Morphine & Nitro
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What is the generic name of Morphine?
Brand name of morphine?
Mechanism of Action of Morphine
- Binds to opiate receptors in CNS
- Alters perception and response to pain
- CNS depression
- Respiratory depression
- Vasomotor center depression
- Releases histamine
Indications and field use of Morphine
- Chest pain of probable cardiac origin
- Major burns
- Isolated muscosceletal injury
- Kidney stones
Why - Binds to opiate receptors in CNS altering perspective of pain
Dosage of Morphine?
Via slow IV push or IM
- Chest pain or isolated muscoskeletal injury -
- MS 2-4mg slow IV push q 5 minutes if BP >100, max 10mg
- Major burns -
- MS 2-4mg slow IV push q 5 minutes if BP >100, max 20mg
Contraindications of Morphine?
- Known hypersensitivity
- Decreased LOC
Drug Interactions with Morphine?
- Potentiated by other CNS depressants
- Overdose/side effects reversed by Narcan
Side effects of Morphine?
- True allergic reaction (Patch with Medical Control)
- Itching/hives (due to histamine release, not allergy, patch with Medical Control)
- CNS depression
Onset of Action of Morphine?
AZ Drug Box Supply of Morphine?
2 x 10mg in 1cc sealed prefilled Tubex syringe or ampule
Special note for Morphine?
Schedule II controlled substance, requires documentation and DEA tracking
What is the Generic name for Nitro?
What is the brand name for Nitro?
What is the class for Nitro?
What is the Mechanism of Action for Nitro?
- Nitrates release nitric oxide which relaxes smooth muscle
- Dilation of vascular smooth muscle
- Reduces preload
- Reduces afterload
- Dilation of coronary arteries
Indications and field use of Nitro?
- Chest pain of probable cardiac origin - Why?
- Reduced preload and afterload decreasing myocardial workload
- Dilation of coronary arteries increases blood flow to myocardium
- CHF - Why?
- Reduced preload reduces amount of blood sent to the lungs
- Reduced afterload allows left ventricle to move blood out of the lungs
Dosage of Nitro?
Dosage is via SL tablet or spray
- Chest pain
- - NTG 0.4mg SL tablet or spray q 5 minutes if BP >100, max 3 times
- CHF with pulmonary edema
- - NTG 0.4mg SL tablet or spray q 5 minutes if BP >100, no max
Contraindications of Nitro?
- Right ventricle MI
- Known hypersensitivity or allergy
- Hypotension BP >100 systolic
- Head injury / CVA
- Erectile dysfunction drugs - Viagra, Cialis, Levitra
Drug Interactions with Nitro?
- Potentiated by anti-hypertensives
- Calcium-channel blockers
Side effects of Nitro?
- Bitter taste / Burning feeling in mouth
- Hypotension - consider starting IV prior to NTG administration
- Syncope - do not have patient walk after NTG admin
Onset of Action of Nitro?
AZ Drug box supply of Nitro?
- Dark glass bottle with 25 0.4mg tablets
- Red spray bottle with 200 metered 0.4 sprays
Special Notes for Nitro?
- NTG is heat, light and air sensitive, so keep in dark closed container
- NTG infusion must be done with glass IV bottle
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