morphine,dilaudid,demerol

Virgo_RN, BSN, RN · Nov 11, 2008

Morphine, fentanyl, hydromorphone. We don't use demerol or phenergan a whole lot. Typically we use Zofran or Compazine for nausea.

lakotasu · May 18, 2009

I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.

Thank you.

GomerPyle · May 18, 2009

In terms of quantity, we dispense dilaudid by the gallons on my busy med/surg floor here in florida. I surmise that this may have a direct correlation to the number of frequent flyers on my floor.:cheers: again, just my

Straydandelion · May 18, 2009

dilaudid....

Quote
.is less likely to cause the usual side effects related to Morphine such as nausea and vomiting.

Working Ortho I secretly called Dilaudid the "headache" pain medicine because it seemed to cause headache's in a lot of my patients. I have found that morphine and dilaudid seem to be used more often then Demerol but could possibly just be the facillity.

Tina, RN · Nov 16, 2010

Interesting! I was just wondering about this myself. I recently returned to floor nursing after 10 years away. Ten years ago, I remember giving demerol to my patients quite frequently. Now, the hospital I work at doesn't even carry it! We use morphine and dilaudid, mainly. When did demerol start to be phased out? Do lots of hospitals not even stock it anymore?

OttawaRPN · Nov 16, 2010

Demerol has received a lot of bad rap worldwide (seizures, delirium, neuropsychological effects) and many hospitals have d/c using it - we don't even carry it with our narcs.

Morphine, in its various forms, has been the gold standard for pain control but we use a lot of Dilaudid - a good alternative to those with Morph allergies.

Here the pharm drug of choice for addicts is Oxycontin so it has a huge street value - when drug stores get robbed, that's what they're going for. They crush it and sniff, snort or shoot.... then buzz.

ZippyGBR, BSN, RN · Nov 16, 2010

from the UK perspective Morphine is the opiate that is usually prescribed as a strong opiate - primarily because in relative terms it is very very cheap ( pennies per 10 mg ampoule) also MR tablets and immediate release tablets and oral liquids are nice and cheap as well.

Pethidine / merperidine has become rarer and rarer due to the side effect profile etc ...

Oxycontin is in our formulary as an alternative to moprhine if morphine is not appropraite , we also use fentanyl - though mainly transdermal patches and the 'lollipops' on the wards but the passers of gas and some of the ED consultants like it as an IV

'weak' opiate wise it's a toss up between codeine and tramadol depending on the preference / fetish of the consultant in question they are both in the formulary and co-codamol is in the ED triage PGDs ...

GooeyRN, ADN, BSN, CNA, LPN, RN · Nov 16, 2010

We used to give tons of Demerol. In 2005, we stopped giving it all the time, (due to there being a lot of seizures from it) and started giving Dilaudid instead. It really ticked off a lot of patients. I guess you can get a better buzz from Demerol? We don't give much morphine- it makes a lot of people itch, and Dilaudid seems to work better for the pain anyway.

BluegrassRN · Nov 16, 2010

Straydandelion said:
dilaudid....
Working Ortho I secretly called Dilaudid the "headache" pain medicine because it seemed to cause headache's in a lot of my patients.

THANK YOU! Anyone else notice an association between Dilaudid and headaches?

grannyrn65 · Nov 16, 2010

lakotasu said:
I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.
Thank you.

Thank you for your enlightenment regarding pain management for both acute and chronic suffers. Unfortunately, it has been my experience that most of our peers will continue with their negative attitude, labeling their patients as drug seekers and addicts, as well as frequent fliers. McCaffrey has zero in on the problems with inadequate pain management. Over the past twenty years I've suffered from episodes of both acute and chronic pain. And I have dread going into the hospital for any type of surgery because of the judgemental attitudes of my peers (after they have seen my extensive history of fractures and surgeries). I have had nurses delay giving me ordered medication because they 'question' the degree of my pain.

When I went back for my second Masters, I was happy to see the professors take the enlighten view of pain management. Hopefully, given the slowly changing education attitude, we will have more nurses who will take the enlighten attitude toward patients.

As for which medication I've used, in 1989 I was prescribed Demerol for bone pain and post surgery, following massive fractures and a three month stay. By 2003, I was being prescribed morphine for a fracture of my ankle. By 2006, it was dilauid following compression fractures of my thoracic vertebra.

In my area, it appears that dilaudid and morphine are used in patient and oxy outpatient.

GrannyRN65

oceanfamily1992 · Dec 23, 2010

Regarding "drug seeking" behavior - as a chronic pain patient myself, I've learned not to specifically request what I know words for me because I'm immediately tagged as a drug seeker. People in pain have learned exactly what does and doesn't work. It's less time-consuming and we get relief sooner if we could simply say what works and what doesn't. Doctors have their favorite medications/habits in treating pain, and if a patient asks for something out of the doctor's ordinary habits, alarm bells seem to go off. The attitudes between nurses and doctors I've witnessed are unacceptable and judgemental. I know we see people who are just there to get drugs, but you can't let that blind you to each individual patient before you. Give each person a chance and make them PROVE they aren't being honest.

Also remember that because pain patients have been treated so disrespectfully so many times, we may act a little off. A little suspsicious of nurses and doctors. A little, or more than a little, fearful, because we know we may not get adequate help simply because we aren't believed. Don't throw out your experience and judgement, but give each patient a clean slate and take great care to not make assumptions. You will end up helping patients who are truly in need, and will help the patient be slightly less fearful the next time they have to go to the ER for pain help.

Pain patients have learned to avoid the ER at all costs. Did you know that most questionairres at pain clinics ask how many times you've been to the ER for pain, as if that's a sign you aren't in pain but just want drugs? If a pain patient shows up at the ER, they're really in trouble and need your compassionate, best help.

Butterfly0328 · Dec 23, 2010

lakotasu said:
I'm an RN who has been in the pain management field for several years. I've also worked ER so have seen many drug abuse patients. The unfortunate statements I have just read here are indicative of the judgemental attitudes and misinformation that still permeates our profession to this day. First of all, Dilaudid is a synthetic version of Morphine. They are basically the same drug except for a couple of molecules difference. 1mg of morphine is the same as 0.1mg of Dilaudid. One reason some people request Dilaudid over Morphine is that Dilaudid, being a synthetic, has fewer "dirty" metabolites and is less likely to cause the usual side effects related to Morphine such as nausea and vomiting. Another reason relates to one's genetic makeup. We all have cytochromes that assist us in processing medications. But we all don't have the same genetic makeup. We are different! That's why medications don't always work the same in EVERY person! That's why some people have unusual reactions to medications. That's why it takes some people a lot longer to wake up from anesthesia than others. The cytochrome P450-2B4 regulates how one metabolizes opioid/narcotic medications and anesthetics. There are cultural and genetic variations throughout the world populations. You can "Google" the cytochrome and find out more info. But please, my colleagues, do not think that everyone who requests Dilaudid is a drug seeker. As nurses, we are not supposed to allow our prejudices to influence our care. According to McCaffrey, who wrote the book on pain, "Pain is what the patient says it is." One cannot possibly experience what another person's pain is. Granted, there *are* those who would manipulate the system, but for the most part, those are people who's pain has not been treated appropriately. The actual condition of addiction does not occur very often. What people see are dependent patients who's pain needs are not being correctly addressed. This leads them to "seeking" behavior. I could go on, for the subject of pain, both acute and chronic and its managment is very complex, but I'll just leave it at this for now. Please don't be so quick to judge. That's not what we, as professionals, are about.
Thank you.

Loved this post. I am not even in nursing school yet-next year. But I have dealt with chronic pain and have a friend who suffers horribly with chronic pain... I do believe that one day when I have that license I will be working in this area. Pain is so misunderstood and so many people suffer needlessly. God Bless you for what you do for those who suffer from this horrible monster!