NU 578 Controlled Substances – Detailed Solutions For
Test Questions
Morphine (standard) Accurate Answer:- Relieve pain, causes
drowsiness and mental clouding, reduces anxiety and creates a sense of well-
being
o Actions through CNS and peripherycan cause resp depression, constipation,
urinary retention, orthostatic hypotension, emesis, miosis (pinpoint pupils),
cough
suppression, and biliary colic
o Relieves pain w/o affecting other senses or LOC
o Large doses affective against sharp pain
o ability to cause mental clouding, sedation, euphoria, and anxiety reduction
can contribute to pain relief.
Morphine actions: Accurate Answer:- Analgesia, eurpohia, sedation,
cough suppression, biliary colic, emesis, elevated ICP, Miosis, Neurotoxicity,
Hormonal changes w prolonged use.
Adverse affects of Morphine Accurate Answer:- Resp Depression
Tolerance to resp depression-long term use
When to NOT give Morphine: Accurate Answer:- elderly/young
(monitor)
Hx of Resp disease (COPD/Asthma)
Concurrent with CNS depressant
RR less than 12
*REVERSE WITH NARCAN*
Morphine depression varies by route: Accurate Answer:- IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
Morphine S/E: Constipation tx Accurate Answer:- Activation of mu
receptors of the gut, suppress propulsive intestinal contractions, intensify
nonpropulsive contractions, increase the tone of the anal sphincter,
inhibit secretion of fluid into the intestinal lumen
,AEfecal impaction, bowel perf, rectal tearing, hemorrhoids
Prophylactic drugs for constipation Accurate Answer:- stimulant lax-
senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
Morphine Side effect: Orthostatic hypotension Accurate Answer:- o R/t
the blunting of the baroreceptor relex and dilating peripheral arterioles and
veins. Causes the release of histamine
Morphine: urinary retention-- 3 mechanisms Accurate Answer:-
Increases tone in the bladder sphincter
Increases tone in the detrusor muscle thereby elevating pressure within the
bladder causing a sense of urinary urgency
Interfere w voiding by suppressing awareness of bladder stimuli
Tx of urinary retention with morphine Accurate Answer:- encourage
urination q 4 hours
Hesitancy and retention esp likely in pt w BPH and drugs with anticholinergic
properties (tricyclic antidepressants, antihistamines) can exacerbate the
prob
Morphine also used as Accurate Answer:- Cough suppression
o Act at opioid receptors in the medulla
Morphine: side effect: Biliary colic Accurate Answer:- Biliary Colic
o Induce spasm of the common bile duct, causing pressure w/in the biliary
tract to rise dramatically
Symptoms epigastric distress to biliary colic
Certain opioids cause less smooth muscle spam r/t morhpine admin?
Accurate Answer:- Demerol
Morphine side effect: emesis Accurate Answer:- Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the
medulla
, ICP associated with Morphine admin? Accurate Answer:- Increase ICP
o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the blood
which dilates the cerebral vasculature causing icp to rise
Birth defects of morphine during preg? Accurate Answer:- o When
taken before conception or during early pregnancy can cause heart defects
(AV septal defect, HLHS, conoventricular septal defects), spina bifida,
gastroschisis
Neurotoxicity of morphine admin? Accurate Answer:- o Delirium,
agitation, myoclonus, hyperalgesia
Primary risk factors renal impairment, preexisting cognitive impairment..
Tx of neurotoxicity Accurate Answer:- hydration, dose reduction. LT
use alternate opioids.
Prolonged use of Morphine Accurate Answer:- o Hormonal changes
Decline in cortisol levels, increase in prolactin levels, decrease in luteinizing
hormone, follicle-stimulating hormone, testosterone, and estrogen
o Immune function
Tolerance Accurate Answer:- can be defined as a state in which a larger
dose is required to produce
the same response that formerly could be produced with a smaller dose.
Cross-tolerance Accurate Answer:- exists among the various opioid
agonists but not between opioid agonists and general CNS depressants.
Physical dependence is a state in which an abstinence syndrome occurs if
drug use is abruptly stopped. The intensity and duration of the opioid
abstinence
syndrome depends on two factors: Accurate Answer:- the half-life of
the drug used and the degree of physical dependence.
To minimize abstinence syndrome, opioids should be withdrawn gradually.
Fentanyl Accurate Answer:- [Duragesic, Abstral, Actiq, Fentora, Onsolis,
Lazanda, Subsys]
Test Questions
Morphine (standard) Accurate Answer:- Relieve pain, causes
drowsiness and mental clouding, reduces anxiety and creates a sense of well-
being
o Actions through CNS and peripherycan cause resp depression, constipation,
urinary retention, orthostatic hypotension, emesis, miosis (pinpoint pupils),
cough
suppression, and biliary colic
o Relieves pain w/o affecting other senses or LOC
o Large doses affective against sharp pain
o ability to cause mental clouding, sedation, euphoria, and anxiety reduction
can contribute to pain relief.
Morphine actions: Accurate Answer:- Analgesia, eurpohia, sedation,
cough suppression, biliary colic, emesis, elevated ICP, Miosis, Neurotoxicity,
Hormonal changes w prolonged use.
Adverse affects of Morphine Accurate Answer:- Resp Depression
Tolerance to resp depression-long term use
When to NOT give Morphine: Accurate Answer:- elderly/young
(monitor)
Hx of Resp disease (COPD/Asthma)
Concurrent with CNS depressant
RR less than 12
*REVERSE WITH NARCAN*
Morphine depression varies by route: Accurate Answer:- IV 7 min
IM 30 min
SQ 90 min
Spinal 4-5 hours
Morphine S/E: Constipation tx Accurate Answer:- Activation of mu
receptors of the gut, suppress propulsive intestinal contractions, intensify
nonpropulsive contractions, increase the tone of the anal sphincter,
inhibit secretion of fluid into the intestinal lumen
,AEfecal impaction, bowel perf, rectal tearing, hemorrhoids
Prophylactic drugs for constipation Accurate Answer:- stimulant lax-
senna
polyethylene glycol (osmotic lax)
lactulose/sodium phosphate
methylnaltrexone (Relistor) aka: rescue therapy
Morphine Side effect: Orthostatic hypotension Accurate Answer:- o R/t
the blunting of the baroreceptor relex and dilating peripheral arterioles and
veins. Causes the release of histamine
Morphine: urinary retention-- 3 mechanisms Accurate Answer:-
Increases tone in the bladder sphincter
Increases tone in the detrusor muscle thereby elevating pressure within the
bladder causing a sense of urinary urgency
Interfere w voiding by suppressing awareness of bladder stimuli
Tx of urinary retention with morphine Accurate Answer:- encourage
urination q 4 hours
Hesitancy and retention esp likely in pt w BPH and drugs with anticholinergic
properties (tricyclic antidepressants, antihistamines) can exacerbate the
prob
Morphine also used as Accurate Answer:- Cough suppression
o Act at opioid receptors in the medulla
Morphine: side effect: Biliary colic Accurate Answer:- Biliary Colic
o Induce spasm of the common bile duct, causing pressure w/in the biliary
tract to rise dramatically
Symptoms epigastric distress to biliary colic
Certain opioids cause less smooth muscle spam r/t morhpine admin?
Accurate Answer:- Demerol
Morphine side effect: emesis Accurate Answer:- Emesis
o Caused by direct stimulation of the chemoreceptor trigger zone of the
medulla
, ICP associated with Morphine admin? Accurate Answer:- Increase ICP
o Mechanism indirect:
Suppressing respiration, morphine increases the CO2 content of the blood
which dilates the cerebral vasculature causing icp to rise
Birth defects of morphine during preg? Accurate Answer:- o When
taken before conception or during early pregnancy can cause heart defects
(AV septal defect, HLHS, conoventricular septal defects), spina bifida,
gastroschisis
Neurotoxicity of morphine admin? Accurate Answer:- o Delirium,
agitation, myoclonus, hyperalgesia
Primary risk factors renal impairment, preexisting cognitive impairment..
Tx of neurotoxicity Accurate Answer:- hydration, dose reduction. LT
use alternate opioids.
Prolonged use of Morphine Accurate Answer:- o Hormonal changes
Decline in cortisol levels, increase in prolactin levels, decrease in luteinizing
hormone, follicle-stimulating hormone, testosterone, and estrogen
o Immune function
Tolerance Accurate Answer:- can be defined as a state in which a larger
dose is required to produce
the same response that formerly could be produced with a smaller dose.
Cross-tolerance Accurate Answer:- exists among the various opioid
agonists but not between opioid agonists and general CNS depressants.
Physical dependence is a state in which an abstinence syndrome occurs if
drug use is abruptly stopped. The intensity and duration of the opioid
abstinence
syndrome depends on two factors: Accurate Answer:- the half-life of
the drug used and the degree of physical dependence.
To minimize abstinence syndrome, opioids should be withdrawn gradually.
Fentanyl Accurate Answer:- [Duragesic, Abstral, Actiq, Fentora, Onsolis,
Lazanda, Subsys]
