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by narcoticjunkie

I have a pt. who stated she was allergic to morphine. She had just had an abdo surgery done. The medications ordered by the MD to control her pain was Tylenol 3 w/ Codeine. When I did my morning assessment I noticed that she was tachycardic (P=130) and I looked back to her progress notes and noticed that her pulse has been rising in the past 2 days. This got me a little concerned that I brought it up to my preceptor. I asked my preceptor if this was due to any reaction with Tylenol 3 w/ Codeine and she told me it might be because Tylenol 3 w/ Codeine converts itself to a form of morphine. So, what my preceptor did was hold the medication and contacted the MD. My question now is this, does Tylenol 3 w/ Codeine actually converts itself to a form of morphine? If it does, how come the MD totally miss this out and still ordered Tylenol 3 w/ Codeine knowing that the pt. is allergic to morphine? This is just crazy!!!!

[Kyrshamarks]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Codiene does convert to morphine.It is the CYP2D7 enzyme in the brain that converts it. Codiene itself actually has no pain relieving properties untill converted. hat is why there are some people that get no relief from codiene. They do not have the proper enzymes, also there are many psychotropic drugs that affect that particular enzyme and affect the pain relieving ability of codiene/morphine.

[TazziRN]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Don't hang the doctor quite yet. I have been doing this a loooong time and I still forget that little tidbit sometimes. So far I've remembered in time, once literally snatching the pill cup out of the pt's hands.



Along that same thought, did you know that if you eat a lot of poppy seeds and then do a drug screen, you will come up positive for opiates?

[JustaPatient]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

is this really true because I am allergic (actually I think the totally accurate term is adverse reaction) to morphine and got no reaction from tylenol 3 w/ codeine. I get that when I go home after every surgery and NO reaction.

[TazziRN]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Yes it's true, but it doesn't mean you will react to all opiates. People who are allergice to the cillins can take the cousins to them without a problem.

[JustaPatient]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Originally Posted by TazziRN

Yes it's true, but it doesn't mean you will react to all opiates. People who are allergice to the cillins can take the cousins to them without a problem.

O Ok thanks...just wondering

[narcoticjunkie]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Originally Posted by TazziRN

Don't hang the doctor quite yet. I have been doing this a loooong time and I still forget that little tidbit sometimes. So far I've remembered in time, once literally snatching the pill cup out of the pt's hands.



Along that same thought, did you know that if you eat a lot of poppy seeds and then do a drug screen, you will come up positive for opiates?

Yeah. Because the source of morphine is the seedpod of the poppy plant. Morphine is actually prepared by etracting it off opium which is the dried juice of the poppy seedpod. Remember the opium war?

[SebagoLaurel]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

The real question is whether the patient is REALLY allergic to morphine. From my understanding (which is new so maybe wrong), very few people are really allergic to morphine. However, probably about 99% of the patients I have ever seen (as student and as a new nurse) all list morphine and/or codeine as allergy. I think they mistake allergy with side effect (which of course, not being pleasant, is something everyone wants to avoid - not realizing that the side effects might go away, be minimized or avoided with another narcotic).

[TazziRN]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Originally Posted by SebagoLaurel

The real question is whether the patient is REALLY allergic to morphine. From my understanding (which is new so maybe wrong), very few people are really allergic to morphine. However, probably about 99% of the patients I have ever seen (as student and as a new nurse) all list morphine and/or codeine as allergy. I think they mistake allergy with side effect (which of course, not being pleasant, is something everyone wants to avoid - not realizing that the side effects might go away, be minimized or avoided with another narcotic).

You're right, they do, but some side effects are still worth avoiding....my mom literally goes crazy with morphine....gets very very agitated. Severe vomiting is another. Morphine makes me puke up my toenails and if nothing else will work and I am hurting bad enough, I'll take it and start praying.

When I get a pt who tells me that they are allergic to codeine the first thing I do is ask "What does it do to you?" Most of the time the answer is nausea/vomiting. Not an allergy.

[JustaPatient]

Re: Tylenol 3 w/ Codeine converts itself to a form of morphine??

Originally Posted by TazziRN

......When I get a pt who tells me that they are allergic to codeine the first thing I do is ask "What does it do to you?" Most of the time the answer is nausea/vomiting. Not an allergy.

Really is what technicly is an allergy? Sorry to sound stupid just wondering.