Dilaudid and Psych patient

Nurses General Nursing

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Specializes in Adult health, Primary care, WH..

i am a new nurse.

i had a patient who was admitted for medical reasons. this patient had an extensive psych history. i finally got admission orders and pain medication 4 hours after the patient had arrive to the floor. i medicated the patient with dilaudid 2mg iv. it was iv pushed over 5 minutes. the policy at my work place allows dilaudid 2 mg iv to be iv pushed in 2-3 minutes. in a couple of minutes,the patient's eyes closed, tacypnea, pupils dilated & slowly responive to light, and became nonverbal. to make it short... i gave narcan 0.4mg iv and was not effective. ativan 0.5mg iv was given and was not effective. benadryl 25 mg iv was given and was not effective. i had to transfer this patient to the icu because of hyperventaliation.

i was simply medicating my patient for c/o pain. this was the first dose given. i don't know what happen. is there an interaction between seroquel and dilaudid? did dilaudid trigger something neuro wise like the neurotransmitters? was it an allergic reaction? or dilaudid was too much for the patient eventhough the adverse effects were opposite of narcotics?

psych patients do some weird stuff.

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no, at worst, any interactions would only be moderate...

was she on any other psych meds?

i'm curious and showing my ignorance:

why give the ativan?

leslie

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Specializes in Adult health, Primary care, WH..
no, at worst, any interactions would only be moderate...

was she on any other psych meds?

i'm curious and showing my ignorance:

why give the ativan?

leslie

The only Psych med was Seroquel 450mg QAM and Seroquel 550mg QHS. The morning dose was already taken prior to admission. Our pharmacy said that Seroquel's max dose is 800mg. The mother of the patient said the patient needed the 450mg + 550mg daily or else the patient's psych history would not be controlled.

The rapid response nurse suggested to give ativan b/c the patient had rapid respiration, the psych history, and appeared anxious.

???

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Specializes in Emergency.

Is it possible that the dose was incorrect (perhaps 4mg was administered instead)?

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Specializes in Adult health, Primary care, WH..
Is it possible that the dose was incorrect (perhaps 4mg was administered instead)?

No, the doseage on the Dilaudid bottle said 2mg/1ml. The order dose was dilaudid 2mg IV PRN Q4 hours. I only gave 2mg.

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i'm going to share something.

when i was first dx'd w/ptsd, this psychiatrist started me on seroquel 300mg po qd.

(supposedly to reduce flashbacks, but ultimately concluded it was just to snow me)

seroquel is extremely sedating.

when he put me on adjunct meds, my husband stepped in since i couldn't manage myself.

any other med that carries sedating effects is just going to increase the effects of both/all meds.

(that's why i asked about giving ativan)

i'm thinking that since this pt has exceeded the recommended dosage, adding dilaudid was just too much...

you know, put him over the line.

it's the truly talented, experienced psychiatrist that knows how to manage those w/mental impairments.

but even then, there are so many adverse events that can happen if not closely monitored.

again, i do think the dilaudid (even 2 mg) pushed him over.

leslie

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but why tachy and DILATING pupils

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Specializes in here and there.

Regardless of the dosage ( 2mg or 4mg of dilaudid), and it really doesnt count.... i really do not think it was an overdose. Pts are not usually tachypneic or have dilated pupils with an overdose ( its the opposite) , and usually narcan works if given on time. It didnt work for the patient. I think something else was going on. Maybe drug interaction or something , but i doubt that it was an overdose. Things happen but even if you pushed it over 12 mins or 1 min.. it would still have happened. I strongly suspect that it was not the dosage.

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no....i don't think it was the dosage of the dilaudid, but do think there was an interaction betw dilaudid and seroquel.

have no idea as to dilated, sluggish pupils and tachypnea...

it sounds like a cerebral response, have no idea how/why though.

will have to research this...

interesting.

leslie

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Specializes in Adult health, Primary care, WH..

Neuroleptic Malignant Syndrome (NMS) or extrapyramidal (EPS) signs and symptoms could of cause this since the patient was on such high dose of Seroquel.

Drug interactions when taking Seroquel:

Barbiturates such as phenobarbital

Carbamazepine (Tegretol)

Cimetidine (Tagamet)

Erythromycin (Eryc, Ery-Tab)

Fluconazole (Diflucan)

Itraconazole (Sporanox)

Ketoconazole (Nizoral)

Levodopa (Laradopa, Sinemet)

Lorazepam (Ativan)

Phenytoin (Dilantin)

Rifampin (Rifadin, Rifamate, Rimactane)

Steroid medications such as hydrocortisone and prednisone

Thioridazine (Mellaril)

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i was just about to post with my findings as well, tampa.

i just found out what mydriasis is...dilated pupils...heh.

anyways, i'm wondering if this pt was using other drugs/meds before admission?

withdrawal would cause the mydriasis and tachypnea, as well as hyperthermia and htn.

i have a feeling it's r/t her dose of seroquel as well, but am wondering why it happened when pushing the dilaudid?

coincidence?

what was her admitting dx?

could it be r/t that?

leslie

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Specializes in Adult health, Primary care, WH..

believe it or not...

the admitting diagnosis for this psych patient was 2nd degree sunburn. this patient went to the beach and baked herself.... with the combination of photosensitivity of seroquel.

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