Long Acting Morphine for Resp Distress in Hospice Pt

[jsdrn]

I'm fairly new to hospice. My pt has COPD, pulmonary hypertension, CHF and 4+ edema of both legs. Roxanol is effective for her SOB, but she's taking it around the clock. Would MS Contin be effective an d maybe allow her to get some rest?

[AtlantaRN, RN]

long acting would help. also nebulized morphine is great especially for copd patients.

linda

[tewdles, RN]

Good idea, the long acting should provide her with a more "even" relief and allow her to use the Roxanol for "rescue". Make sure to use adjuvant therapy to keep her anxiety and depression in check. Getting more rest and sleep will certainly improve her quality of life. It does for most of us anyway.

[shrinky]

Definitely agree with the other replies. If she is taking that much Roxanol she needs the MS Contin now in addition to Nebulized Morphine which will not be absorbed as much as oral. We have also used nebulized Lasix when none of the above help.

[psvec]

yes it would definitely help.. is anyone a hospcie nurse? What do you know about nebulized lasix? any evidence fot that?

[tewdles, RN]

I am a hospice nurse but have never used nebulized lasix...am anxious to hear about that.

[psvec]

I read it somewhere and we are going to try to use it at our facility. Do you use morphine in the nebulizer?

[jenkayaker]

When using nebulized Morphine you have to ask the pharmacy if it is premixed, as our pharmacy compounds, it changes the metabolized effects.

[rnboysmom]

There are a lot of short studies on nebulized lasis, some favorable some inconclusive. Lasix, like morphine works to selectively vasodilate capillaries in the lungs (same as morphine). Some of the benefits of lasix (if it works for your patient) are lack of diversion risk, lack of potential sedating effects and lack of need for a hard script. I have seen nebulized lasix work wonderfully for some but not for others. Trial and error may be the key. But lasix is definitely an option (especially in the home setting where there may be issues with medication diversion). We usually start with 20mg and have gone to 40mg.

[tewdles, RN]

"But lasix is definitely an option (especially in the home setting where there may be issues with medication diversion). "

Why are we worried about diversion of lasix???

[rnboysmom]

We are not worried about diversion of lasix (although I have seen some pretty strange happenings in homes with severe diversion issues). Lasix is an alternate option to consider as an alternate to morphine when there may be diversion issues in the home (as I stated originally).

[tewdles, RN]

I guess I am not aware of any situation that would warrant replacing morphine with lasix, so therefore did not understand the comment.