May 10, 2007, 3:27 pm

Look What They’ve Done to My Meds, Ma!

urodonal

Ouick! Get this man his medication!

Isn’t this the most dramatic representation of pain you’ve ever seen in an ad?

My back aches just looking at it.

Urodonal is for victims of uric acid.

It dissolves the uric acid.

It’s for gout, rheumatics and arteriosclerosis (I think).

I’d like to tell you I know all this because I can read French, but actually I ran the words through my handy-dandy Mac Widget translator.

Up until now I only knew: “Moi?” (from Miss Piggy), “au revoir” (from the old Lawrence Welk ending-theme song – hey, I was a kid) and “Oui, oui madame” (from stereotypical French waiters in movies).

And now I can say “uric acid” in French.

Who says you can’t have it all?

******************************

Two notes from my last post re: nursing education.

  • An LPN commented that you can obtain your LPN education through a trade school. That should have occurred to me, but I was focused on the RN.
  • Western Career College really does produce RNs. I have it from a reliable source that they are offering an LPN to RN bridge program in Sacramento. I stand corrected!

******************************

Hmmmm….

Something is happening in the world of medications and I’m not sure what it is.

Once upon a time, we gave Compazine for nausea. And lo, it was good.

Then they told us not to because the side effects could be, well, uncomfortable. Stiff jaw, tongue hanging out. Major bummer.

Then they told us to give Phenergan. And we did. And lo, it kinda helped.

Yet, something better came along! It was called Inapsine and in tiny does it kicked nausea’s butt! And lo, it was hella good.

But… in big doses it caused a nasty heart rhythm called Torsades de Pointes (what, is it French day today?).

So they took it away. And lo, some nurses were sad.

They told us to give Phenergan. Again. And lo, it sorta worked. Again.

But Phenergan can cause necrosis if it is in a tiny vein! Bad Phenergan! Many cautions were put forth in its administration.

Ah, we still had Tigan! Either in the derriere or up the derriere, it worked its marvels on those tiny sprites who were unable to keep down any fluids.

Then they told us we couldn’t use it any more. Like aspirin, it can cause/worsen Reye’s Syndrome.

So all that we have left to give is Zofran.

What happens when they decide Zofran is bad for you?

*****

Once upon a time, there was a potent narcotic called Dilaudid. Small amounts of medication could take away very large amounts of pain.

I learned, however, patients in sickle-cell crisis could need much, much more. Often four-to-eight milligrams intravenously.

Most folks, though, would get relief from 0.5-1.0 milligrams intravenously.

Gradually things have changed.

Now, you might give two milligrams. Or four. Or six. Or eight. Or twenty. For headaches. I’m not exaggerating.

What happened to Dilaudid?

Did they change the formulation?

Did they dilute it down to nothing?

Or have drug seekers become immune to the “Big D”?

*****

For five bazillion years, “Fleet” has been the name in enemas. They even have a mascot: Eneman! Why, I personally have administered enough Fleet enemas to clean the colon of an entire county.

But now they have told us to stop.

I guess some folks had electrolyte disturbances.

I feel for them. I really do. But now I have no buffer between myself and the soap suds enema the ER doctor invariably orders at the height of the busy shift.

When you can’t count on Fleets anymore, what is the world coming to?

*****

And what is up with Levophed?

Besides blood pressures.

When I was a new nurse, barely off Florence Nightingale’s knee, the mantra of the cardiac set was:

“Levophed leaves ’em dead.”

If we pulled out the Levophed, it meant the patient not only was “heading for the light”, he had made it to the light and had set up housekeeping!

Now, it’s the go-to drug for septic shock. I recently hung it for the first time in probably twenty years.

Go figure.

*****

And finally, the eternal question that every nurse asks the first time they have to count the drugs.

(After they ask why they have to count narcotics when the Pyxis keeps track, anyway….)

Why do we have to count the Lomotil?

Is there a high street value on anti-diarrheal medication?

Oh, wait, a quick check of that invaluable medical source known as Wikipedia shows that diphenoxylate is chemically related to Demerol!

Don’t let that get around to the drug seeking population or the ER will see a massive rise in the amount of diarrhea issues as opposed to constipation complaints!

Well, I guess that solves my Fleets issue…

15 Comments


  • Peggikaye

    May 10, 2007 at 11:00 pm

    I think the scariest thing I’ve heard was when I talked to a friend who’s baby (27 months old )had brain cancer. They’d put her on hospice and sent her home .. on Dilaudid. I knew then that we were praying for a peaceful passing now … she passed away 4 days later.

    No child should ever have to hurt so much they need dilaudid ..



  • Fallen Angels

    May 11, 2007 at 7:03 am

    Completely off-topic… yesterday on my way to school I passed by the county trauma center/hospital. Small group of nurses out for a walk at lunch time…one of them wearing her cap!! Too cool!! For a moment I wondered if it was you…this IS the North Bay Area after all. But no, judging from your pic below…it wasn’t you.



  • Candy

    May 11, 2007 at 8:37 am

    Ah, lomotil — the magic little pill. Don’t leave home without it.

    Diphenoxylate hydrochloride is the antidiarrheal agent while atropine sulfate (a schedule V drug) is the anticholinergic agent in the cocktail. Atropine is related to meperidine (demerol), but the buzz anyone would get from it is more likely to come from not having the screaming ‘ree than from any “fun” narcotic action.

    Atropine is a parasympatholytic that inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias.

    It’s available in opthalmic solutions and ointment as well as oral and injection forms. It’s given to hospice patients to get rid of secretions.



  • Susan Palwick

    May 11, 2007 at 8:52 am

    I once had a bad reaction to Lomotil and went to Urgent Care literally crying in pain: turned out I had a paralyzed ileum or somesuch. The UC doc called Poison Control, who informed him that the antidote for Lomotil is . . . Narcan.

    So he sent me home with a Narcan prescription, which I elected not to fill (once the Lomotil wore off, I was fine). I couldn’t quite imagine explaining the situation to my friendly local pharmacist.



  • Kim

    May 11, 2007 at 9:11 am

    Diphenoxylate is an opioid agonist used for the treatment of diarrhea that acts by slowing intestinal contractions. It was discovered at Janssen Pharmaceutica in 1956. It is a congener to the narcotic Meperidine of which the common brand name is Demerol.

    I wonder if both Atropine and Diphenoxylate are related then. That would explain the count….



  • tscd

    May 11, 2007 at 10:12 am

    Wow, soapsuds enemas! A literal bowel washout. Over here, we are big fans of arachis oil.



  • emmy

    May 11, 2007 at 10:50 am

    Zofran is among a group of “drugs that in some reports may be associated with torsades de pointes but at this time lack substantial evidence for causing torsades de pointes.” according to the Center for Education and Research on Therapeudics. It is on their list of Drugs That Prolong the QT Interval and/or Induce Torsades de Pointes. Levophed is on the list also, however according to the list it is among “Drugs to be avoided for use in patients with diagnosed or suspected congenital long QT syndrome.”



  • Candy

    May 11, 2007 at 12:24 pm

    I love how you blended pain meds (and lomotil) which would tend to bind up a pt (especially the opiods) with enemas, which would likely be needed if too much pain meds were administered…

    My mom (like many elderly folks) was on the constipation/diarrhea bandwagon for a while — Senecot morning and night (“just in case”), with a prune juice chaser if there was no “production” by morning. I reminded her that she didn’t have to “go” every day, but she seemed to think if she didn’t, she’d explode. And of course, with all those laxatives and stimulants, she did, often with no warning and in inconvenient and embarrassing places. So she’d take a lomotil to slow things down and the cycle started all over again. We have things sort of on an even keel now that I’m managing her meds, but she’s still worried if one days goes by without any movement.



  • ERnursey

    May 11, 2007 at 6:22 pm

    Just four years ago we would give Morphine 2mg every 10 minutes to a max of 10mg. Now we give Dilaudid 1mg every 15 minutes up to 4mg which is about the equivalent of 32mg of Morphine. What the heck?



  • ERnursey

    May 11, 2007 at 6:25 pm

    I forgot the rest of my comment, sorry. Levophed is an excellent drug for shock, much better than Dopamine which almost always causes tachycardia. It got it’s bad rep because it was only hung as a last resort when the patient was always in irreversible shock. In my hospitals shock program, which has been seen in several journals, Levophed is the first line drug. We have excellent results from that as well as early recognition and agressive treatment of shock,



  • jen

    May 11, 2007 at 7:43 pm

    ERnursey and I must work at the same place………because we do levophed in my ED, and now 6 of morphine is standard instead of the 2mg we used to give standard a year ago……..



  • Jen B.

    May 11, 2007 at 7:52 pm

    Interesting how medication protocols change so seemingly quickly. I enjoy your interesting posts very much. As an aside, there was an article about emergency medicine blogging in the most recent Annals of Emergency Medicine that featured blogger Gruntdoc. Here’s the link in case you’re interested: http://www.annemergmed.com/article/PIIS0196064407003757/fulltext



  • Erica

    May 11, 2007 at 9:59 pm

    Funny, I was just discussing the Lomotil thing with a colleague the other day – the interesting thing to us was that, at least at our facility, the pharmacy gurus stock the lomotil in one of the regular matrix drawers of the Pyxis, meaning no real control over what’s there other than the count. And we didn’t know about the link to Demerol… very interesting…



  • TC

    May 12, 2007 at 11:02 pm

    God, I love compazine. If I was a drug seeker, it would be my drug of choice. It works on nausea like nobody’s business. I think it’s all about money, myself. The trademark probably ran out and they’re on to using something that makes the drug co’s more $$

    BTW, vasopressin is good for septic shock, esp if the pt is acidotic, because other pressors lose their efficacy in an acidotic state but not vasopressin. And at low doses it “shouldn’t” affect urine output.



  • geena

    May 22, 2007 at 6:32 pm

    Ah, I loved this post, Kim 🙂 I was surprised when they brought back Levophed, too. Now I love it… so much better than Dopamine. Why on earth did it ever fall out of favor?
    Neosynephrine, too… great drug.

    Dopa sucks!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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