Drug which is contraindicated in head injury?

NCL (MP) Nursing Officer - 2019

Pharmacology

Easy

Appeared in: NCL (MP) Nursing Officer - 2019

Explanation

Morphine is contraindicated in head injury because it causes respiratory depression, leading to carbon dioxide (CO₂) retention.
Increased CO₂ acts as a potent cerebral vasodilator, which increases blood flow to the brain and dangerously elevates intracranial pressure (ICP).
The sedative effects and pupillary constriction (miosis) caused by morphine can mask crucial neurological signs, such as changes in level of consciousness and pupil response, making it difficult to monitor the patient's condition.
Morphine can also cause hypotension, which may decrease cerebral perfusion pressure and worsen secondary brain injury.

Option B: Antibiotics are not contraindicated; they are often necessary.
Option C: Oxygen is a critical and essential treatment, not a contraindication.
Option D: Intravenous (I/V) fluids are a cornerstone of management, not a contraindication.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological contraindications in traumatic brain injury (TBI) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse caring for a patient with a head injury must perform frequent and accurate neurological assessments (e.g., Glasgow Coma Scale, pupillary checks). Understanding that morphine masks these signs is critical for patient safety.
Nurses must advocate for appropriate pain management. While pain control is important, using contraindicated drugs like morphine can have fatal consequences. The nurse should question any inappropriate orders.
What if? If a patient with a head injury has severe pain, alternative strategies are used. In a controlled setting (like an ICU with intubation and ventilation), short-acting opioids like fentanyl may be used cautiously, as their effects can be more easily managed and reversed. Non-opioid analgesics may also be considered.

How to Approach the Question

First, identify the core clinical condition presented in the question, which is 'head injury'.
Recall the primary goals of managing a head injury: preventing secondary brain injury by controlling intracranial pressure (ICP) and maintaining cerebral perfusion.
Evaluate each drug option based on its known physiological effects and how it would impact ICP and cerebral perfusion.
Analyze Morphine: It is an opioid known for causing respiratory depression. This leads to CO₂ retention, a potent cerebral vasodilator that increases ICP. This effect is directly harmful in a head injury.
Analyze the other options: Oxygen (prevents hypoxia), Antibiotics (prevents infection in open wounds), and I/V fluids (maintain blood pressure) are all supportive or necessary treatments.
Based on this analysis, conclude that Morphine is the only option that is actively harmful and therefore contraindicated.

Concept Tested & Keywords

Concept Tested: Pharmacological contraindications in traumatic brain injury (TBI)
Stem keywords: drug, contraindicated, head injury
Lead-in keywords: which is
Negative lead-in flag: false