What are the administration intervals for Morphine, Diazepam, and Pantoprazole?

Medication Administration Intervals

For severe chest pain and restlessness, administer morphine 4 mg IV every 3-4 hours as needed, diazepam 5 mg IV every 3-4 hours as needed, and pantoprazole 40 mg IV once daily.

Morphine 4 mg IV

• Administer every 3-4 hours for acute severe pain, as this represents the standard interval for immediate-release morphine in acute settings 1
• For severe chest pain requiring rapid relief, bolus doses can be given as frequently as every 10-15 minutes during initial titration until pain control is achieved 1, 2
• Once pain is controlled with initial boluses, transition to scheduled dosing every 4 hours with the same dose available for breakthrough pain 1
• The analgesic effect of immediate-release morphine lasts approximately 4 hours, with peak plasma concentrations occurring within 1 hour after administration 3

Critical pitfall: Never extend the dosing interval beyond 4 hours for immediate-release morphine during acute pain management, as this leads to inadequate pain control 1. If pain returns before the next scheduled dose, increase the dose amount rather than increasing frequency 4.

Diazepam 5 mg IV

• Administer every 3-4 hours as needed for moderate anxiety and restlessness 5
• The FDA label specifically states for moderate anxiety: "2 mg to 5 mg, intramuscular or intravenous. Repeat in 3 to 4 hours, if necessary" 5
• For severe anxiety, 5-10 mg IV can be repeated every 3-4 hours if necessary 5
• Inject slowly, taking at least one minute for each 5 mg (1 mL) given to minimize adverse effects 5

Important consideration: Diazepam and morphine can be administered concomitantly without dose adjustment, as pantoprazole does not affect diazepam clearance or metabolism 6. The combination of morphine and diazepam may provide superior pain relief with balanced side effects compared to either agent alone 7.

Pantoprazole 40 mg IV

• Administer once daily (every 24 hours) 8
• Pantoprazole has a duration of antisecretory action lasting 24 hours despite a short plasma elimination half-life 8
• The onset of antisecretory activity occurs within 15-30 minutes of IV administration 8
• Complete acid suppression is achieved within approximately 2 hours and sustained for 24 hours 8

No dose adjustment needed: Pantoprazole can be administered with morphine and diazepam without pharmacokinetic interactions 6.

Practical Administration Algorithm

1. Initial phase (first 1-2 hours):

   • Morphine 4 mg IV boluses every 10-15 minutes until pain controlled 1, 2
   • Diazepam 5 mg IV once for restlessness (inject slowly over 1 minute) 5
   • Pantoprazole 40 mg IV once 8

2. Maintenance phase (after pain control achieved):

   • Morphine 4 mg IV scheduled every 4 hours, with same dose available for breakthrough pain every 1-2 hours 1
   • Diazepam 5 mg IV every 3-4 hours as needed for persistent restlessness 5
   • Pantoprazole 40 mg IV once daily 8

3. Reassessment: Review total morphine consumption every 24 hours and adjust the regular dose accordingly, as steady-state is achieved within 24 hours 1