco rd ing to p ain assessm ent.
D o no t hesitate to give sufficient and effective d o ses.
– M o rp hine, tram ad o l and co d eine have sim ilar m o d es o f actio n and sho uld no t be
co m bined .
34
Notes on the use of morphine and derivatives:
– M o rp hine is an effective treatm ent fo r m any ty p es o f severe p ain. Its analgesic effect
is d o se-d ep end ent. I ts ad verse effects have o ften been exaggerated and sho uld no t be
an o bstacle to its use.
– T he m o st serio us ad verse effect o f m o rp hine is resp irato ry d ep ressio n, which m ay be
fatal. T his ad verse effect results fro m o verd o se. It is, therefo re, im p o rtant to increase
d o ses grad ually . R esp irato ry d ep ressio n is p reced ed by d ro w siness, w h ich is a
warning to m o nito r resp irato ry rate (R R ).
T he R R sho uld rem ain equal to o r greater than the thresho ld s ind icated belo w:
Neo nate R R ≥ 3 5 resp iratio ns/ m in
C hild ren 1 to 1 2 m o nths R R ≥ 2 5 resp iratio ns/ m in
C hild ren 1 to 2 y ears R R ≥ 2 0 resp iratio ns/ m in
C hild ren 2 to 5 y ears R R ≥ 1 5 resp iratio ns/ m in
C hild ren > 5 y ears and ad ults R R ≥ 1 0 resp iratio ns/ m in
R esp irato ry d ep ressio n m ust be id entified and treated quick ly : verbal and p hy sical
stim ulatio n o f the p atient; ad m inistratio n o f o xy gen; resp irato ry sup p o rt (bag and
m ask ) if necessary . If no im p ro vem ent, ad m inister nalo xo ne (antago nist o f m o rp hine)
in bo lus o f 1 to 3 m icro gram s/ k g as necessary until R R no rm alises and the excessive
d ro wsiness reso lves.
– M o rp hine and co d eine alway s cause co nstip atio n. A laxative sho uld be p rescribed if
the o p io id treatm ent co ntinues m o re than 4 8 ho urs. Lactulose P O is the d rug o f cho ice:
child ren < 1 y ear: 5 m l/ d ay ; child ren 1 -6 y ears: 5 to 1 0 m l/ d ay ; child ren 7 -1 4 y ears:
1 0 to 1 5 m l/ d ay ; ad ults: 1 5 to 4 5 m l/ d ay ).
I f the p atient‟s sto o ls are so ft, a stim ulant laxative ( bisacodyl P O : child ren > 3 y ears:
5 to 1 0 m g/ d ay ; ad ults: 1 0 to 1 5 m g/ d ay ) is p referred .
– Nausea and vo m iting are co m m o n at the beginning o f treatm ent.
A d ults:
haloperidol P O (2 m g/ m l o ral so lutio n): 1 to 2 m g to be rep eated up to 6 tim es d aily
o r metoclopramide P O : 1 5 to 3 0 m g/ d ay in 3 d ivid ed d o ses with an interval o f at least
6 ho urs between each d o se
D o no t co m bine halo p erid o l and m eto clo p ram id e.
C hild ren:
ondansetron P O : 0 .1 5 m g/ k g to be rep eated up to 3 tim es d aily . D o no t exceed
4 m g/ d o se.
D o no t use m eto clo p ram id e in child ren.
– F o r chro nic p ain in late stage d isease (cancer, A ID S etc.), m o rp hine P O is the d rug o f
cho ice. I t m ay be necessary to increase d o ses o ver tim e acco rd ing to p ain assessm ent.
D o no t hesitate to give sufficient and effective d o ses.
– M o rp hine, tram ad o l and co d eine have sim ilar m o d es o f actio n and sho uld no t be
co m bined .
34
