Darvocet vs Percocet

[NurseyPoo7]

When you call an MD/PA/NP, what exactly makes them prescribe certain pain medications over another. I understand if its an inflammation deal, they may go with an NSAID depending on the pts hx, but in terms of Darvocet/Percocet/Vicoden, etc. what makes them choose one over the other? Is it just personal preference?

[kmoonshine, RN]

Usually it involves the severity of pain and the pts history.

Darvocet is a C-IV, usually used for mild-moderate pain.

Vicodin is a C-III, usually used for moderate pain.

Percocet is a C-II, usually used for moderate-severe pain.

You need a prescription each time to get percocet filled (no call-ins by the doc). Vicodin and Darvocet can have a certain number of refills (I believe its 3 for vicodin and 6 for darvocet, and can be called in). Percocet has a higher potential for abuse and is usually used for people with increasing tolerance to pain meds (ie previously on vicodin but no longer controlling their pain), or people with severe pain (ie post-surgical, kidney stones, fractures, etc).

Some providers are better with pain control and treat appropriately; others stick to the "motrin, tylenol" plan. However, if someone is in acute pain, I think there's nothing wrong with bringing out the "big guns" (ie opiates) to make them more comfortable. Afterall, the duration is usually limited (less than a week for many people), so why not help the pt feel better for a little bit? (granted, there are many people on these meds for chronic/long-term pain, which I will not be addressing in this post).

[VORB]

It's a good idea to first ask the pt what has worked for them in the past (if they have a Hx) before calling the doc, as docs will often ask the nurse what it is the pt wants. A lot of docs are not too handy in the pain mgt dept (and will admit same), so a little coaxing (coaching?) by the nurse never hurts.

[CaLLaCoDe, BSN, RN]

It's a good idea to first ask the pt what has worked for them in the past (if they have a Hx) before calling the doc, as docs will often ask the nurse what it is the pt wants. A lot of docs are not too handy in the pain mgt dept (and will admit same), so a little coaxing (coaching?) by the nurse never hurts.

What's your drug of choice? :chuckle:chuckle:chuckle

[Cobweb]

Another consideration are the major side effects--you may want one for a patient with bad kidneys, a different one for a patient with low respirations, etc.

[superramvette]

The abuse thing ruins it for everyone. I had a compound TIB/FIB fracture with femur bone graft/ titanium rod. They gave me an initial script for perc. To me the only time I ALMOST didnt hurt was when I was on it. Tylenol was pointless and I went through them pretty quick. Even though my pain was legit I had a helluva time getting them instead of darvocet. So to any nurse who hasnt felt BONE pain try to talk your docs into PERCOCET for bone patients

[TheCommuter, BSN, RN]

I'm surprised nobody mentioned drug allergies as a consideration for what the physician will prescribe. One of my rehab patients was allergic to about 50 different meds, and propoxyphene was the only pain killer he could take. Therefore, the doc decided to prescribe Darvon, which is Darvocet without the acetaminophen.