How much pain medication is "too much pain medication"?

BroadwayRN, ASN, RN · Dec 30, 2008

A chronic user of pain medication and a former IV drug abuser gets 500 mg of Tylenol and 50 mg of Trammadol q 6 hrs. She also has prn order for (2) 325 mg of tylenol also q 6 hrs additional she has an order for 1 mg of Ativan q 6 hrs. Everyone administers it she even complains that at night she is given 1000 mg of tylenol!!! Is Tylenol contraindicated for people with Hepatitis C or not???

Hep C patients can have 1,000 mg of Tylenol up to 4 x a day. I don't think she's taking too much pain medication. The Ativan doesn't count as a pain medication. We see patients in the ED who take enough pain med to kill a horse and they function just fine. Not my idea of an ideal situation but if the doctor is prescribing it, they'll sure take it. I gave 4mg of Dilauded to a woman who fell and hurt her elbow, it wasn't fx'd, and within 30 minutes she was asking for more and she had also had 50 of Phenergan.

BelleKat, BSN, RN · Dec 30, 2008

Hi,I believe pt are not supposed to get over 3 Gms of Tylenol per 24 hours. Since the pt has hep C it seems like they would,'t want to give so much Tylenol since it is hepatotoxic but it seems like they are trying to avoid narcotics too.

:twocents:

DeadHeadRN, BSN, RN · Dec 30, 2008

People with liver disease should not be given excess amounts of Tylenol since it is processed by the liver. People with Hep C can get Tylenol, but personally I would question the doc about ordering so much. In my hospital people with liver disease (including Hep C)usually have Tylenol ordered PRN for fever, not for pain relief ATC in addition to another 4 PRN doses, as other NSAIDS can be used that will not affect the liver.

We see patients in the ED who take enough pain med to kill a horse and they function just fine. Not my idea of an ideal situation but if the doctor is prescribing it, they'll sure take it.

I hear you! I work on a surgical floor but we seem to get all the back patients regardless of whether or not they will have surgery. They know the magic words -BACK PAIN- and are often frequent flyers. These are the pts that ring 30 minutes before their meds are due just to make sure you remember that they're due in 30 minutes. I had one pt getting 3mg dilaudid IVP Q3h and another 2 mg dilaudid po Q3h for breakthrough pain. All while walking around, talking on his phone, playing cards, etc. I'm sorry, but I think that's too much pain medication.

november17, ASN, RN · Dec 30, 2008

That's a pretty low dose of tylenol. I seriously doubt it would be dangerous at all for that patient if you are following the proper dosage (1,000 mg per dose, repeated no more often than every 6 hours or 4000mg per day).. As long as there is no advanced cirrhosis present I don't think it's a big deal - and even then it is only recommended that patient would get half the normal dose.

RNperdiem, RN · Dec 30, 2008

The title of your post had me expecting a patient on a jaw-dropping amount of narcotics-especially a former drug abuser who may have a high tolerance.

The above guidelines about Tylenol seem about right.

If the regimen is actually controlling her pain, then she sounds fine.

hypocaffeinemia, BSN, RN · Dec 30, 2008

It's regular-strength Tylenol. Here's what you do: Get her to open her mouth, take a handful, and throw it at her. Whatever sticks, that's the correct dosage.

gal220RN, BSN, RN · Dec 30, 2008

It sounds like an appropriate dosage of Tylenol, but written in a dangerous way that could be misunderstood. She should have either a scheduled dosage or prn, but not both. Ativan is purely for anxiety. You are right to consider her liver function status when administering meds. Are her LFT's elevated?

nitroprussideNlight · Dec 30, 2008

It's regular-strength Tylenol. Here's what you do: Get her to open her mouth, take a handful, and throw it at her. Whatever sticks, that's the correct dosage.

Dr. Cox I'm so glad I've found you!

classicdame, MSN, EdD · Dec 30, 2008

The correct amount of pain medication is whatever it takes and no more. If risks outweigh benefits, then consider alternative medications, such as anti-inflammatory, muscle relaxer, sedative, tranquilizer --- I personally do not see why a known drug user ought to be made to suffer. The objective is to control pain, not behavior.

mcknis · Dec 30, 2008

YES pain control is key! We have known drug abusers who stay in the hospital, but are told by other nurses that they don't want to feed their habit, so these nurses only give a smaller portion than what they are used to. Pt ends up being in more pain than they started with (or not started with).

morte, LPN, LVN · Dec 30, 2008

I work in an assisted living facility! A client there who needs knee surgery but is refusing it has Hepatitis C.
A chronic user of pain medication and a former IV drug abuser gets 500 mg of Tylenol and 50 mg of Trammadol q 6 hrs. She also has prn order for (2) 325 mg of tylenol also q 6 hrs additionally, she has an order for 1 mg of Ativan q 6 hrs. Everyone administers it she even complains that at night she is given 1000 mg of tylenol!!! Is Tylenol contraindicated for people with Hepatitis C or not???

the 4000 mg limit is for acute use, no more than 2-3 days at a time.....2000 is for longer term use.....which means she has little room to use the prn dose......why is it that this is all she is getting? is it HER choice?