morphine,dilaudid,demerol - page 2
by EJSRN 66,768 Views | 34 Comments
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 morphine....... Read More
- 0Nov 10, '08 by undertakeressThe hospital I am doing my clinicals at uses primarily Dilaudid.
On a personal note, I can't have morphine (hives at the injection site) or phenergan (makes me freak out) or toradol (anaphlaxis)...so when the lovely kidney stones (of which I've had 8) rear their head, 1mg of Dilaudid usually does the trick to ease the pain, usually combined with 25mg of Benadryl.
- 14May 18, '09 by lakotasuI'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.
- 0May 18, '09 by Straydandeliondilaudid.....is less likely to cause the usual side effects related to Morphine such as nausea and vomiting.
- 0Nov 15, '10 by Tina, RNInteresting! 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?
- 1Nov 16, '10 by OttawaRPNDemerol 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.
- 0Nov 16, '10 by ZippyGBRfrom 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 ...
- 0Nov 16, '10 by GooeyRNWe 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.