What is "stacking"?

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    Can anyone please tell me what "stacking" is? I am a new nurse and 1st heard the term this weekend in regards to a patient who was on hospice and had been prescribed both morphine and hydrocodone. Thanks!
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  3. 12 Comments so far...

  4. 0
    Hi, I have no idea. However as an old nurse the best thing I have learned is it is ok to say, "I don't know." When you hear terms, medications, procedures, etc., and you can't remember what it means or have never heard of it ASK. I ask patients what such and such meds is for (who can remember every medication!) I ask patients what their disease is, yesterday I had a patient with Sorjerns (sp) disease. It wasn't why she was in the hospital, she was having a minor procedure done. Of course you hopefully aren't asking some basic questions, how do I take a blood pressure, what is a heart rate, etc. And of course have reference books handy to look things up. But you won't find "stacking" in any medical reference book!!!!!
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    I don't know what stacking is. When we are using multiple meds to treat a symptom in hospice we call it polypharmacy in my neck of the woods.
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    I have heard of stacking related to taking steroids. It is the idea that taking more than one dose at a time (stacking doses) produces better gains or effects than taking one steroid dose, or one steroid, alone. I haven't heard of "stacking" in regards to prescribed medications, but we do frequently talk about giving an Ativan/Phenergan/Benadryl/etc "chaser." It does make sense though when discussing Morphine and Vicodin, that "stacking" these two medications will provide better immediate pain control than just taking either one alone.
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    To the best of my knowledge "stacking" means alternating between these two drugs. First take hydrocodone, then the next dose should be morphine, etc. They both treat pain in different ways, so it is believed to be more effective in pain management. We used this term in school when we were learning about arthritis, and how beneficial it is to "stack" Tylenol and Motrin - not taking at the same time, but alternating doses.
  8. 0
    Quote from studentNURSEwyo
    To the best of my knowledge "stacking" means alternating between these two drugs. First take hydrocodone, then the next dose should be morphine, etc. They both treat pain in different ways, so it is believed to be more effective in pain management. We used this term in school when we were learning about arthritis, and how beneficial it is to "stack" Tylenol and Motrin - not taking at the same time, but alternating doses.
    we call this practice alternating...for obvious reasons and it leaves little question as to what the plan involves.
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    The only time I have heard this term is in regards to men tx. The doc ordered albuterol and ipratroprium. Administer one amp of one then one amp of the other right after the first.
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    I have heard of stacking. We refer to it with neb txs. For example, if someone comes in with a severe asthma attack, the ERP may order 3 neb txs "stacked" which means one right after the other. I don't know what "stacked means" in your situation though.
  11. 1
    Quote from whisperinrain
    Can anyone please tell me what "stacking" is? I am a new nurse and 1st heard the term this weekend in regards to a patient who was on hospice and had been prescribed both morphine and hydrocodone. Thanks!
    The hospice Nurses at my facility often recommend "stacking" pain meds and the term can be used to describe an entire host of meds but is most commonly used in pain management. Think of the patients who take two different kinds of HTN meds, a beta blocker and an ACE inhibitor. Why not just increase one and get rid of the other?

    Basically...you know how you give a pain med, lets say q4hrs and the med works the first 2 hours but really tapers out the last 2? Well you give a second different pain med 2 hrs after administering the first pain med to bridge out the last half of the first med. Each of the meds covers the downtime of the other achieving maximum effectiveness.

    You use two different meds to treat one thing, in that case pain. The two meds work independently but handle the same issue. Seperate they are only somewhat effective, used in combo the sum of their effects is greater than on their own.
    TiffanyRN!! likes this.
  12. 0
    my step dad has stage IV cancer and they use the term "stacking" to refer to the confusion he gets when too many narcotics build up and his crappy liver doesnt metabolize them so he gets "stacked up" with narcs


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