Question about Fentanyl/Durogesic patches - page 3

Fentanyl patch and relief of osteo pain Has anyone had any experience with the use of the Durogesic/ Fentanyl patches for people who suffer from chronic osteoporosis pain? I would appreciate... Read More

  1. by   NRSKarenRN
    even one 50mg duragesic patch can be fatal in someone who has never used narcotic pain medicines before.

    this drug is interended for transdermal (skin) slow sustained release. anyone who tampers with the drug patch is at high risk of harming themselves and their loved ones.
    it must be used by clients with adequate instruction and prescribed only by knowledgeable practitioners who monitor/evalute the clients pain response and side effects.

    website:
    http://www.duragesic.com
    Last edit by NRSKarenRN on Feb 22, '04
  2. by   elkpark
    Fentanyl patches are a godsend to people with chronic pain, but, all of us out there that are administering them, PLEASE be aware that there is a high risk of diversion/abuse. The literature is full of articles nowadays. I am a surveyor/inspector for my state and for CMS (the Feds) and investigated a death on a psych unit in our state related to a patient who was abusing patches (cause of death was acute fentanyl toxicity) that were legitimately prescribed by the attending on the psych unit and administered by the nursing staff. The hospital ended up in serious trouble with the Feds because the person was dead and the nursing staff could not account for the used patches.

    The preferred method of disposing of them is to cut them in half and flush the two halves, according to the DEA. That way, the gel is washed out and diluted. The other acceptable method is to secure the patch(es) in a tamper-proof container until they can be incinerated. Amazingly enough, a sharps container is NOT considered a tamper-proof container by my state DEA -- they need to be LOCKED UP somewhere ...

    And, as another poster mentioned, a used patch should be handled the same as any other partially used dose of narcotics -- two people should witness and sign that it was wasted.
  3. by   ktwlpn
    Isn't it SOP to check placement of the patch at least once a shift-or more frequently? It is even on our MAR-we do it and we sign it off...We have staff and residents that will pull of duragesic patches mistaking them for nitro patches...so we have to be vigilant..
  4. by   Dave ARNP
    In LTC they also have a tendency to fall off during normal care activites. I've gotten calls that houskeeping found them, they came off on a showerbed, even lost one on a strecher in the ambulance.

    Patches not only need to be checked Qshift, they need to be marked so that some sort of identification can be made as to whom they belong.

    -Dave
  5. by   barb4575
    I have two...Shane and ShyAnne...they are the loves of my life. I had four miscarriages in my forties and no biological children of my own. But, I thank God for my dogs....awwwwwww yours is so cute too!

    Barbara

    Quote from hoolahan
    I have also seen it used very successfully in the elderly with sever DJD (degen joint dis aka arthritis OA etc...)

    One lady was so snowed from the qid (foru times a day) darvocet, she luterally was wearing a diaper b/c she had no strentgh to move. I suggested the lowest dose patch to her doc, we stopped the darvocet, and her dtr was so amazed, in a week's time, she perked up, started making it to the BR, and stopped using the doapers. Her entire quality of life was changed.

    One thing, it is difficult for the elderly to manipulate this patch. I wroite to the manufacturer and c/o b/c it was so hard to see the clear backing, and I can't tell you how many times I found someone wearing the patch w the backing still on it. I asked them to color-code the doses and to make the backing and the pATCH A CONTRASTING COLOR or make an outline, so the older folks could see it. They write me back thanking me, but not sure if it has changed anything.

    Also , have to dispose of the used patches carefully, it could kill a young child or animal if they ate it out of the garbage or laying around the home. They need to be folded up and flushed.
  6. by   sixes
    Quote from Tookie
    Thank you both Renreian and kids-r-fun for replying
    Forgive my ignorance - could you please give me an explanation for the followig they are not abbrevations that l am used to using
    LOLs'
    BID toTID dosing
    Thank you both for replying
    sandra
    LOL's lots of laughs
    BID you get medicine twice a day
    TID you get medicine three times a day

    I'm guessng you aren't in the health care profession and if you are your a newbie
    Hope this helps
  7. by   jrenae
    We use the Duragesic patch for a client with severe Rheumatoid Arthritis, and it works well for pain, but it does cause her to be nauseated. Also if you have problems keeping them on, go to their web site and there is a number you can call and answer a few questions and they will send the client free biooculsive bandages to apply over the patch to keep it secure. Thought I would pass this on.
    Yesterday is the past, tomorrow is the future, and today is a gift THE PRESENT. Use it wisely.
  8. by   Dave ARNP
    Where are you folks at that patients do so well with Duragesic?

    I've found them virtually useless for chronic non-malignant pain.
    Cancer pain does fairly well with them, especially Lung.

    I write fewer Duragesic patches than any other schedule II out there.
    Now the Actiq trans-mucosals... THEY'RE AWESOME!

    -Dave
  9. by   ktwlpn
    Quote from MD Terminator
    Where are you folks at that patients do so well with Duragesic?

    I've found them virtually useless for chronic non-malignant pain.
    Cancer pain does fairly well with them, especially Lung.

    I write fewer Duragesic patches than any other schedule II out there.
    Now the Actiq trans-mucosals... THEY'RE AWESOME!

    -Dave
    In our LTC (2 out of our 3 docs are lousy at pain control issues) we have used them only for terminal cancer pain and had good results.We recently had a pain control inservice at the staff's request.It was presented by a drug rep and was a commercial for duragesic patches.She was touting it heavily for all chronic pain.She did bring us nice snackage but as for pain control she did not teach us anything we did not know and she did not make a dent with the nurses that withhold pain meds (you know---Nurse "He was asleep" Smith and Nurse" I don't want to make him stop breathing Jones" ) I have afew new residents-very challenging-multiple problems...One fella has necrotic feet and a stage 3 sacral decube...I have to give him regular tylenol round the clock before his doc will start taking him up the ladder and he will almost never write any standing orders-it's always PRN....darn shame
  10. by   Dave ARNP
    Me thinks Dave needs to have an inservice with your staff!

    -Dave, who wants to smack people like that.
  11. by   gwenith
    Quote from sixes
    LOL's lots of laughs
    BID you get medicine twice a day
    TID you get medicine three times a day

    I'm guessng you aren't in the health care profession and if you are your a newbie
    Hope this helps
    It's a language thing for us BID = bd TID = TDS

    Don't even start me on how many time sI have had to look up drug names!!! :chuckle
  12. by   sixes
    Quote from gwenith
    It's a language thing for us BID = bd TID = TDS

    Don't even start me on how many time sI have had to look up drug names!!! :chuckle
    I think we should get together and make a universal language in nurseing
    I get so confused sometimes trying to figure it alll out here we have RSW you all take about crns and such maybe we should start an abbreviation dictionary
  13. by   pumpkinsooner
    Quote from Dave ARNP
    Where are you folks at that patients do so well with Duragesic?

    I've found them virtually useless for chronic non-malignant pain.
    Cancer pain does fairly well with them, especially Lung.

    I write fewer Duragesic patches than any other schedule II out there.
    Now the Actiq trans-mucosals... THEY'RE AWESOME!

    -Dave
    I have the unfortunate pleasure of being an RN who has to personally use both Duragesic and Actiq. I'll keep the dosage to myself; suffice to say it would put you to sleep for weeks.

    I had ulcerative colitis which went to toxic megacolon, and had the J-pouch surgery, then had some complications, and almost before I knew it I had undergone five laparotomies in 23 months, all through the same vertical incision. The best explanation they can give me for 'why does it still hurt?' is that the muscle and fascia are stretched and sutured in such a way to irritate the nerves. I went to a pain mgmt specialist who put me on OxyContin; we got up to 120mg a day of it before I figured out I wasn't digesting the stuff. It was coming out whole in the toilet. I changed MDs and now I use the above meds, both of which bypass the upper gastric tract (except, of course, for the mucous membranes of the mouth).

    I had problems with the patches sticking at first, too. I've learned that I have to put them on my back, preferably my lower back, away from my waist. I can't put them on my chest or my arms because the movement loosens them up too much. I also rub the edges and press them down all around for at least 90 seconds. I also got under-dosed at first, and I change my patches q48 instead of q72; I think my skin is warmer than most and the change to q48 actually helped quite a bit. Maybe you could consider that.

    The Actiq are indeed wonderful, but they are simply out of most people's price range. If you don't know how much the things cost, you really should find out. If I were not on an insurance plan that paid for them -- and I had to get a special waiver for it -- the Actiq I take would cost $2800 a month, and I think I'm underestimating it. Cephalon does have a program to send it at no cost to patients with malignant pain, but they won't talk to you if you're non-malignant. You can check the retail price at walgreens.com, although the last time I looked it was out of date with the new quantities per box. There's only one pharmacy in my part of the state that will carry Actiq, and they absolutely refuse to dispense single units -- boxes only.

    Please feel free to email me privately if you'd like to discuss more. I'm just now coming out of the dark and starting to function again, and it's helpful to me to talk about my good and bad experiences with pain management. And for everybody else, I know there are drug seekers out there, but many of us just hurt and want some relief. Good luck to all of us!!

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