Narcotic question

Musical-Kid-RN · Oct 10, 2002

I'll tell you what little I know. Dilaudid is the name I know it by. I've seen it used mainly in end of life/hospice situations. It is mainly used as an analgesic but may also be used as a cough suppresant (that's one KICKIN' cough syrup!). It comes in IV, IM, PO, and PR forms. There's also Dilaudid HP that is superconcentrated. Dilaudid is an opiate and, I'm told, about 10 times stronger than Morphine (although I have no hard evidence to back that up). It's highly addictive (thus used mostly in hospice cases, I'd gues). Although, I will say that my adult nurse friends say that they are seeing it being used more and more now that Demerol use is decreasing here. Hope that's some help.

frankie · Oct 11, 2002

aus nurse - hydromorphone is a semisynthetic derrivitave of morphine. It is produced by modifications in the morphine molecule. It is similar to oxymorphone, hydrocodone, and oxycodone. It is available in parenteral, oral, rectal suppository. The duration of action is 4-5 hours (the same as morphine) and the plasma half life is 2-3 hours (morphine is 2 hours). Patient response to the morphine derrivitaves varies, as with any other class of drug. I have seen hydromorphone used in end-of-life situations for pain relief/sedation. I have seen people on hydromorphone for chronic pain associated with a severe medical illness. I have seen this used via the rectal route for pain releif and sedation - usually again in end of life times. Hydromorphone is an alternative for patients who may have untoward effects from morphine or other pain relief meds. I do not see this drug used much. Hope this helps - frankie

CMERN · Oct 11, 2002

Dilaudid, we use in the E.R. for patients with pain from Kidney Stones.....some times for pts with pain that isn't responding to other meds. Dilaudid is usually given 1-2 mg, where as for example it's not uncommon to give morphine 2-4 mg. I ,as a nurse have more confidence in morphine and Dilaudid for pain relief minus nausea than say,...demerol. Pts seem to respond well to dilaudid, of course if a "drug seeker" ever gets a dose of dilaudid, they all of a sudden are "allergic":uhoh3: to all other pain medicines. yeah, right.:chuckle

fab4fan · Oct 11, 2002

Hydromorphone (Dilaudid) is a synthetic opioid...equianalgesic dose: Hydromorphone 7.5mg po=MSO4 30mg po; hydromorphone 1.5mg parenterally=MSO4 10mg parenterally.

Can also be used for severe chronic non-malignant pain. When being used for pain, addiction rate is low. Long-term use will require titration due to physiologic tolerance (which is not addiction).

Some patients report feeling "jumpy/jittery" on this med...sometimes switching to another opioid may be required if the pt. finds the side-effects intolerable.

aus nurse · Oct 11, 2002

Thankyou all for the replies...very enlightening. I see I was not spelling it right either lol

This particular person combines hydromorphone with midazolam for analgesia for chronic non-malignant pain. It is not the level of analgesia that I am concerned with, pain level is objective and it is not for me to judge. However the side effects of extreme sedation are a concern IMO. There is a great risk of burning the house down (a smoker) or MVA (yes still has a licence).

I have not posted this to start up another thread on analgesia for chronic pain and all the minefields that it brings. I am however concerned that we are not doing the right thing for this person....surely the side effects are too dangerous for the cause.

I thank you for the information..it allows me a more educated decision.

fab4fan · Oct 11, 2002

It is a common mistake to put opioids with benzo's in order to provide pain relief.

Here is what most pain specialists, and current literature will tell you: If a pt. is on opioids and benzo's, and sedation is a problem, then the benzo's should be tapered off, not the opioids. Many make the mistake of decreasing the narcotic...this is not the correct intervention.

M. McCaffery and C. Pasero have included some info on this topic in the pain mgmt. manual they co-authored. Bascially, the data are mixed regarding the benefit of using benzo's as an adjuvant. Basically, what they say (as well as the American Pain Society) is that benzo's are "not effective analgesics except for muscle spasm, and opioid titration should precede treatment with benzo's. Although a trial of clonazepam or alprazolam can be justified in refractory neuropathic pain on the basis of anecdotal experience, the relative safety of these drugs, and the common coexistence of pain and anxiety, wider use of benzo's as adjuvant analgesics is not warranted..."

Hope this info is helpful to you.

aus nurse · Oct 11, 2002

Thanks fab4fan...excellent info.

It gives me an idea how to advise this person, which has been a difficult case management.

fab4fan · Oct 11, 2002

aus nurse: You're welcome...glad it was useful.

shannonRN, BSN, RN · Oct 11, 2002

found this website...thought it might be helpful.

http://www.nursespdr.com/members/database/ndrhtml/hydromorphonehydrochloride.html

aus nurse · Oct 11, 2002

Thanks for the link Shannon..all good.

I had seen a bit online but was interested in what you guys think as you use it more than we do here.

Thanks again:)

BadBird, BSN, RN · Oct 13, 2002

My personal experience with Dilaudid happened when I herniated a disc in my back, my Dr. put me on Vicodin which did not touch the pain, then percocet which did not help either. When I was admitted and given 1mg IV Dilaudid it was he first time I was pain free in 10 days. I could have had it Q2hrs. but only needed it Q4-5 hrs. I was on it for 2 days which helped me immensely along with IV solumedrol. On the 3rd day I told the Dr. that I did not think that I needed it anymore and he switched me to Percocet. After my surgery I was given a script for Percocet and Motrin, I only needed the motrin. It is nice to know that there is a medication out there that will knock out horrific pain if needed, of course I did not abuse it or any narc. I did not even fill the percocet script. I can say that when I went into the ER the Dr. gave me Demerol which just made me thirsty and sleepy but did nothing for the pain. Thank god for the Dilaudid.