b. Extreme caution should be used when treating clients who have asthma,
impaired liver function, or a low volume of blood.
c. It is generally unwise to treat migraine or arthritis with narcotic analgesics
since these maladies are chronic and thus increase the possibility of addiction.
However, narcotic analgesics are useful in relieving the pains of terminal cancer, but
they should be used in doses as small as practicable with as long a delay as possible
between doses. This extends the period over which the drug is effective.
a. Action and Uses. Morphine, which is the most potent of the drugs derived
from opium, is a powerful central nervous system depressant, having a selective action
on respiration and pain sensation. These functions are greatly reduced by amounts of
morphine that have only moderate effect upon general consciousness. The drug exerts
a narcotic action manifested by analgesia, drowsiness, changes in mood, and mental
clouding. The relief of pain following administration of morphine is often accompanied
by euphoria. The combined properties of pain relief and euphoria make morphine a
useful drug for relieving severe heart pain. Morphine also exerts an antidiarrheal
action, but it is not used in the treatment of diarrhea. The opiate used for this purpose
b. Indications for Morphine. Only when simple measures fail and severe pain
continues, or when a severely injured person must be moved quickly (as from a
wrecked vehicle or aircraft) or in the event of a heart attack, is it wise to give morphine
at once. However, if the use of morphine is indicated, it should be given without
hesitation. Its ability to stop pain may be lifesaving. Severe pain can increase the
severity of shock, and shock is deadly.
c. Administration. The drug is most often given parenterally. The usual dose
for adults is 10 mg, 4 to 6 times a day as necessary. The dose given, route of
administration, and the time should be entered on the client's record immediately after
the drug is given.
d. Untoward Effects. Whenever morphine is administered, a number of toxic
effects may occur, the most severe and dangerous of which is depression of
respiration. This reaction is especially likely in people with asthma and other chronic
bronchial conditions. Naloxone hydrochloride (Narcan), discussed later in this section,
may be given as directed for the treatment of depressed respiration. Other reactions
include vomiting (which results from the stimulation of the vomiting center in the brain),
dryness of the mouth, constipation, urinary retention, and possibly physical dependence
upon the drug.
e. Morphine Poisoning. Acute morphine poisoning results from an over
dosage of the drug. A delayed type of morphine poisoning may occur from the
intramuscular injection of the drug into chilled skin areas, burned clients, or into clients