Narcotic info

  1. If a patient had Morphine Sulfate, 15mg every 12 hours ordered and had a PRN order for Hydrocodone, 10mg 3 times daily...how far apart would you want to give the Hydrocodone from the Morphine. If the Morphine is extended release, does it really matter?
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  2. 4 Comments

  3. by   rehab nurse
    If the Morphine is scheduled, and the Hydrocodone is PRN, just give the PRN as many hours apart as scheduled. It has no bearing on when the morphine is given. You could give the two together according to this order. If the doctor for some reason didn't want the Hydrocodone given in a certain time period around the morphine, he would have written it.

    For example: Hydrocodone 5/500 one by mouth every 4 hours as needed for breakthrough pain, not to be given two hours before or after morphine given.

    Does this help???
  4. by   Myxel67
    Quote from skittlebear
    If a patient had Morphine Sulfate, 15mg every 12 hours ordered and had a PRN order for Hydrocodone, 10mg 3 times daily...how far apart would you want to give the Hydrocodone from the Morphine. If the Morphine is extended release, does it really matter?


    If the Morphine is slow release, then the hydrocodone would be for breakthrough pain. Rx label directions for hydrocodone state it can be given q 4 to 6 hrs. A younger, larger pt might require the hydrocodone sooner than an older or smaller person. Usually the doctors at our hospital will state q 4-6 hrs as opposed to a number of doses during the day.

    I can't think of any reason to order morphine q 12 hrs if it isn't extended release.

    My hysband broke his hip in a bicycle accident at age 48. His doctor had ordered Toradol IM q 6 hrs and Percocet q 3 - 4 hrs. The nurses interpreted the order that he could have one or the other. I was livid because he was in extreme pain. I had to get the doc to tell the nurses he could have Percocet between the Toradol injections. He was in rehab, so he needed good pain control in order to participate in the PT.

    The nurses argued that they had never had a pt who needed so much pain medication. I reminded them that he was 48, in good health, and would generally metabolize pain meds more quickly than their usual hip fx pts who were usually in their 70's or 80's.
    Last edit by Myxel67 on Sep 24, '07
  5. by   leslie :-D
    Quote from skittlebear
    If a patient had Morphine Sulfate, 15mg every 12 hours ordered and had a PRN order for Hydrocodone, 10mg 3 times daily...how far apart would you want to give the Hydrocodone from th.e Morphine. If the Morphine is extended release, does it really matter?
    if the mso4 is immediate-acting, its onset will be sooner and wouldn't have to give a prn hydrocodone with it.
    if the pt is in acute pain and you're giving a long-acting mso4, then you could give the prn with it, since the hydrocodone's onset will be sooner than the long-acting mso4.
    and obviously, the long-acting mso4 will have a longer duration than short acting.
    in managing a pt's pain, you want to plan strategic times in administration, so all meds work synergistically.
    other than that, you want to monitor bp and rr throughout the regimen.

    leslie
  6. by   EmmaG
    Quote from skittlebear
    If a patient had Morphine Sulfate, 15mg every 12 hours ordered and had a PRN order for Hydrocodone, 10mg 3 times daily...how far apart would you want to give the Hydrocodone from the Morphine. If the Morphine is extended release, does it really matter?
    What you describe sounds like extended release morphine. As an aside, please check the package carefully to make sure you're giving the correct med. I've seen it happen far too many times where someone grabs an immediate-release morphine when MSContin is ordered (not so much in the reverse, though).

    The hydrocodone is ordered for breakthrough pain not relieved by the slow release med. So you give it prn as ordered. If you find that there is a need for frequent breakthrough dosing, then you need to alert the doc so that he can adjust the long-acting med. 15 mg q 12h is a pretty low maintenance dose.

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