Differences in pain medication

queenjean · Jul 18, 2008

Let's not forget the toradol here.

I'm beginning to love this little non-narcotic. I really feel like this provides more pain relief than fent, dilaudid, or morphine for tissue pain such as pharyngitis. I've had several pts who have been admitted with what amounts to a bad case of strep throat, and have been receiving IV pain med q 2 hrs, or on a PCA. They'll still be complaining of inadequate pain control, but if I call and get an order for a one time dose of toradol, they are good to go for hours.

sharona97, BSN, RN · Jul 18, 2008

queenjean said:
Let's not forget the toradol here.
I'm beginning to love this little non-narcotic. I really feel like this provides more pain relief than fent, dilaudid, or morphine for tissue pain such as pharyngitis. I've had several pts who have been admitted with what amounts to a bad case of strep throat, and have been receiving IV pain med q 2 hrs, or on a PCA. They'll still be complaining of inadequate pain control, but if I call and get an order for a one time dose of toradol, they are good to go for hours.

I agree!

Altra, BSN, RN · Jul 18, 2008

queenjean said:
Let's not forget the toradol here.
I'm beginning to love this little non-narcotic. I really feel like this provides more pain relief than fent, dilaudid, or morphine for tissue pain such as pharyngitis. I've had several pts who have been admitted with what amounts to a bad case of strep throat, and have been receiving IV pain med q 2 hrs, or on a PCA. They'll still be complaining of inadequate pain control, but if I call and get an order for a one time dose of toradol, they are good to go for hours.

Gee, I'm coming to your hospital, if a sore throat will get me a PCA ...

queenjean · Jul 19, 2008

If I'm pushing pain medication on you every 1-2 hours, you're getting a PCA!

Seriously, the first one of these, I thought-what a wimp! Then he got to the floor--drooling because it hurt too much to swallow his own saliva. They ended up taking him to ICU a day later and intubating him, his throat was swelling so fast.

Not to hijack the thread, but maybe once every 2 months we get someone with a horrible, horrible case of pharyngitis/tonsillitis that was unresponsive to the initial round of outpt antibiotics, they end up being hospitalized for pain control and possible surgery.

Anyone else noticing an increase in this sort of thing? I assume it has to do with resistant bacteria and poor healthcare access. Only in the last 3 or so years have I been noticing this; 8 years ago when I first became a nurse, I never saw anyone on an adult floor admitted with pharyngitis.

Or maybe we just have nice ER docs who admit for anything (not really true about that last part, but some nights--particularly SUNDAY nights--it sure seems like it!).

kmoonshine, RN · Jul 19, 2008

queenjean said:
If I'm pushing pain medication on you every 1-2 hours, you're getting a PCA!
Seriously, the first one of these, I thought-what a wimp! Then he got to the floor--drooling because it hurt too much to swallow his own saliva. They ended up taking him to ICU a day later and intubating him, his throat was swelling so fast.
Not to hijack the thread, but maybe once every 2 months we get someone with a horrible, horrible case of pharyngitis/tonsillitis that was unresponsive to the initial round of outpt antibiotics, they end up being hospitalized for pain control and possible surgery.
Anyone else noticing an increase in this sort of thing? I assume it has to do with resistant bacteria and poor healthcare access. Only in the last 3 or so years have I been noticing this; 8 years ago when I first became a nurse, I never saw anyone on an adult floor admitted with pharyngitis.
Or maybe we just have nice ER docs who admit for anything (not really true about that last part, but some nights--particularly SUNDAY nights--it sure seems like it!).

I've never seen a person admitted for pharyngitis; but I've seen people with peritonsillar absesses admitted, and they all seem to get heavy narcotics.

It sounds like the patient who went to ICU had epiglottitis. Extreme sore throat + drooling = BAD.

nurse678 · Apr 6, 2011

Wow I had no idea fentanyl was the strongest... was thinking dilaudid was the strongest followed by morphine and then fentanyl...I feel so dumb

steelydanfan · Apr 7, 2011

heaverboo said:
I work on orthopedics and pain meds are big on my floor! What is the difference and in your opinion and which medication is stronger?
I know percocet is oxycodone/tylenol and lortab is hydrocodone/tylenol...which is better? Fentanyl/Morphine/Dilaudid/Demerol what's the difference? Patients ask me often which is the best choice. Percocet vs Lortab? Agh...so many choices!! And I dont know how to respond when patients ask

Your pharmacy should have an equagesic(?) dosage chart that you can refer to, or just call and ask. Your hospital pharmacist is an invaluable resource, and unless they are swamped, will be happy to help. They are generally the most collaborative department in your orificenal of resources.

LouisVRN, RN · Apr 7, 2011

Agree with the poster who loves Toradol. Especially I have found for young-middle age men whose pain is not controlled with dilaudid alone or anyone with a history of drug abuse or a fever that's unresponsive to Tylenol or pt can't take PO/rectal. Also for some patients continuing with their home Lyrica/Neurontin can make all the difference in how they respond to pain control.

I also agree with the poster that said sometimes it is entirely individualistic and people do not allows follow what we know to be fact. My husband for instance can take 2 5/500 Percocet and not feel anything. I take one and I'm puking and feel drunk for about 6 hours to the point I pretty much can not stand up. Demerol, you better have a wheelchair nearby because I will be barely conscious in about 20 minutes. I've never had anything stronger than that but unless I'm having MAJOR surgery I really just want Ibuprofen. Its helped me through 4 wisdom teeth extractions (done at the same time) and having my tonsils removed.

TiffyRN, BSN, PhD · Apr 7, 2011

Equanalgesic chart. I am linking to wikipedia entry. Note; it must be from a non-American English speaking country because it lists pithidine (which is called demerol in the US) and a couple of others I'm pretty certain are not prescribed in the US.

http://en.wikipedia.org/wiki/Opioid_comparison

But even with that, it's all about dose and combination.