Pain meds that affect BP

anh06005, MSN, APRN, NP · Feb 13, 2015

The kicker to your question is that each of these medications may affect each patient in a different way.

The stronger pain meds (dilaudid, morphine) are probably more likely to cause negative effects like lower BP and lower respiratory effort BUT not every patient. For some they may be able to tolerate it but for some reason not hydrocodone.

There are actually new things in some of my local clinics regarding genomics to determine which meds are best for patients. It's a cheek swab, the DNA gathered is analyzed, and the genomics company sends a report to prescribers analyzing the patient's medication list and which meds might be better for the patient based on their metabolic pathways and body's use of various medications.

Thus just because a medication is stronger doesn't mean a person's body reacts to it more strongly than a weaker med depending on many factors...if that makes sense. (See a news article here: DNA testing to determine adverse reactions to medicine )

Basically there is no right answer to your question lol. It's kind of a "well let me give this...." and you'll know in a few minutes how your patient will react.

Good thing to keep in mind: TYPICALLY the stronger the narcotic (there is a type of "scale" for narcotics) the more likely it is to cause change in vitals and such.

brownbook · Feb 13, 2015

anh06005's answer is amazing. Every body can react differently to any medication.

To be blunt you are thinking about this the wrong way.

The number one concern with pain medications is respiratory depression, (they stop breathing.) That can kill a patient. Except for some very unusual situation (which I can't think of?) a sudden drop in blood pressure due to a pain medication won't kill anyone, probably won't even harm anyone?

A better question for you to ask is what do I do if my patient's blood pressure suddenly drops (regardless of the reason).

And much more importantly what do I do if my patient is slow to arouse with shallow respiration, again regardless of the reason?

If you really know your BLS you can do the number one intervention your patient needs that can save their life.

Here.I.Stand, BSN, RN · Feb 13, 2015

I've personally never seen doses of IV narcotics tank someone's BP. Sometimes the MAP might get a little soft if the dose is high and if the patient needs extra fluids, but never to the point of it being dangerous. If they're on a drip and I see the MAP trending down I might lower the dose and see what happens; if the patient stays comfortable and the BP comes back up, great. If their pain becomes uncontrolled, then I'll address the pain and BP as separate issues (calling the MD if necessary.)

As previous posters have said, I'm more worried about excess narcotics affecting the pt's LOC and respiratory effort. Even with LOC though, we still need to use our thinking skills and not just assume sleepy=overnarcotized. A while back I had a patient whose pain was so severe after thoracic surgery that he didn't sleep for like 3 days. We kept going up and up on his narcs...well after 3 days, he had a decrease in LOC. And then they cut back on his narcs almost to nil. Was he getting a lot of narcs, yes. But his RR never dropped below 12, and remember he hadn't slept in 3 days. I'm sure he was exhausted! In the MD's defense though, they did see his pain return pretty quickly and realized that that was unacceptable, we got anesthesia involved and he ended up getting an epidural.

The pain med that I HAVE seen tank the BP is Tylenol in neuro patients. Yes, plain Tylenol. Hopefully if you're working the floor or SNF though, that reaction would be documented by the time the pt gets to you.

AnnieOaklyRN, BSN, RN, EMT-P · Feb 14, 2015

It all depends on the patient and the narcotic.

The factor here is whether or not the narcotic causes a Histamine release.... Morphine does and Fentanyl doesn't, thus Morphine effects your BP and Fentanyl does not. You need to look up which narcotics do cause the release and you will figure out which ones effect BP.

How much it will drop your patent's BP is dependent on your patient of course and their underlying condition which needs to be taken into account as well. How fast you push it will also effect this... If you push Morphine to fast you may see red splotching on their skin near their IV, that is another side effect of the histamine release.

Annie

JWG223 · Feb 14, 2015

Clinical experience is the only way to go, here. I have had all kinds of reactions/non-reactions from patients regarding this topic.

RNstudentRochelle · Dec 29, 2015

As a student nurse I have seen where morphine has dropped a patient's blood pressure and for that reason the order was changed by the doctor to Fentanyl.