Differences in pain medication

janis9799 · Jul 18, 2008

I am a new grad but I will answer as a pt... when I had my two c-sections, I was given Lortab for the first section and percocet for the second one. Percocet I thought worked better for the pain.

GrumpyRN63, ADN, RN · Jul 18, 2008

percocet stronger than lortab/vicodin, then least effective is codeine.

Greatest pain effect to least as follows;

Fentanyl, Dilaudid, Morphine and lastly Demerol, Most places have done away completely w/Demerol as it has poor pain effect, high incidence of myoclonic SE's and lowers the seizure threshold., our facility doesn't even stock it anymore, Grumpy

kmoonshine, RN · Jul 18, 2008

From my experience:

Percocet is stronger than lortab.

Fentanyl is the strongest, followed by dilaudid, then morphine.

I've used demerol once, so I'm not very familiar with its efficacy; but my understanding is that it is similar to morphine in terms of pain relief, perhaps a little stronger (due to its fast onset)...

ilstu99 · Jul 18, 2008

heaverboo said:
I work on orthopedics and pain meds are big on my floor! What is the difference and in your opinion and which medication is stronger?
I know percocet is oxycodone/tylenol and lortab is hydrocodone/tylenol...which is better? Fentanyl/Morphine/Dilaudid/Demerol what's the difference? Patients ask me often which is the best choice. Percocet vs Lortab? Agh...so many choices!! And I dont know how to respond when patients ask

IMO - depends on the need and the patient's response. Morphine doesn't do much for me, but Demerol knocks me on my orifice. My response to patients would probably to ask what they've tried before, and how it worked for them. Compare that with the options offered by their physician, and go from there.

Mara123RN · Jul 18, 2008

From my experience

Percocet is stronger than Loratab

Demerol is pretty much a drug of the past for reasons posted by Grumpy

Dilaudid is the drug seekers choice so I think that may be the strongest other than Fentanyl which requires patient be in step down or ICU

Morphine is best for chest pain because it also dilates the arteries-thus better O2 supply

leslie :-D · Jul 18, 2008

All are opiate agonists and schedule ii substances.

Dilaudid, morphine, demerol, fentanyl all indicated for severe, visceral pain.

Oxycodone, hydrocodone indicated for mod-severe.

Dr's preferences are going to depend on metabolism, distribution, duration, adverse effects and type of pain (skeletal, somatic, visceral, neuro...)

when pts ask these questions, they usually want to know differences r/t strength, duration.

SunnyAndrsn · Jul 18, 2008

I personally found that percocet worked better for me, best when taken in conjunction with visitril. Please remember that their are different strengths of percocet-- 5/500 is a common one that we use, but we also see 10/650 as well.

Hydrocodone/tylenol dosages can vary as well.

Overall, the persons individual response should dictate which is used. If one med doesn't work well, then another should be tried. I had a pt. who said morphine was 'useless'. Go figure, it was my best friend.

heaverboo said:
I work on orthopedics and pain meds are big on my floor! What is the difference and in your opinion and which medication is stronger?
I know percocet is oxycodone/tylenol and lortab is hydrocodone/tylenol...which is better? Fentanyl/Morphine/Dilaudid/Demerol what's the difference? Patients ask me often which is the best choice. Percocet vs Lortab? Agh...so many choices!! And I dont know how to respond when patients ask

strugglingnurse · Jul 18, 2008

As per our pain specialist, 1 mg dilaudid= 5mg morpine. (in terms of strength). Fentanyl is the strongest of all narcotics, and therefore is administered in mcg's.

GilaRRT · Jul 18, 2008

I guess it depends on how you want to define strong. Actually, other narcotics exist that are much more potent than fentanyl when we compare microgram of one to migrogram of another and effects on the various opoid receptors and patient response.

Sufenta for example is several times more potent than fentanyl; however, it has such a very short duration of action.

Another narcotic carfentanyl is around 1000 times more potent than fentanyl. This is what some people use to tranquilize large animals. Rumors exist that say this substance or similar substance was use in the 2002 Russian hostage crises. The success of the substance in question is debatable however.

However, if I have something that that will put down an elephant or something that only lasts a few minutes, can we really consider them strong medications for ongoing pain control?

Much really depends on the patient. Had a guy in the ER a while back with a nasty tib/fib fracture. I pumped several hundred micrograms of fentanyl into him with no effect. Then, I gave 25 mg of demeral, and he ended up having adequate pain control. Strange but true.

suespets · Jul 18, 2008

all I can add to prior post.demoral injection I once had taught me why there are addicts in this world, I felt great! Also percacet to me, is useless hydro not much better,ultram ,pretty much glorified tylenol or asa.Certainly, all the sched 2's are the best for overall relief,but morphine can really make some elderly squirrly . sue

jessi1106, BSN, RN · Jul 18, 2008

strugglingnurse said:
As per our pain specialist, 1 mg dilaudid= 5mg morpine. (in terms of strength). Fentanyl is the strongest of all narcotics, and therefore is administered in mcg's.

Hmmm....Our facility says that 1 mg Dilaudid =7-10 mg of Morphine. Wonder which is true?