Random Med Questions-narcotics and IV push

Boog'sCRRN246, RN · Sep 2, 2009

"I know potassium needs to be diluted and given slowly"

Unless you're practicing for lethel injection, potassium should never be pushed :uhoh3:

TessaMae · Sep 3, 2009

You would want to look up any IV med that you are not familiar with before giving it IV push or giving it in general. You need to know how to give it and what the side effects are amongst other things.

I have a couple random questions regarding medications...first off..
Can someone break down some of the narcotic pain meds to me? Norco, Dilaudid, Morphine...what are the differences between these? I have heard Dilaudid is really strong and the "big cheese" of pain meds so to speak while a lot of patients don't like morphine b/c of side effects or it makes them feel "weird"...a lot of this info is what I hear nurses with experience say, not necessarily text books. Nurses who have experience with a lot of pain meds-can you break some of the commonly used ones down for me and why they would be prescribed to certain pts over other meds?
Also, what are some meds that you automatically know not to give quickly through IV push (I know potassium needs to be diluted and given slowly, Lasix too) but what are some other ones? Everytime I give a med IV push I try to do it a little slow but I guess it isn't necessary for all meds...
Thanks for your help and input:D

Rook · Sep 5, 2009

Dilaudid (hydromorphone) is 8-10X stronger than morphine. Fentanyl is 100X stronger than morphine.

I think methadone is the same strength as morphine but has the advantage of a a 24hr half life (though this can vary from 15-50hr depending on the pt) and you only need Qday adimnistration.

Depends on the MD usually some like to give hydromorphone some like morphine.

Also IV meds are 5-6 times more potent than oral drugs so giving 5mg of say morphine orally is the same as giving 1mg IV.

There are also exteneded release oral narcos like oxycontin and MS contin. In which chronic pain/cancer patients can often take up to 100+mg Q12H. Have to remember its an oral drug and its time release so if you say give a 60mg MS contin pill that patient is actually getting 5mg/hr. Had to educate a few RNs the other day about this (it was a 40mg tab of MS contin) b/c they thought they were giving the whole 40mg dose at once and almost didn't give it.

meandragonbrett · Sep 5, 2009

Dilaudid is stronger than morphine and it also lasts longer than morphine. Fentanyl is stronger than dilaudid but has a much shorter half-life. Be careful when giving fentanyl....giving it too fast will cause a rigid chest wall and you get yourself into a can't ventilate situation.

In general, you don't see as much of a change in systolic BP with fentanyl and dilaudid due to a lack of histamine release (as for morphine...there is a lot of histamine released).

Giving some phenergan with morphine will help to prevent some of the decrease in SBP that you usually see.

Dilaudid and fentanyl are preferred in hemodynamic instability.

ChiSmile6 · Sep 7, 2009

thank you!