oxy er and ir

[Denise in PA]

I'm a new nurse working on a unit that at times has oncology patients. I just had a patient that came to the floor after hours in the ER. The patient has pancreatic CA and had orders for Oxy ER 20 mg. bid and Oxy IR 5 mg q 4 prn. (Both home meds) The patient was in a lot of pain and requested both meds at the same time. The experienced RNs said no problem. Should you administer the ER and then wait to document breakthrough pain or is it okay to give both at the same time?

Thanks for any input.

[macawake, MSN]

I'd say that the whole point of pain treatment is to keep the patient as comfortable as possible and do what you can to minimize the occurence of breakthrough pain. Looking at the pharmacokinetics of the extended release oxycontin/oxykodon it's takes about three hours to maximum analgesic effect. In my opinion the extended release should be given to maintain the drugs steady state and the patient was "in a lot of pain" so it sounds like they definitely needed the prn/immediate release pain killer at the time. The patient in all likelihood occasionally takes the ER and IR simultaneously at home.

I guess that you are concerned of the possibility of respiratory depression and of course you assess for that. But by the sound of it, the patient already had breakthrough pain and it needs to be treated. I of course haven't seen your patient, so this is only a general recommendation, not specific regarding this particular patient. I believe that it is good pain management to keep "one step ahead" of pain instead of chasing it when it's already present. I think you're doing the right thing asking your more experienced colleagues for advice. I remember being worried when starting out of "snowing" my patients completely. The drugs we administer are often potent and it's good practice to be vigilant, but we shouldn't be so afraid that our patients suffer needlessly.

[loriangel14, RN]

I have given both at the same time numerous times. If they are currently in a lot of pain giving only the er isn't going to provide much relief.

[sissiesmama, ASN, RN]

I have given both at the same time numerous times. If they are currently in a lot of pain giving only the er isn't going to provide much relief.

I have too. Cancer is horrible - but pancreatic cancer - I wouldn't wish that on anyone. I still remember one of my previous patients that had it - I cried quite a few times after caring for him..

Anne, RNC

[Denise in PA]

Thanks so much for your responses.

[OCNRN63, RN]

I'm a new nurse working on a unit that at times has oncology patients. I just had a patient that came to the floor after hours in the ER. The patient has pancreatic CA and had orders for Oxy ER 20 mg. bid and Oxy IR 5 mg q 4 prn. (Both home meds) The patient was in a lot of pain and requested both meds at the same time. The experienced RNs said no problem. Should you administer the ER and then wait to document breakthrough pain or is it okay to give both at the same time?

Thanks for any input.

I would have given both, no problem. The ER is to keep the pain med. at a therapeutic level; the IR is in case pain breaks through. If the pt. is in pain, he needs the IR.

[KelRN215, BSN, RN]

I'm a new nurse working on a unit that at times has oncology patients. I just had a patient that came to the floor after hours in the ER. The patient has pancreatic CA and had orders for Oxy ER 20 mg. bid and Oxy IR 5 mg q 4 prn. (Both home meds) The patient was in a lot of pain and requested both meds at the same time. The experienced RNs said no problem. Should you administer the ER and then wait to document breakthrough pain or is it okay to give both at the same time?

Thanks for any input.

Yup, give both. The oxycontin (ER) is a standing dose. The patient's pain is not being controlled with his standing doses so he needs a dose of his PRN oxycodone (IR).