morphine,dilaudid,demerol - page 2

why is dilaudid the most common IV pain control method. Just wondering why i dont see more morphine. Why isnt demerol used very often? In my experience patients do not respond very well to... Read More

  1. Visit  lakotasu profile page
    14
    I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.

    Thank you.
  2. Visit  GomerPyle profile page
    0
    in terms of quantity, we dispense dilaudid by the gallons on my busy med/surg floor here in florida. i surmise that this may have a direct correlation to the number of frequent flyers on my floor. again, just my
  3. Visit  Straydandelion profile page
    0
    dilaudid....
    .is less likely to cause the usual side effects related to Morphine such as nausea and vomiting.
    Working Ortho I secretly called Dilaudid the "headache" pain medicine because it seemed to cause headache's in a lot of my patients. I have found that morphine and dilaudid seem to be used more often then Demerol but could possibly just be the facillity.
  4. Visit  Tina, RN profile page
    0
    Interesting! I was just wondering about this myself. I recently returned to floor nursing after 10 years away. Ten years ago, I remember giving demerol to my patients quite frequently. Now, the hospital I work at doesn't even carry it! We use morphine and dilaudid, mainly. When did demerol start to be phased out? Do lots of hospitals not even stock it anymore?
  5. Visit  OttawaRPN profile page
    1
    Demerol has received a lot of bad rap worldwide (seizures, delirium, neuropsychological effects) and many hospitals have d/c using it - we don't even carry it with our narcs.

    Morphine, in its various forms, has been the gold standard for pain control but we use a lot of Dilaudid - a good alternative to those with Morph allergies.

    Here the pharm drug of choice for addicts is Oxycontin so it has a huge street value - when drug stores get robbed, that's what they're going for. They crush it and sniff, snort or shoot.... then buzz.
    Ginger80 likes this.
  6. Visit  ZippyGBR profile page
    0
    from the UK perspective Morphine is the opiate that is usually prescribed as a strong opiate - primarily because in relative terms it is very very cheap ( pennies per 10 mg ampoule) also MR tablets and immediate release tablets and oral liquids are nice and cheap as well.

    Pethidine / merperidine has become rarer and rarer due to the side effect profile etc ...

    Oxycontin is in our formulary as an alternative to moprhine if morphine is not appropraite , we also use fentanyl - though mainly transdermal patches and the 'lollipops' on the wards but the passers of gas and some of the ED consultants like it as an IV

    'weak' opiate wise it's a toss up between codeine and tramadol depending on the preference / fetish of the consultant in question they are both in the formulary and co-codamol is in the ED triage PGDs ...
  7. Visit  GooeyRN profile page
    0
    We used to give tons of Demerol. In 2005, we stopped giving it all the time, (due to there being a lot of seizures from it) and started giving Dilaudid instead. It really ticked off a lot of patients. I guess you can get a better buzz from Demerol? We don't give much morphine- it makes a lot of people itch, and Dilaudid seems to work better for the pain anyway.
  8. Visit  BluegrassRN profile page
    2
    Quote from Straydandelion
    dilaudid....

    Working Ortho I secretly called Dilaudid the "headache" pain medicine because it seemed to cause headache's in a lot of my patients.

    THANK YOU! Anyone else notice an association between Dilaudid and headaches?
    ChrisMonty and sevensonnets like this.
  9. Visit  grannyrn65 profile page
    0
    Quote from lakotasu
    I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.

    Thank you.
    Thank you for your enlightenment regarding pain management for both acute and chronic suffers. Unfortunately, it has been my experience that most of our peers will continue with their negative attitude, labeling their patients as drug seekers and addicts, as well as frequent fliers. McCaffrey has zero in on the problems with inadequate pain management. Over the past twenty years I've suffered from episodes of both acute and chronic pain. And I have dread going into the hospital for any type of surgery because of the judgemental attitudes of my peers (after they have seen my extensive history of fractures and surgeries). I have had nurses delay giving me ordered medication because they 'question' the degree of my pain.

    When I went back for my second Masters, I was happy to see the professors take the enlighten view of pain management. Hopefully, given the slowly changing education attitude, we will have more nurses who will take the enlighten attitude toward patients.

    As for which medication I've used, in 1989 I was prescribed Demerol for bone pain and post surgery, following massive fractures and a three month stay. By 2003, I was being prescribed morphine for a fracture of my ankle. By 2006, it was dilauid following compression fractures of my thoracic vertebra.
    In my area, it appears that dilaudid and morphine are used in patient and oxy outpatient.

    GrannyRN65
  10. Visit  oceanfamily1992 profile page
    1
    Regarding "drug seeking" behavior - as a chronic pain patient myself, I've learned not to specifically request what I know words for me because I'm immediately tagged as a drug seeker. People in pain have learned exactly what does and doesn't work. It's less time-consuming and we get relief sooner if we could simply say what works and what doesn't. Doctors have their favorite medications/habits in treating pain, and if a patient asks for something out of the doctor's ordinary habits, alarm bells seem to go off. The attitudes between nurses and doctors I've witnessed are unacceptable and judgemental. I know we see people who are just there to get drugs, but you can't let that blind you to each individual patient before you. Give each person a chance and make them PROVE they aren't being honest.

    Also remember that because pain patients have been treated so disrespectfully so many times, we may act a little off. A little suspsicious of nurses and doctors. A little, or more than a little, fearful, because we know we may not get adequate help simply because we aren't believed. Don't throw out your experience and judgement, but give each patient a clean slate and take great care to not make assumptions. You will end up helping patients who are truly in need, and will help the patient be slightly less fearful the next time they have to go to the ER for pain help.

    Pain patients have learned to avoid the ER at all costs. Did you know that most questionairres at pain clinics ask how many times you've been to the ER for pain, as if that's a sign you aren't in pain but just want drugs? If a pain patient shows up at the ER, they're really in trouble and need your compassionate, best help.
    ChrisMonty likes this.
  11. Visit  Butterfly0328 profile page
    1
    Quote from lakotasu
    I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.

    Thank you.
    Loved this post. I am not even in nursing school yet-next year. But I have dealt with chronic pain and have a friend who suffers horribly with chronic pain... I do believe that one day when I have that license I will be working in this area. Pain is so misunderstood and so many people suffer needlessly. God Bless you for what you do for those who suffer from this horrible monster!
    mrsmamabear2002 likes this.
  12. Visit  Butterfly0328 profile page
    1
    Quote from oceanfamily1992
    Regarding "drug seeking" behavior - as a chronic pain patient myself, I've learned not to specifically request what I know words for me because I'm immediately tagged as a drug seeker. People in pain have learned exactly what does and doesn't work. It's less time-consuming and we get relief sooner if we could simply say what works and what doesn't. Doctors have their favorite medications/habits in treating pain, and if a patient asks for something out of the doctor's ordinary habits, alarm bells seem to go off. The attitudes between nurses and doctors I've witnessed are unacceptable and judgemental. I know we see people who are just there to get drugs, but you can't let that blind you to each individual patient before you. Give each person a chance and make them PROVE they aren't being honest.

    Also remember that because pain patients have been treated so disrespectfully so many times, we may act a little off. A little suspsicious of nurses and doctors. A little, or more than a little, fearful, because we know we may not get adequate help simply because we aren't believed. Don't throw out your experience and judgement, but give each patient a clean slate and take great care to not make assumptions. You will end up helping patients who are truly in need, and will help the patient be slightly less fearful the next time they have to go to the ER for pain help.

    Pain patients have learned to avoid the ER at all costs. Did you know that most questionairres at pain clinics ask how many times you've been to the ER for pain, as if that's a sign you aren't in pain but just want drugs? If a pain patient shows up at the ER, they're really in trouble and need your compassionate, best help.
    I couldn't agree with your more. This friend I have has had a multi-level fusion, Degenerative Disc Disease, and Fibromyalgia just to name a few and last year she began to experience the same symptoms she has prior to her fusion surgery when she had spinal cord compression. Her pain doctor and her neurosurgeon told her to go to the ER if she felt she may be at risk of stenosis again and if she was experiencing a lot of pain. I finally talked her into going after she put it off for about 2 weeks. Long story short, the insurance company intially refused to even cover this visit, stating it was not an emergency!! Thank goodness her pain doctor was one to document everything and in the notes from one of her office visits he had noted the fact that he recommened she go to the ER in the event her pain became worse. Once I faxed all this documentation into the insurance the claim was processed. We have a long way to go in this area. It's so very hard for those who have never experienced chronic pain to understand it.
    mrsmamabear2002 likes this.
  13. Visit  cmram28 profile page
    0
    I worked as a pharmacy tech in the Trauma unit before I became an RN and I asked the pharmacist the difference in short morphine is a short acting narcotic and dialudid is a long acting narcotic. The ratio of dilaudid to morphine is 7.5mg:1 mg ...keep in mind it all depends on the patient. Personally I had kidneys stones and morphine did little for my pain which felt as if I were giving birth thru a straw!! Dilaudid was a savior. Demerol is antequated and is being phased out; too many side effects.

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