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aerosolized morphine (nebulized morphine)
Indications:
-> relief of dyspnea in palliative care
* of no benefit [2]; use oral morphine
Dosage:
1) morphine for injection 10 mg/mL
2) 5-20 mg every 3-4 hours PRN Administration:
1) nebulizer (e.g. Pulmoaid)
2) 3 mL normal saline
3) 3 mL syringe with 20 gauge needle & alcohol prep pads
4) albuterol &/or ipratropium (Atrovent) may be added to morphine in nebulizer & administered simultaneously
Pharmacokinetics:
1) bioavailability 10-15%
2) loss of drug into atmosphere
Adverse effects:
1) GI effects should be less than oral form
a) constipation
b) nausea
2) fatal respiratory arrest, especially with
a) drug abuse
b) patients with poorly controlled asthma Mechanism:
1) unknown
2) may be local effects involving afferent nerve pathways
Interactions
drug adverse effects of opiates
General
morphine (morphine sulfate [MS], MS Contin, Roxanol, Oramorph SR, Kadian, Avinza, DepoDur, Duromorph)
aerosolized agent
References
- Farncombe & Chater, J Pain Symptom Manage 8:221, 1993
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015