Ideas to avoid being wrongly labled

[angelbear]

I am a nurse I also have fibromyalgia and a host of other things. I have chronic pain it is ligetamit and there is medical testing that proves there are causes for the pain ie. severe arthritis. It seems to me there should be a way to be able to present in a pain crisis at an ER without being mislabled. My idea is that the primary physician could make up some sort of card we could carry. It could contain info such as DX's and what meds we are on and what works best for our pain crisis? I dont know if this is possible but that is my idea. The hope would be that it would exbidite our treatment and alevieate suspision. What do you all think.

[mwbeah]

NUBAIN (nalbuphine hydrochloride) is a synthetic opioid agonist-antagonist analgesic of the phenanthrene series. It is chemically related to both the widely used opioid antagonist, naloxone, and the potent opioid analgesic, oxymorphone. Chemically nalbuphine hydrochloride is 17-(cyclobutylmethyl)-4,5(alpha)-epoxymorphinan-3,6(alpha),14-triol hydrochloride. Nalbuphine hydrochloride molecular weight is 393.91 and is soluble in H 2 O (35.5 mg/mL @ 25°C) and ethanol (0.8%); insoluble in CHCl 3 and ether. Nalbuphine hydrochloride has pKa values of 8.71 and 9.96. The molecular formula is C 21 H 27 NO 4 - HCl.

CLINICAL PHARMACOLOGY

NUBAIN is a potent analgesic. Its analgesic potency is essentially equivalent to that of morphine on a milligram basis. Receptor studies show that NUBAIN binds to mu, kappa, and delta receptors, but not to sigma receptors. NUBAIN is primarily a kappa agonist/partial mu antagonist analgesic.

The onset of action of NUBAIN occurs within 2 to 3 minutes after intravenous administration, and in less than 15 minutes following subcutaneous or intramuscular injection. The plasma half-life of nalbuphine is 5 hours, and in clinical studies the duration of analgesic activity has been reported to range from 3 to 6 hours.

The opioid antagonist activity of NUBAIN is one-fourth as potent as nalorphine and 10 times that of pentazocine.

NUBAIN may produce the same degree of respiratory depression as equianalgesic doses of morphine. However, NUBAIN exhibits a ceiling effect such that increases in dose greater than 30 mg do not produce further respiratory depression in the absence of other CNS active medications affecting respiration.

NUBAIN by itself has potent opioid antagonist activity at doses equal to or lower than its analgesic dose. When administered following or concurrent with mu agonist opioid analgesics (e.g., morphine, oxymorphone, fentanyl), NUBAIN may partially reverse or block opioid-induced respiratory depression from the mu agonist analgesic. NUBAIN may precipitate withdrawal in patients dependent on opioid drugs. NUBAIN should be used with caution in patients who have been receiving mu opioid analgesics on a regular basis.

Significant Interactions

Interaction with other Central Nervous System Depressants.

Although Nubain possesses narcotic antagonist activity, there is evidence that in non dependent patients it will not antagonise a narcotic analgesic administered just before, concurrently, or just after an injection of Nubain. Therefore, patients receiving a narcotic analgesic, general anesthetics, phenothiazines, or other tranquilizers, sedatives, hypnotics, or other CNS depressants (including alcohol) concomitantly with Nubain may exhibit an additive effect. When such combined therapy is contemplated, the dose of one or both agents should be reduced.

Patients Dependent on Opioids

Patients who have been taking opioids chronically may experience withdrawal symptoms upon the administration of NUBAIN. If unduly troublesome, opioid withdrawal symptoms can be controlled by the slow intravenous administration of small increments of morphine, until relief occurs. If the previous analgesic was morphine, meperidine, codeine, or other opioid with similar duration of activity, one-fourth of the anticipated dose of NUBAIN can be administered initially and the patient observed for signs of withdrawal, i.e., abdominal cramps, nausea and vomiting, lacrimation, rhinorrhea, anxiety, restlessness, elevation of temperature or piloerection. If untoward symptoms do not occur, progressively larger doses may be tried at appropriate intervals until the desired level of analgesia is obtained with NUBAIN.

[Traveler]

I think the card idea is great- if ER staff would take it seriously and pay attention to it. Working in hh I can't tell you the number of times I have called the hospital myself and spoken with the admitting nurse and then faxing them a patient's med sheet for patients with pain on regualr pain meds. I had a patient who was end stage ca but didn't want hospice. She was on oxyc. 80mg bid, roxinal, and phenergan pops. I made sure the hospital knew this and I had the patient also take her med sheet with her. We had worked a long time to get her pain under control and it finally was. When she got home from the hospital several days later, her pain was totally out of control. They hadn't paid any attention to any of my calls or faxes. Very frustrating. They finally upped her dosage a little in the hospital when the daughter of the patient told the staff she was going to bring some of her mom's meds from home.

Ann