An older adult who weighs 68 kg requires an opioid analgesic after hip replacement sur-gery. Which medication and dosage is suitable for this older adult?
a. Morphine sulfate 2.5 mg intravenously (IV) every 2 hours PRN
b. Morphine sulfate 5 mg subcutaneously every 2 hours PRN
c. Oxycodone (Oxy-Contin) 20 mg by mouth every 4 hours PRN
d. Oxycodone (Oxy-Contin) 0.5 mg by mouth every 4 hours PRN
A
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A Correct. Morphine sulfate 2.5 mg IV every 2 hours PRN is a suitable dosage for an adult who weighs 68 kg because this medication, when administered by IV route, peaks in 20 minutes and has a half-life of 1.5 to 2 hours. The action of this medication peaks very quickly and thereafter begins to diminish, providing a great deal of control for the nurse. After 2 hours, the nurse can administer addi-tional morphine but must remember that, potentially, 1.25 mg of active morphine continues to circulate in this individual's blood stream.
B Incorrect. Five mg of morphine every 2 hours subcutaneously is an excessive dose for an older adult because morphine administered in this manner peaks in action at 20 minutes, and a 5-mg dose can be sufficient to cause respiratory de-pression. In addition, because the half-life is 1.5 to 2 hours, 2.5 mg of morphine can still be present in the circulation when it is time for the next dose.
C Incorrect. Oxy-Contin, an extended-release form of Oxycodone, has a peak ac-tion of 1 hour and a half-life of 3-5 hours. Twenty milligrams is an excessive dose for an older adult weighing 68 kg because it can induce respiratory depres-sion at its peak, and 4 hours after administration, 10 milligrams of medication can remain active. Oxy-Contin is also more likely to cause hallucinations and delirium in an older adult than morphine sulfate.
D Incorrect. A dosage of 0.5 mg is unlikely to be therapeutic.
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