Question

a spouse of a hospice patient wants to know why the sublingual dose of morphine is so much lower than the MS Contin dose that was given orally, and the IM dose that was recently given in the hospital. please specify all correct answers. Thank you very much.

A. MS contin acts slowly, sublingual morphine acts rapidly with more intensity.

B. He is losing consciousness, so his need for pain is less

C. MS Contin was partly metabolized in the liver before it started working.

D. Sublingual does enter the bloodstream more quickly than IM does so the effects can be more sudden and profound.

E. This dose must be a mistake. He should need more medicine, not less. You should contact the provider immediately, and tell him I told you so.

(fyi for this question, the answer morphine in low dose subling enters bs more quickly than IM and effects are pround, is incorrect per this teacher....)

Answer 1

ANSWER : A, C and D

RATIONALE:

A. It is true that MS contin if delivers orally, it has a slow action. On the other side, if given sublingually the action is rapid and can be given more often. It is safe to monitor patient for 24 hours if the medicine are given orally and if there is any adverse reaction can be able to provide rescue medications.

B. It is a false statement, the patient condition is not explained here in the question. Moreover, the drug MS contin is given only for patients with chronic pain with lowest effective dose for shortest duration.

C. Of course it is true. When you consume a morphine, the patient body through the process of metabolism, the drug will be changed into other substances in the liver before it start its action.

D. It is true. If the medicine is given sublingually for a patient with not have any tolerance on opioids, then there will be a sudden action which may leads to other adverse reaction or may develop with other signs and symptoms. The patient should be closely monitored for 24 hours to give rescue medications if necessary.

E. This is also false statement. The dose should only be started after understanding the patient conditions. Also, higher starting dose in patients who are not opioid tolerant may cause fatal respiratory depression.