No More Demerol? - page 2

Our hospital has a policy that allows pharmacy to change every order for Demerol to Dilaudid. I was talking to the chief of staff and he said that Demerol is the drug of choice for those "seeking"... Read More

  1. by   P_RN
    Don't the drugs have to be more similar than Morphine/Dilaudid and Demerol?

    I can see maybe Percocet to Tylox (same basic stuff) but Demerol is not equivalent.
    BTW my insurance MerckMedco has just removed protonix from its preferred drug list.
  2. by   nursesaideBen
    On our floor, if you're getting pain meds IV it's either Morphine, Dilaudid, or Fentanyl. Also we give a huge amount of Protonix both PO and IV and now apparently Zosyn is the antibiotic of choice for EVERYTHING because it's stacked up in our med refridgerator like fire wood lol
  3. by   kukukajoo
    A few years ago my neck went out and I was on the couch for a month. I lived next door to a major loser (and user) and only knew him because our kids played together and I only let them play in my yard and house (NO WAY my kids were stepping foot in that place!). One day he stopped over to see how I was doing and fetch his kids and saw the bottle of dilaudid and was literally BEGGING me for some!! Wanted to know who prescribed it and read the bottle and then whined when he saw it was same doc he sees that won't prescribe narcs to him. Hmmm wonder why.... When you have gotten caught writing illegal scripts from pads stolen from his office (more than once!). When I saw the doc the next day I mentioned he may be getting a call from this person and he said he already had!!!
  4. by   schroeders_piano
    I think it is funny that they switch Demerol to Dilaudid. Every hospital I have worked in would not give Dilaudid to anyone except end-stage cancer patients. I guess it is just in my neck of the woods.
  5. by   psychnurse96
    I realize this thread could go on indefinitley. I think all of you had very good points to make, and I agree in some regard to the "phasing out" of the Demerol, but speaking as a patient with a hx of multiple back surgeries, I did have very good results from the use of IM Demerol, but did have the severe anxiety/near panic episodes from having been given the drug IV. Why the difference? I would like to know if anyone has any specific scientific explaination..
    I do see how the "seekers" would find this a drug of choice, as it does make ones' head swim.
    Dilaudid? Having a reasonable rapport with some of my psych patients, dilaudid does have a high street value. In fact, some meth patients have even admitted to trading their meth for dilaudid...
    Drug habituation has been around as long as the drugs. My primary complaint-the "seekers" who ruin the system for the patients who are in legitimate pain...
  6. by   NRSKarenRN
    Quote from psychnurse96
    i i did have very good results from the use of im demerol, but did have the severe anxiety/near panic episodes from having been given the drug iv. why the difference? i would like to know if anyone has any specific scientific explaination....
    remember pharmacokinetics: slower absorption im compared to iv.


    demerol inj: ahfs detailed monograph

    administration

    meperidine hydrochloride is administered orally; by subcutaneous, im, or slow iv injection; or by slow, continuous iv infusion. the drug is least effective when given orally.


    some experts discourage administration of meperidine hydrochloride by the oral route because of extensive first-pass metabolism in the liver and resultant increased formation of the toxic metabolite, normeperidine.

    each dose of the meperidine hydrochloride oral solution should be taken in one-half glassful of water, since the undiluted solution may produce slight topical anesthesia on mucous membranes.

    when repeat doses are necessary, the im route is preferred over subcutaneous administration because of occurrence of local tissue irritation and induration following subcutaneous injection.
    when meperidine hydrochloride is administered im, it should be injected into a large muscle mass, taking care to avoid nerve trunks.
    if iv administration is required, meperidine dosage should be decreased and the commercially available injections should be administered very slowly, preferably as dilute solutions. alternatively, the commercially available injection containing 10 mg/ml, which should be used only with a compatible infusion device and does not require further dilution, may be used; the 10-mg/ml injection is intended for single use only, and unused portions should be appropriately discarded. when meperidine is given parenterally, especially by the iv route, the patient should be lying down. an opiate antagonist and facilities for administration of oxygen and control of respiration should be available during and immediately following iv administration of the drug.

    [color=#4d6781]cautions



    since meperidine may increase ventricular response rate through a vagolytic action, the drug should be used with caution in patients with atrial flutter and other supraventricular tachycardias. in one study in patients with myocardial infarction, meperidine hydrochloride in iv doses of 100 mg appeared to cause various circulatory disturbances including increases in mean aortic pressure, systemic vascular resistance, and heart rate. occasional occurrence of sinus tachycardia in postoperative patients has been attributed to meperidine.

    inadvertent im injection of meperidine into or near nerve trunks can result in sensory-motor paralysis, which may or may not be transient.

    some commercially available formulations of meperidine hydrochloride contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals. the overall prevalence of sulfite sensitivity in the general population is unknown but probably low; such sensitivity appears to occur more frequently in asthmatic than in nonasthmatic individuals.

    meperidine should be used with caution in patients at risk for accumulation of normeperidine (e.g., those with renal or hepatic impairment) and during prolonged therapy and/or therapy with high dosages in other patients (e.g., those with sickle cell anemia or cns disease, burn patients, cancer patients) at risk for neurotoxic effects of the metabolite. such patients should be observed closely for potential manifestations of cns stimulation (e.g., seizures, agitation, irritability, nervousness, tremors, twitches, myoclonus) associated with accumulation of the metabolite.



    duke health: pharmacodynamics/kinetics

    onset of action:
    analgesic: oral, subq, i.m.: 10-15 minutes; i.v.: ~5 minutes
    peak effect: oral, subq, i.m.: ~1 hour
    duration: oral, subq, i.m.: 2-4 hours
    distribution: crosses placenta; enters breast milk
    protein binding: 65% to 75%
    metabolism: hepatic; active metabolite (normeperidine)
    bioavailability: ~50% to 60%; increased with liver disease
    half-life elimination:
    parent drug: terminal phase: neonates: 23 hours (range: 12-39 hours); adults: 2.5-4 hours, liver disease: 7-11 hours
    normeperidine (active metabolite): 15-30 hours; can accumulate with high doses or with decreased renal function
  7. by   psychnurse96
    "Don't the drugs have to be more similar than Morphine/Dilaudid and Demerol?

    I can see maybe Percocet to Tylox (same basic stuff) but Demerol is not equivalent.
    BTW my insurance MerckMedco has just removed protonix from its preferred drug list."

    You know, I agree. This has been a never ending topic among the staff at my workplace. We are more often than not, asked-often told-to substitute certain drugs primarily because of what the insurance is willing to pay for.
    Frustrating, since like you had brought up, the drugs may not always be molecularly similar. In the wonderful world of psych, as a lot of you already know, it can be challenging-to say the least-when a patient is on a certain med for an extended period of time-sometimes with adequate results-then because of beurocracies-they are forced to change to something new.
    More often than not, we have the joy of experiencing an increase of behaviors as a result of the change, have to "play" with the dosage, and wait for their bodies to metabolise the new drug.
    Of course these are psych patients who are in the hospital against their will-don't get me wrong, they NEED to be there-but these seemingly unessecary setbacks just seem to prolong their stay.
    So, sorry for the rambling. I am taking advantage of this site. I can gripe about some of works little-or big-frustrations, and not risk losing my job!
    Glad we have so many well educated professionals on this site-You all have been very helpful.

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