Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Restlessness and confusion may require treatment with an antipsychotic, e. Home Medicines guidance Prescribing in palliative care. Careful assessment of symptoms and needs of the patient should be undertaken by a multidisciplinary team. Oxycodone hydrochloride can be used in patients who require an opioid but cannot tolerate morphine. Subcutaneous injections of hyoscine butylbromide , hyoscine hydrobromide , and glycopyrronium bromide can also be used to treat bowel colic.
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In patients with disturbed Renal function Caution should be exercised in the use of Morphine in patients with renal dysfunction syrunge. If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. Qualitative and quantitative composition Morphine Sulfate BP 0.
Signs of morphine toxicity and overdosage include pinpoint pupils, respiratory depression, and hypotension. Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally sryinge paradoxical agitation. Anorexia Anorexia may be helped by prednisolone or dexamethasone.
Morphine salts are sensitive to changes in pH and morphine is liable to be precipitated out of solution in an alkaline environment. Rectal route Morphine is also available for rectal administration as suppositories; sulphte oxycodone hydrochloride suppositories can be obtained on special order. Sjostrom et al BR. The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose.
Morphine Sulfate Injection BP 2mg/ml
Show table of contents Hide table of contents 1. There have been many studies on the pharmacokinetics of morphine following administration by various routes and methods. In addition to the effects of container type and vehicle, reasons for this variation include the effect of excipients temperature and light during storage. Published reports regarding the stability of morphine are at variance, especially in syringes used in patient-controlled analgesia PCA devices.
The administration of morphine during labour may cause respiratory depression in the new-born infant. Confusion and restlessness Haloperidol has little sedative effect.
Staff using syringe drivers should be adequately trained and different rate settings should be clearly identified and differentiated ; incorrect use of syringe drivers is a common cause of medication errors.
Eulphate K Parker et al Jama v.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Morphine immediate-release 30mg 4-hourly or modified- release mg hourly is usually adequate for most patients; some patients require morphine immediate- release up to mg 4-hourly or modified-release mg hourlyoccasionally more is needed. Metoclopramide hydrochloride has sulphatr prokinetic action and is used by mouth wulphate nausea and vomiting associated with gastritis, gastric stasis, and functional bowel obstruction. Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations.
If symptoms persist, they can be given regularly via a continuous infusion device. Morphine and some other opioids have a dose-related histamine-releasing effect which may be responsible in part for reactions such as urticaria and pruritis as well syrimge hypotension and flushing.
Circulatory failure and deepening coma may occur in more severe cases Treatment of Morphine Overdosage.
Morphine Sulfate Injection BP 2mg/ml – Summary of Product Characteristics (SmPC) – (eMC)
If the patient can syrinfe taking medicines by mouth, then oral morphine may be substituted for subcutaneous infusion of morphine or diamorphine hydrochloridesee table above of approximate equivalent doses of morphine and diamorphine hydrochloride.
Opioid analgesics with some antagonistic syrinnge, such as buprenorphine, butorphanol, nalbuphine, or pentazocine, may precipitate withdrawal symptoms in patients who have recently used pure agonists such as morphine. A corticosteroid, such as dexamethasonemay also be helpful morphibe there is bronchospasm or partial obstruction. Subcutaneous injections of hyoscine butylbromidehyoscine hydrobromideand glycopyrronium bromide can also be used to treat bowel colic.
Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. In theory injections dissolved in water for injections are more likely to be associated with pain possibly owing to their hypotonicity.
The pain of muscle spasm can be helped by a silphate relaxant such as diazepam or baclofen. Review pain management if rescue analgesic is required frequently twice daily or more.
The use of physiological saline sodium chloride 0. Pain control Diamorphine hydrochloride is the preferred opioid since its high solubility permits a large dose to be given in a small volume see under Mixing and Compatibility, below. Transdermal route Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or in patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.