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Giving med with known adverse effects

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A weird part of this job is giving people medications that are more likely to hurt than help them.

I regularly give medications that I wouldn't let my own family take for the same condition- and neither would the doc. Most commonly this involves antibiotics for likely viruses, which is usually not all that harmful. They do increase antibiotic resistance, causing people to be more likely to get sick. Frequent minor side effects like nausea. I have seen a few major incidents like anaphylaxis and tendon rupture for abx prescribed with pretty weak rationale. I am sure that if I could track every er pt I have ever seen, I could find a death directly linked to an un-needed abx, but not all that common.

Then, of course there are medications that assist people in hurting themselves- GERD med for people who's reflux is worse when they eat terrible food, for example. I have medicated people who's chief complaint is that their breathing is so bad they can't even smoke.

There are lots of examples, but recently gave somebody meds, actually, a prescription) for medication, likely to kill him.

Pt had a hx including alcoholism and polysubstance abuse. He came in with right sided abd pain after eating a large, greasy meal. Unsuprisingly, the problem was his gall bladder. Surprisingly, his pain was helped by toradol. No reason to think this problem would reccur as long as the pt made reasonable diet choices. And, the guy was pretty reasonable.

I sent him home with gall bladder instructions and a prescription for Vicodin. We know for a fact that this drug has a huge potential for an adverse effect needing hospitalization. We have hospitalized this patient for an adverse effect relating to this drug category.

The potential benefit of this drug was trivial: The pain could easily be avoided, and was well managed by the equivalent of ibuprofen 800 mg po.

The risk was lengthy hospitilization, or potentially death.

There is no other drug we would give with this risk/benefit ratio.

It's very frustrating. More so than usual with this guy- a nice enough guy, not even lobbying for narcs.

danceyrun

Specializes in Oncology.

Why are you giving abx for viral infections?

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

Why are you giving abx for viral infections?

If a patient or family demands a abx loud enough and persistently, some docs will cave and give a rx, even though it's totally uncalled for in that case.

NSAIDs carry the risk of upper GI bleeding, and alcoholics have an increased risk for bleeding, so maybe that's why the doc prescribed Vicodin. It may have been the safer option in the prescriber's estimation, especially if the guy was as reasonable as you say and would only use it when he really needed it and in moderation.

NSAIDs carry the risk of upper GI bleeding, and alcoholics have an increased risk for bleeding, so maybe that's why the doc prescribed Vicodin. It may have been the safer option in the prescriber's estimation, especially if the guy was as reasonable as you say and would only use it when he really needed it and in moderation.

True, but we did give him NSAIDs. And, his pain would be better avoided than managed- simply by eating healthy food. And Tylenol is a good pain medicine, as is Tramadol.

And, he has no more ability to use narcotics in moderation than an alcoholic can drink the two glasses of red wine recommended by many doctors. The characteristics of the addiction don't change in relation to an illness.

The question is risk/benefit. Sure there is some benefit to being a bit more comfortable, but for this guy, do the benefits outweigh the risks? Heroin is also a good pain med, but we don't use it because of risk/benefit.

This particular prescriber is old school. Very common for him to give narcs when others refuse to. He never checks the database, and give narcotics to people who are obviously lying.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

Toradol is a NSAID.

She said Tramadol, not Toradol

angikat

Specializes in geriatrics, psych. Has 20+ years experience.

If a patient or family demands a abx loud enough and persistently, some docs will cave and give a rx, even though it's totally uncalled for in that case.

True! I work LTC and I have take care of a few residents that get very angry and insist that we call the doctor and tell him that the resident needs a shot of rocephin for his runny nose. I have tried and tried to argue the fact that a cold doesn't require a shot and that if they ever truly needed the drug it may not work. Still the resident insists, yelling at staff to "call the doctor and get me a shot!" I had one man that took a shot of rocephin every couple of months when he got a runny nose. The doc caved with this little old man every time.

Sent from my iPhone using allnurses. Angi/LPN (🔜RN)

She said Tramadol, not Toradol

At first she said toradol and I was commenting on that. I did not see her post about tramadol until after I posted. My apologies.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Every drug has benefits and risks. I have Cushings from steroids...but I need the steroids to walk and move....to control my disease.

Chemo is poison intent on killing everything yet we give it to cure cancer. Gentamycin can cause deafness...but the infection will kill you.

"That which does not kill us makes us stronger." - Friedrich Nietzsche

I try not to get too deep too often. It will make you crazy.

Do-over, ASN, RN

Specializes in CICU.

Are any of the medications we give benign? I wouldn't think so, otherwise they wouldn't have an effect on the body, which is the point, right?

That was terrible grammar. Sorry.

Every single manufactured medication that we administer has known adverse effects. Every one.

Every single manufactured medication that we administer has known adverse effects. Every one.

Exactly, but not everyone will experience adverse effects. As Esme pointed out, in many cases, the benefits truly outweigh the risks. I would much rather treat my strep throat with amoxicillin that could potentially give me diarrhea or a yeast infection than develop bacterial endocarditis from an untreated infection. Dying from something that is treatable doesn't seem like a good idea to me

If chemo greatly increases my odds of beating cancer, then the side effects would be an acceptable risk.

zmansc, ASN, RN

Specializes in Emergency.

Every single manufactured medication that we administer has known adverse effects. Every one.

And every single "natural" medication does too. Manufactured medications actually are more tightly regulated, monitored, and controlled.

Christy1019, ASN, RN

Specializes in Emergency/Trauma/Critical Care Nursing. Has 11 years experience.

I agree with the above posters, but wanted to add something about cholecystitis. Although I'm glad this pt found relief from toradol, that is not generally the case. I had acute cholecystitis probably 4 times before it was taken out and had it not been for the narcotics given in the ED and the Norco prescribed to me, I would've likely dug my own gallbladder out with a spoon lol. And regarding the healthy diet... There's only so much broiled fish and baked chicken breasts a person can eat in a week, especially when working midnight shifts as an ER nurse.

I agree with the above posters, but wanted to add something about cholecystitis. Although I'm glad this pt found relief from toradol, that is not generally the case. I had acute cholecystitis probably 4 times before it was taken out and had it not been for the narcotics given in the ED and the Norco prescribed to me, I would've likely dug my own gallbladder out with a spoon lol. And regarding the healthy diet... There's only so much broiled fish and baked chicken breasts a person can eat in a week, especially when working midnight shifts as an ER nurse.

I hear you. I love strawberries, but have an anaphylactic reaction. So, I just carry extra epi for when I get the urge.

Every drug has benefits and risks. I have Cushings from steroids...but I need the steroids to walk and move....to control my disease.

Chemo is poison intent on killing everything yet we give it to cure cancer. Gentamycin can cause deafness...but the infection will kill you.

"That which does not kill us makes us stronger." - Friedrich Nietzsche

I try not to get too deep too often. It will make you crazy.

These are good examples of a sensible risk/benefit ratio.

The other day I was the third nurse to try an IV on a normotensive pt tolerating po, with no iv meds indicated. 5 sticks so the pt could get the equivalent of three shot glasses of water an hour for 3 hours.

Since there was some risk of infection, and no benefit at all, this was clearly silly. I had nothing better to do at the time, and have fun getting hard iv's, so I got something out of it, but she didn't.

I do this stuff pretty regularly.