Morphine is contraindicated in

Appeared in: UPPSC 2017

Explanation

Morphine is contraindicated in bronchial asthma.
The primary reason is that morphine stimulates the release of histamine from mast cells.
Histamine is a potent bronchoconstrictor, meaning it causes the smooth muscles of the airways to tighten.
In a patient with pre-existing airway hyper-reactivity like asthma, this bronchoconstriction can trigger a severe and potentially fatal asthma attack.
This effect is a direct pharmacological property of morphine and is non-immunological.

Option A: Morphine is indicated, not contraindicated, in angina, particularly unstable angina.
Option C: This is a relative contraindication, not an absolute one. Morphine can cause spasm of the sphincter of Oddi, potentially worsening pain, but it is often still used for severe pancreatitis pain when benefits outweigh risks.
Option D: Morphine is a standard and indicated treatment for the severe pain associated with myocardial infarction (MI).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications of Morphine as background academic context rather than a clinical decision trigger.
A nurse must always verify a patient's history for respiratory conditions like asthma or COPD before administering morphine. This is a critical patient safety check.
Respiratory assessment is a priority nursing intervention before and after morphine administration. Monitor respiratory rate, depth, rhythm, and oxygen saturation.
What if? If a patient with severe pain has a history of asthma, the nurse should anticipate the need for an alternative analgesic and consult with the prescriber. A high-potency opioid with lower histamine-releasing potential, such as fentanyl, might be considered if an opioid is unavoidable.

How to Approach the Question

First, identify the core of the question, which is asking for a contraindication to morphine.
Recall the main pharmacological actions and side effects of morphine. Key side effects include respiratory depression, constipation, nausea, and histamine release.
Evaluate each option based on morphine's pharmacology.
Option A (Angina) & D (Myocardial Infarction): Recognize that morphine is used to treat the pain in these conditions. So, they are indications, not contraindications.
Option C (Pancreatitis): Recall the concern about sphincter of Oddi spasm. This is a known issue but is often considered a relative contraindication.
Option B (Bronchial asthma): Connect the side effect of histamine release with the pathophysiology of asthma. Histamine causes bronchoconstriction, which would dangerously worsen asthma. This makes it the most definitive contraindication among the choices.

Concept Tested & Keywords

QHNqAomUU1yPw3ROgxwzWk

E6 Pharmacology KD Tripathi Essentials 9e Part 2 pp. 136-138, 137-139

E6 Pharmacology Nurses Shanbhag 3e p. 160-162

Practise the full UPPSC 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.