Dilaudid???

Had never given this medication before.... Had a pt the night before last who had SEVERE biliary colic, jaundiced... Dr had him on 6mg Dilaudid IVP q 2hours!!!! Believe me, he was requesting (and needing) this every 2 hours on the dot. I was very hesitant to give such a LARGE amount of a drug of which I had no prior experience. Gave it very slowly IVP (over 15 minutes) each time, while staying at the bedside to observe. Pt on continuous EKG telemetry, 02 and pulse ox.

Know from the drug book that hydromorphone hydrochloride is 7-10 times more analgesic than morphine, with a shorter duration of action. Manifests less sedation, less vomiting, and less nausea than morphine, and can induce pronounced respiratory depression and hypotension.

Any of you more experienced nurses out there with anecdotal information on Dilaudid??? By the way, pt had some very funky EKG rhythms (bigeminal PJC couplets with BBB which very closely resembled PVC's). BP, respiratory status was fine. Pt generally stayed awake and fully oriented, dozing briefly between injections (Had been on methodone at home for chronic pain syndrome from a devastating MVC.)

[thisnurse]

dilaudid is used on our med surg unit. not as much as morphine but more than demorol.

not sure why some docs prefer it but they do. never saw a pt have a problem with it. in fact, the older people i have given it to seem to get less disoriented than when they are prescribed oxycotin.

it gets thisnurse thumbs up

[Cascadians]

We had a lung cancer pt who was allergic to morphine: broke out in itchy rash, plus morphine motion sickness nausea.

Doc tried elixir Dilaudid instead, which was better. Hospice pharmacist actually flavored it with Watermelon syrup.

Final try was Fentanyl Patch which controlled tumor pain a little more steadily.

[kewlnurse]

When i did ortho we used dilaudid almost exculsivly, 6 mg q 2 is a hefty dose =30 of ms04, but not outragous. Just make sure you have quick access to narcan.

[Zee_RN, BSN, RN]

I certainly prefer Dilaudid to Demerol. Hate Demerol. You were wise to administer it as you did, though. If you don't give it frequently and the patient wasn't accustomed to it, you were right in being cautious.

[zumalong]

When we have patients with renal colic we always give them Dilaudid. Faster acting and we can get them OOB to ambulate if they will be able to pass stone without surgery. You also mentioned your patient was on methadone at home--he already had a tolerance for opiods so could handle higher doses.

Never heard of methodone for pain??/ Thought it was a substitute for Herion withdraw???

[TMPaul]

Methadone is a very effective analgesic. Not used frequently- guess it's because of the stigma attached to it. I have prescribed it for my cancer patients before with excellent pain control.

[aimeee, BSN, RN]

Stigma is part of it, but another big reason is that many doctors are just not familiar with it. Methadone is used a lot of the UK, especially in hospice situations. It is very inexpensive too...about 1/5th the cost of generic Morphine. You really have to know what you are doing in order to dose it correctly though because it takes time to build up in the system and it has a much longer half life than the other opiods.

[P_RN, ADN, RN]

That IS a high dose, but I have given higher and more frequently to Sickle Cell Crisis patients. Many of them are in such excruciating pain I just wanted to stand there and mainline it for them.