Which pain meds together???

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I've been off orientation since Jan. 15 at my first job as an RN. I work on a floor where we have post-op and trauma pts so we give a fair amount of pain meds. I find it difficult to figure out what pain meds I can give together so I ask other seasoned nurses what is safe or calling pharmacy. Some I have down pat now but if something new pops up, I don't know if it's ok.

Example: the other day I had a pt (youngish, obese male) who was in an MVA with multiple back and rib fractures who was getting scheduled 10 mg Oxycodone Hydrochloride Q4H and then the PA added scheduled 15mg Morphine Sulfate Q12H as the pt was still in pain. I had already given the scheduled Oxy at Noon and didn't think I should give the MS so shortly afterwards so I waited 4 hours then gave the MS. We don't give oral MS much let alone 15 mg but do give 2mg/3mg/4mg IVP Q2/Q4 often.

When I gave report to the very seasoned night RN, she said that I could've given the MS shortly after since it was ER and the the Oxy was IR. Also, she wasn't thrilled about having to give it at 4 am.

Question(s): Is that correct? How do YOU know what is safe? Experience? Ask seasoned nurses? Call Pharmacy? Is there a resource online like Micromedex where you can plug in all of the pertinent info? That might be reinventing the wheel but I'm not sure.

Thank you for in advance for your replies!!

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Yes that is correct. Morphine Sulfate is extended relief and lasts 8 to 12 hours. Oxycodone, hydrocodone and other immediate release pain medications are often given in conjunction for break through pain.

If you are ever unsure, ask either a seasoned nurse or pharmacy, just as you mentioned. I'm not sure about any specific online resources though. Maybe someone else knows?

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Specializes in Family Nurse Practitioner.

I was about to say that the Morphine was probably MS Contin (controlled released morphine) judging by the schedule the PA put him on and the dose of 15mg, but I saw that the nurse you gave report to already answered that question. I've had patients on the floor with chronic pain who were on a 40-60mg dose of MS Contin scheduled Q12H. I would have to see the patient to judge if I would give them together. Most likely I would go ahead and give them. The oxycodone starts wearing off at about 1.5-2 hours in most patient's I've worked with and it takes about 45minutes to an hour to kick in. Dilaudid lasts about 1/2 hour to 45 minutes before they're in pain again. A good option is an NSAID and/or tylenol with a narcotic or between doses of narcotics. Give oxycdone. One hour later give 1000mg Tylenol when start complaining again. Give oxydone 2 hours later.

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Specializes in Acute Care, Rehab, Palliative.

I usually give the ER and IR together if they are having pain. If they're not in pain I would give the ER and then the IR as soon as they needed it. If pain meds are ordered and they are in pain I don't hesitate to give it.

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Specializes in Family Nurse Practitioner.
Yes that is correct. Morphine Sulfate is extended relief and lasts 8 to 12 hours.

Morphine Sulfate is just the full name of morphine. It can be extended release or immediate release.

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Specializes in Acute Care, Rehab, Palliative.

MS Contin is the long acting.

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Specializes in Critical Care.

Extended release (ER) morphine, which includes the brand name "MS Contin", exerts essentially the same effect all the time when given as a round-the-clock scheduled medication (usually BID depending on the patient's metabolism). This makes the time that you give it irrelevant to when it's working since it's working all the time. Regardless of when you give another pain medication, such as immediate release oxycodone, you are going to be "giving it with" the ER morphine. In other words, if you feel it's ok to give the IR morphine 6 hours after the ER morphine, then it makes absolutely no sense to feel like you can't give it 1 hour after giving the ER morphine, it's the same difference.

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Example: the other day I had a pt (youngish, obese male) who was in an MVA with multiple back and rib fractures who was getting scheduled 10 mg Oxycodone Hydrochloride Q4H and then the PA added scheduled 15mg Morphine Sulfate Q12H as the pt was still in pain. I had already given the scheduled Oxy at Noon and didn't think I should give the MS so shortly afterwards so I waited 4 hours then gave the the MS.

I'm not a US nurse and our orders aren't written the same way as yours. But if I interpret the above correctly you're supposed to give the morphine every twelve hours and the oxycodone every four hours? If this is correct then when waiting four hours after administering the oxycodone to administer the morphine, you were actually allowed to/supposed to give the oxycodone again !? at the same time as you administered the morphine (since four hours had passed).

If the patient is still in pain after you've administered the ordered meds you should in my opinion contact the patient's provider so that the provider can take the appropriate steps to make sure that the patient's pain is adequately managed. In this case you didn't administer all the analgesics that were ordered but decided to wait.

I understand that you as a new nurse might be afraid to overdose the patient but if the patient has pain, their vital signs permit more opioid analgesics and you have an order, I would give the meds! Then follow facility protocol for evaluation/assessment of the effect of the administered medication/watch for side effects.

We don't give oral MS much let alone 15 mg but do give 2mg/3mg/4mg IVP Q2/Q4 often.

The oral bioavailability of morphine is 20-40%, compared to 100% for iv morphine. This means that your 15mg po MS Contin is roughly the same as 5 mg iv. Steady state is achieved in about a day. So just as Muno said it doesn't really matter when you give the oxycodone (in relationship to the morphine) if the patient is regularly taking both these meds.

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Specializes in PACU, pre/postoperative, ortho.

OP, keep asking questions of more senior nurses you work with, pay attention to your pts' history for clues to their tolerance, & look at what prior shifts have given. In time, you'll find it easier to decide how much you should medicate.

Be aware that the little elderly lady with chronic pain may tolerate a heck of a lot more than the 250 lb 30 yr old male with his first injury & narcotic naive. It's amazing the amount of narcotics, benzos, & myo relaxants that can be given together for some people to achieve a measure of pain relief & yet, still breathe!

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Thank you all so much for your replies!

Yes, it was MS Contin. I had already given the Noon dose of 10 mg Oxycodone Hydrochloride before I saw that the PA had added the 15mg Morphine Sulfate. I knew that the Trauma Resident was already involved in a Trauma in the ER as I had called him regarding another patient shortly before this and the PA was on another unit by that time.

I should've asked a seasoned RN since I couldn't talk to the PA/Resident, looking back.

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