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| No. 60 | 
Jul 01, 2009, 09:53 AM
 Re: OMG...NO vicodin or percocet????
What did Forest Gump say? Stupid is as stupid does....it doesn't matter how much education is given regarding medication. People just don't listen. I normally write it down on discharge specifically stating that percocet CANNOT be taken with tylenol or acetaminophen.
Unfortunately those with resultant problems have one problem- NO ONE appears to read, and somehow no one understands that alcohol and tylenol do not mix-AGAIN NO READING.
So many patients take medications wrong, so many over-medicate or just don't even bother because they don't understand the importance of their meds.
HOWEVER, I don't want the FDA telling me I can't have a percocet or my tylenol, FIX THE DAMN HEALTHCARE INDUSTRY AND LEAVE MEDS ALONE.
HOW ABOUT REQUIRING THE DUMMIES TO SIGN AN AFFADAVIT THAT THE PHARMACIST EXPLAINED THE RISKS PRIOR TO PURCHASE? Too bad we can't ferret them out from the responsible users of medications.
Just my   | | Advertisement Sponsored Links | | | | No. 61 |
Jul 01, 2009, 10:20 AM
Re: OMG...NO vicodin or percocet???? Originally Posted by southernbeegirl  while i dont disagree with your post.....what the heck ever happened to personal accountability?????????
if you are going to take something then you should know what the heck you are taking and stop blaming people for your own ignorance! (i know, i know, i live in a fantasy world huh?)
There's knowing, and there's knowing. Most people don't know a thing about pharmacology. The point in my previous post is that a person CAN follow directions and still OD on acetaminophen. Yes, if a person diligently followed each fine-print instruction that comes with a medication, s/he may not make that mistake. But they still might simply because they don't understand that their medication has a common OTC medication already in it. Some people have pointed out that many consumers assume Tylenol is safe since it is in so many OTC meds. The big picture is that people don't understand that overdosing on Tylenol is far more immediately dangerous than any other common OTC medication.
I agree with you about accountability. Since we must assume that the average consumer knows nothing about pharmacology, it is the job of the pharmaceutical companies to simplify the naming of medications, and the provider to reinforce education. The patient should take whatever precaution is needed in order for them to understand what they are taking to the best of their ability. But if they can't read English, or have some kind of learning deficit, or come from a cultural background which does not esteem personal accountability in regards to medicine (this is huge and is not for us to judge), we should recognize this and prescribe/educate accordingly.
I think there are a lot of nurses on this board that don't understand the difference between a combo drug vs separating the opiate from the analgesic. Why would non-nurses understand any better?
| | No. 62 |
Jul 01, 2009, 10:31 AM
Re: OMG...NO vicodin or percocet???? Originally Posted by kanzi monkey How is this amazing? Why would they? Are they supposed to know what APAP is too? I don't think it's strange at all that people get confused about what they're taking. It doesn't say Tylenol on a bottle of generic Acetaminophen, or Advil on a bottle of Ibuprofen. And people may read warnings, though they may not read active ingredients, because they think they'll be safe if they follow the instructions. Picture this: a patient with a bottle of Tylenol and a bottle of Vicodin. The warning on Tylenol says not to exceed 4 grams of acetaminophen a day. Fair enough. The bottle of Vicodin says Hydrocodone 7.5/APAP 500mg. Ok, there's no "acetaminophen" in that, right?--must be safe to take them together! Maybe the prescriber advised the patient not to do this--perhaps the patient had TAKEN said medication as he's being educated by his provider and he's forgotten. It's a recipe for disaster.
I meant no disrespect to the general public. I find it amazing in this day and age that people have not been educated by their doctors, pharmacists, nurses and/or warning labels. As I stated before, I caught my dh - who by no means is stupid - trying to take 1000mg of tylenol with his vicodin. He was clueless. I guess too many people just assumed he knew. It is hard sometimes I think for us as medical people to realize that all this stuff isn't basic knowledge for some.
| | No. 64 |
Jul 01, 2009, 10:43 AM
Re: FDA Panel Votes to Eliminate Vicodin and Percocet Originally Posted by kemper1974 I have rheumatoid arthritis, and I don't see my rheumatologist writing out oxycontin or dilaudid or mscontin for my occasional severe pain.
How about a script for oxycodone and a script for tylenol? (I know tylenol is OTC, but sometimes writing a script for it helps get it in the patients hands when they are in the pharmacy) This would give you the equivalent of percocet.
If you take vicodin for severe pain, I don't think hydrocodone is made separately, though perhaps that will change in response to this FDA rec. In the interim, would vicoprofen work? Maybe the anti-inflammatory property would be beneficial.
I don't think your rheumatologist will leave you hanging. RA is serious and needs to be treated. I'm sorry for your suffering.
| | No. 66 |
Jul 01, 2009, 11:06 AM
Re: OMG...NO vicodin or percocet????
My SIL worked for FDA and then several pharmaceuticals, they have plenty to worry about and work on.
She does analysis of studies to ensure compliance, with that in mind the stories I have heard have boggled my mind. In some ways she is perfect, if it isn't right it isn't getting signed off on...however how many people are like her?
Even before I was a nurse I had heard acetaminophen was the number one reason for liver transplants.
My point in medicine is that we need to take the time to educate patients on medication. Pharmacists should take the time to educate patients on medications. Schools should be educating students on not taking medications without reading labels and educating them on PREVENTION.
THE POINT IS EDUCATION. I don't need the FDA to take my tylenol away or the option of percocet if that's what works. What about personal responsibility. Maybe we shouldn't give any meds at all and have them doled out because people can't be trusted to follow directions That's where this is headed-this is way beyond BLAME THE VICTIM, this is saying CONSUMERS are too stupid to respond to warnings.
Don't know about you, but I'd like to keep my options to choose open.
As for the FDA, they may keep us safe in some ways but hinder us in others. Europeans enjoy the use of many different drugs that have been used for years and subjected to trials under their auspices. If something like giving a live vaccine allows someone suffering with horrible autoimmune diseases or skin rashes to have remission, then that educated person should not be made to leave this country to get it. For all we have, and all we spend and regulate we have the worst outcomes.
Let's face it, the real reason is probably some legislator's kid, wife or family member hooked on pain killers died or needs a liver transplant. Isn't that the reason most things like this pop up?
M
| | No. 67 |
Jul 01, 2009, 11:13 AM
Re: FDA Panel Votes to Eliminate Vicodin and Percocet Originally Posted by I love my cat! I think one reason that many people take too much acetaminophen is because they cannot get the appropriate pain medications from their MDs to manage their pain in the first place. They are not believed as really having real pain, they are labeled as "seekers", malingerers, etc......
I am referring to people with chronic pain.
So, they self medicate and pop extra strength Tylenol 24/7 and often washing it down with a few drinks.
Hey, I guess I don't have any problems with Vicodin and Percocet being banned. I DO have a problem with people that have relied on this medications, often for years, not being medicated for their conditions adequately as a result of the ban.
To add, I know several Pain Management Specialists that HATE Vicodin (they do not like hydrocodone at all) and they will only prescribe Percocet for Chronic Pain Management. If I run into one of these MDs in the next few weeks, I'll ask what they would be if the drugs do get banned.
(Just wondering....could other AN members ask MDs in their Hospitals/Clinics/Offices what they would choose for pain management? I am curious to hear what other MDs have to say...even if it is just a hypothetical situation).
Actually, don't we have a couple MDs on this site? What would you do if this ban really happened?
Thanks!
Chronic pain management depends on the nature of the pain (visceral, neuropathic, somatic, etc.) Tricyclic antidepressants, some SSRIs, gabapentin, and some anti-epileptics are working for some chronic pain conditions such as neuropathy or fibromyalgia. Ultram often works for severe pain when used in combination with some of the above. Ibuprofen is a great anti-inflammatory, and for people who can't tolerate that for GI reasons, a cox2 inhibitor like Celebrex may be a good option. Tylenol PRN or around the clock may be extremely helpful for arthritis pain. Opiates aren't the first choice for most chronic pain, for obvious reasons, but when it's needed I certainly think a combo is inappropriate . I think something long-acting should be on board, like MS-contin. Maybe fentanyl patch or oxycontin for very severe pain (ie, cancer associated pain, and if morphine doesn't work). For breakthrough pain I'd look again to ibuprofen, tylenol, ultram, MSIR, or oxycodone, starting with the OTCs, then moving up the ladder in strength.
I am not a chronic pain specialist, though I am interested in it and am considering pursing this career path down the line (I just got my master's and will sit for the NP board in a few weeks) I'd like to hear what other folk would recommend as well.
I'm listening to "Here and Now" on NPR right now talking about the proposed ban--just said 56,000 ED visits for tylenol OD/year. Outrageous.
| | No. 69 |
Jul 01, 2009, 11:40 AM
Re: OMG...NO vicodin or percocet???? Originally Posted by MAISY, RN-ER
Don't know about you, but I'd like to keep my options to choose open.
M
If percocet and vicodin get banned (which they probably won't. I bet they'll just get black boxed), the only clinically significant change is what formulation of hydrocodone a patient may get. As far as I know the only medication left with hydrocodone would be vicoprofen (maybe narco? does it have less acetaminophen?). For most people, I don't think switching vicodin to vicoprofen would be a problem--especially since a patient could safely take tylenol with vicoprofen. If they can't have ibuprofen, well, they'd have to try another option.
Besides this, for patients that currently take 2 percocets q4 hours, or 2 vicodin q 6 hours, they can just take 2 oxycodones and 2 regular strength tylenol q4 hours, or 2 vicoprofen and 2 extra strength tylenol q 6 hours, which is almost exactly the same. So, no options are lost. Options are GAINED however in that patients can adjust how much narcotic to take, and how much acetaminophen to take as they see fit.
I remember when people were getting so angry about trans-fat being removed from their food. People argued that they liked it and didn't want the government to tell them what to eat. But there's no consumer value to trans-fat at all--it allows foods to be cooked at higher temperatures and increases a foods shelf-life. That's it. And it is 10x worse for you than saturated fat. Sometimes taking something AWAY is good for people. And people argue that it's their right to have it. Who says? Why is it someone's right to have a product if it has no benefit over another option, and if, in fact, it carries a risk of significant personal harm?
If people UNDERSTOOD the trans-fat issue, they wouldn't have been so adamant about keeping it around. If people understand that eliminating acetaminophen/narcotic combination medications will likely have no influence on how their pain is managed they won't care if that product is removed from the market.
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