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

[solumedrol]

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!!!! :angryfire

[txspadequeenRN, BSN, RN]

A allergy is more on the lines of skin rash or shortness of breath (throat swellign shut). What I have found is the majority of people state they are allergic to a drug and they are just having S/E. Like one patient told me she was allergic to benadryl because it made her sleepy.. go figure.

HopeToBeANurseSoon said:

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

[solumedrol]

texas_lvn said:

Do they have poppy seeds or seaseme seeds?

Big Macs don't have poppy seeds on them. LOL. It will be great though if they do. Instead, they have sesame seeds on them.

[SebagoLaurel]

Good question. I am not best to answer, but an allergy is when for whatever reason, your body has antibodies (?) that fight the allergen. Allergens can be (not sure they always are) dangerous, causing anaphylactic reactions. I heard an expert MD speak once (mainly about food allergies) but when discussing different allergens, she said that most things that cause people to say they have "allergies" are really just "irritants" in the body. These are not dangerous, and since the symptoms are similar (sneezing, coughing, etc), not sure what difference it makes.

With meds, if the the reaction to a medicine is a side effect, rather than allergy, then there are workarounds - especially with pain managent. For example, if s/e is mild, it can go away after few days (for example, if makes you lethargic, start taking when dont have to drive for couple days, take only at night for while, 1/2 strength, etc.), then gradually add more. If n/v, start taking compazine for few days with it. If too strong, try another form of the opiod - maybe no reaction to that. Probably why someone who THINKS they are allergic (strength of reaction does NOT make it allergy) to morphine, can take Tylenol #3. Not really allergic to morphine, but in form of Tylenol #3, less/no reaction.

The reason I think it makes a difference is that I dont think doctors do patients any favors by letting them continue to think their reactions are allergic when they are not. It is more than just thinking, well since reactions are not pleasant, would not want to take it anyway. The reason I think this is that I am a brand new Hospice NP and RN (part time each). You would be surprised at how many people will reject ALL pain medicine because 10 years ago they had an "allergic" reaction and nothing anyone can say will convince them it was not allergic - nor will they consider working with palliative care MD or NP to find good pain management. Oh well - as they keep telling me - everyone has the right to be in pain. Just frustrating when I think maybe they could be made to feel better.

In my clinicals it was opposite sometimes - perfectly healthy younger people not willing to try anything to help themselves with pain cause they are afraid they will lose their narcotics. Say it took so long to find what works, etc.

[lpnstudentin2010, LPN]

thanks all for answering my question...just wondering.