in which CCS case morphine avoided for pain??????? - northeast

[ArchivalUser]

I am not talking about resp. depression or constipation.

other than that?

[ArchivalUser]

diverticulitis


u can use in all other cases except the resp. depression and diverticulitis..........constipation os not a contraindication............but u should not use it in obstipation.

[ArchivalUser]

UW gives it myhope.

so doesnt make sense to me.

[ArchivalUser]

i am usually giving morphin for pain 7/10 even in gallbladder disease. the following is my generic standard order:

cbc
bmp
ua
iva
oxy
vitals
card

ecg: always when suspicion of HTN, tachycardia
cxr: ER patients, chest or abd pain, fever, AMS, DKA

beta HCG
tsh

Tylenol for fever
Loperamide for diarrhea (exception suspicion of e. coli O157, c diff)
Colace (stool softener) for constipation
Metoclopramide (Reglan) (parkinson-like side effects) for nausea
Morphin for pain 7/10

5 min:
follow up on new medicines
counsel

diet
exercise program
activity

rehab
physiotherapy
occupational therapy
Advance directives

VACCINES:
50: influenza
65: pneumococcal

SCREENING:
18: Blood pressure every two years
20: Total cholesterol + HDL every 5 years
25: Women 25 or younger or at increased risk for STD: Screen for Chlamydia annually

21: pap
40: mammogram
45: fasting plasma glucose every 3 years; if 100-126: 75 g OGTT
50: colo every 10 years, FOBT annually
50: if family history: DRE + PSA, 40 or older in AAs, if 4-10: bone PSA bone:free is high, indication of ca

[ArchivalUser]

http://www.umm.edu/altmed/drugs/morphine-sulfate-088500.htm


Contraindications:
Hypersensitivity to morphine sulfate or any component of the formulation; increased intracranial pressure; severe respiratory depression (in absence of resuscitative equipment or ventilatory support); acute or severe asthma; known or suspected paralytic ileus (sustained release products only); sustained release products are not recommended in acute/postoperative pain; pregnancy (prolonged use or high doses at term)


Warnings/Precautions:
An opioid-containing analgesic regimen should be tailored to each patient's needs and based upon the type of pain being treated (acute versus chronic), the route of administration, degree of tolerance for opioids (naive versus chronic user), age, weight, and medical condition. The optimal analgesic dose varies widely among patients. Doses should be titrated to pain relief/prevention. When used as an epidural injection, monitor for delayed sedation.
May cause respiratory depression; use with caution in patients with impaired respiratory function or severe hepatic dysfunction and in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (codeine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone). Infants 400 mg/day. Infumorph® solutions are for use in microinfusion devices only; not for I.V., I.M., or SubQ administration.

Use caution in CNS depression, toxic psychosis, delirium tremens, or convulsive disorders. Sedation and psychomotor impairment are likely, and are additive with other CNS depressants or ethanol. Extended or sustained release dosage forms should not be crushed or chewed. Controlled-, extended-, or sustained-release products are not intended for "as needed (PRN)" use. Some preparations contain sulfites which may cause allergic reactions.

Use caution in renal impairment (metabolite accumulation); use caution in gastrointestinal motility disturbances (particularly with sustained release preparations), thyroid disorders (Addison's disease, myxedema, or hypothyroidism), prostatic hyperplasia, or urethral stricture.

Elderly and/or debilitated may be particularly susceptible to the CNS depressant and constipating effects of narcotics. May mask diagnosis or clinical course in patients with acute abdominal conditions.

Adverse Reactions:
Note: Percentages are based on a study in 19 chronic cancer pain patients (J Pain Symptom Manage, 1995, 10:416-22). Chronic use of various opioids in cancer pain is accompanied by similar adverse reactions; individual patient differences are unpredictable, and percentage may differ in acute pain (surgical) treatment.
Frequency not defined: Flushing, CNS depression, sedation, antidiuretic hormone release, physical and psychological dependence, diaphoresis

>10%:

Cardiovascular: Palpitations, hypotension, bradycardia

Central nervous system: Drowsiness (48%, tolerance usually develops to drowsiness with regular dosing for 1-2 weeks); dizziness (20%); confusion

Dermatologic: Pruritus (may be secondary to histamine release)

Gastrointestinal: Nausea (28%, tolerance usually develops to nausea and vomiting with chronic use); vomiting (9%); constipation (40%, tolerance develops very slowly if at all); xerostomia (78%)

Genitourinary: Urinary retention (16%)

Local: Pain at injection site

Neuromuscular & skeletal: Weakness

Miscellaneous: Histamine release

1% to 10%:

Central nervous system: Restlessness, headache, false feeling of well being

Gastrointestinal: Anorexia, GI irritation, paralytic ileus

Genitourinary: Decreased urination

Neuromuscular & skeletal: Trembling

Ocular: Vision problems

Respiratory: Respiratory depression, dyspnea