Pain Meds

RockinChick66 · May 30, 2012

Dr

Vicodin with 500 mg of acetaminophen is still out there--I got a bottle myself very recently. It has indeed been banished from the inpatient end of our system, however.As to the posters questioning why oxycodone would be ordered along with Vicodin or Percocet, it's obvious that the intent of the provider is to adequately manage the pain. For a lot of folks 2 Percocet or 2 Vicodin q4 or 6h will not be sufficient to control pain, but add in a dose of 5-10 mg of oxycodone in the middle that interval and the patient may remain quite comfortable.

Thanks for clarifying. But it is confusing to me as why they would banish it from inpatient and not for personal use. As its more controlled in hospital and more likely to be abused as personal use. Smh

MunoRN, RN · May 30, 2012

Having both plain oxycodone and oxycodone APAP ordered simultaneously is not unusual and does serve a purpose; The current max daily dose of acetaminophen is 3 grams, even with 325mg combinations that limit could be exceeded in a 24 hour period, so the plain oxycodone is available if the patient can still have oxycodone (roxicet 2 tabs q 4 hours) but has already hit their APAP limit.

There's nothing wrong with multiple pain med options as long as the prescriber and the Nurse have similar understandings of how the orders will be interpreted. And I've never understood how the "give morphine for pain 8-10, percocet for pain 5-7, etc" thing works. A patient's pain rating is by no means a scientific measurement, yet this format seems to assume it is.

It's understandable to assume 500mg APAP combinations are already extinct since most hospitals have banned them for a few years now, even though they don't have to be off the market for another year or 2, which leaves mainly the unsuspecting public as the best way to get rid of already produced 500-750mg combinations. (By the way, there's still an active FDA recommendation to do away with all APAP combinations, which I'm sure opiate abusers are very much looking forward to).

whoa-now · May 30, 2012

Actually on a post op unit. It's great that the MD has given you, the nurse a couple of different pain meds to choose from. This way you don't have to have him paged/called once, twice, or more to change a pain med order that is either inefective or doesn't agree with your patient. As others have said. Know your stuff when answering questions. Rate their pain, what's their hx with pain meds and so on. Then use your best nursing judgement. The MD knows and trusts that since you are bedside with your patient, it's ultimately your call.

roser13, ASN, RN · May 30, 2012

Can I point out that vicodin with 500mg of acetaminophen is no longer available. The FDA has banned. No longer available in our hospital any way. IF the doctor writes for this, our pharmacy with auto sub it for the 5-7.5-10/325.

Oops, someone forgot to tell anyone in my area that Vicodin is banned. The script I filled post-op last week (for myself) is contraband, I guess :)

mmc51264, BSN, MSN, RN · May 30, 2012

Where I am, they seem to be giving more Percocet and less Vicodin. I asked about it and was told that hydrocodone was more nephrotoxic that oxycodone. If pt is post-op, the alternate morphine for higher pain levels with the percocet for lesser pain. As they heal, they switch to acetaminophen and roxicet (alternate)

linnaete, ASN, BSN, MSN · May 30, 2012

I have found pain medicine to be very subjective, people have different feelings towards them. As long as they are stable & AAO, I like to have them help choose their pain medication (with my guidance) and report back how they feel after each one. This helps keeps them in collaboration with their own care and more inclined to actually pay attention and report accurately. (Not for everyone, but I try.)

Also keep vitals in mind - many post-op patients will have temp increases. For sake of mind and concerned family members, I often will try the acetaminophen-based pain meds if the vital signs have a trend. And don't forget the IS!

psu_213, BSN, RN · May 30, 2012

Our electronic orders come with the PRN reason in them (for example: 1 percocet PRN moderate pain (4-6), 2 percocet PRN severe pain (7-10)--yes, the complete order comes with frequency, route, etc...I just wanted to show how the PRN part was written). The prescriber can always change the default order sentence, but most of the time this is there.

Also, by the pt will probably have an idea of what they want...i.e. one or two pills. Plus, as someone mentioned, look at what they have had before and if it has worked for them (the importance of pain reassessment!).