Codeine for analgesia

[NurseFirst]

Hi,

I just found out from a dear friend that her mom is dying from advanced terminal CA (mets everywhere)--recently discovered.

Her mom can't take morphine and reportedly is on codeine.

I was a bit surprised, because I don't think of codeine as, generally, a particularly strong analgesic (I couldn't even find it on any of the equalanalgesic charts) and hadn't heard of it being used for CA pain (but what do I know? I'm only a 2nd/2 yr student).

Could someone enlighten me? My friend also mentioned something about demerol--maybe it had been used in the hospital? I'm not sure. But I understand that many places shy away from demerol because it tends to make pts loopy. I told her that we've used dilaudid for some folks for whom morphine didn't work--though I'm not sure if there is any cross-sensitivity between morphine and dilaudid. Can anyone help me out ?

Thanks very much in advance,

NurseFirst

[letina]

letina- i haven't seen that type of device either, although it sounds wonderful but imagine it would be costly. unfortunately cost of care is a major factor in the care we give (most times).

leslie

Yes, it is a marvellous piece of equipment, yet I'm surprised it's not familiar, as it's manufactured in the US. Surprisingly, it is extremely cost-effective, not sure exactly how much it costs, but it's definitely not an expensive item.

To tell you the truth, I can't imagine what we'd do without them here for our palliative/terminal patients. Here, have a look :

http://www.marcalmedical.com/HTML/MS26/index1.html

Tina :)

[mebeafrn]

CD situations? I'm drawing a blank at that term.

We use Ativan for terminal restlessness, Haldol would be preferred for actual delirium. I have not seen Ativan as a buccal paste. Is it compounded for you that way?

Chemical Dependency-CD,if we have pt.s going thru withdrawl,esp. if have been self medicating at home or end stage liver disease and still using. As with the other feedback,we usually crush,mix w/few gtt. H20 to paste. We do use pre-prepared gels with Ativan if oral isn't a good option. We also use gel compunds for pain,antiemetic,agitation,delerium

[mebeafrn]

Can I just ask, are syringe drivers not used in the US? I don't think I've ever seen it mentioned on any of the threads and was just wondering, as they are widely used in the UK in terminal/palliative care.

We use subq cont infusion pumps with bolus option or if the pt. has an access device we run an infusion that way. If the drugs aren't compatible,short stability etc.... we run more than one pump or stop,flush,push,flush,restart etc.... we have syringe pumps,used with access device,meds in syringe,same action as threading a nut on a bolt,to put pressure on plunger...