kymedic2007 Posted March 9, 2006 Posted March 9, 2006 During a recent clinical rotation i was instructed to admin 25mg Phenergan, 10mg Nubain IV to a 76 yoa female pt whose cc was abdominal pain she was stable cao only complaint was the abdominal pain....my question is .....does the 25mg phenergan seem a bit much with the 10mg nubain? i even repeated the dosage to my preceptor and she said "yes that is correct", needless to say it was lights out for that lady she was out cold.
flight-lp Posted March 9, 2006 Posted March 9, 2006 Yeah, I would have started out with 12.5 if not 6.25mg. I also probably would not have given the Nubain until I could ascertain a reasonable idea of etiology. So much for the doc trying to get a decent H/P................................
Ridryder 911 Posted March 9, 2006 Posted March 9, 2006 It is not an unusual order.. I do not like administering Phenergran to anyone over 65 because of the side effects I have seen, If I have to administer it I too prefer 6.25 to 12.5mg (diluted IV). In our ER our Doc's no longer will prescribe Phenergran sue to the caustic effects on the veins. even after explaining we will dilute it down... they prefer Zofran. Although Zofran is a very good antiemtic the costs is about $350.00 a pop in comparison of Phenergran at $15.00... be safe, R/R 011
Dustdevil Posted March 9, 2006 Posted March 9, 2006 25 is not excessive. The amount of Nubain is irrelevant. If the patient is suffering from nausea, or is likely to experience nausea from the Nubain, then 25mg is quite appropriate. Although, it would be dependent upon the patient herself. Weight, physical condition, etc... The only reason one might cut back to 12.5 in a well developed adult is if it were being inappropriately used as a "potentiator." Of course, the routine use of Phenergan as a "potentiator" of analgesia is quickly falling by the wayside though. Recent literature casts serious doubts on the entire theory, but old habits die hard. And, as Rid said, the IV use of Phenergan is to be avoided unless very clear benefits outweigh the risk. But if it's appropriate to give, then 25 is appropriate for a non-impared adult.
Nate Posted March 9, 2006 Posted March 9, 2006 I always give 12.5, you can always give more if needed. When you give it, push it extremely slowly. I've never had anyone say anything about "burning" when ever I've given it very slowly. However, I did watch a nurse "slam" it and then laughed after the little old lady slaped her across the face. Turned out that the little old lady was a former nurse herself. I don't know the exact age that is required, but if you give it to a child who is to young it will cause them to freak out.
just me Posted March 13, 2006 Posted March 13, 2006 During my clinical the charge nurse gave Phenergran to an elderly lady [late 60's?]. She did say she doesn't like it becasue of the 'burning' effect it can have, and mentioned she pushes it slowly. I do not like administering Phenergran to anyone over 65 because of the side effects I have seen I suppose this is going to be a greenhorn question, but why age 65? Are the side effects more harmful than good in elderly? I'm just curious after the episode I saw in the ER.
als_medic_uk Posted March 13, 2006 Posted March 13, 2006 Mature patients may be more sensitive to the anticholinergic properties of the medicine; however, I do expect that 25 mg would be perfectly acceptable, although if the patient has had previous reactions/effects to the drug, them a lower dosage ought to be used, along the lines of paediatric administration. Nalbuphine has been discontinued since 2003 in the UK, due to its associated sex references [regarding pain]. Regards.
Doczilla Posted March 13, 2006 Posted March 13, 2006 The 25mg is not an absurd dose, though I'll start with 12.5mg when giving IV, particularly in the elderly. Phenergan is an antihistamine, and it can be difficult to predict who will respond poorly to it (i.e., with oversedation). The elderly tend to be more sensitive to CNS effects of many drugs. I got burned once on an elderly patient on the trauma service who started sundowning. After a few days and an extensive workup which revealed nothing, we determined it was the Pepcid she was being given in-hospital for ulcer prophylaxis that did it (standard practice in hospitalized patients). Once switched to Protonix, the sundowning ceased. Zofran (or Anzemet, depending on which facility I'm at) is my DOC for nausea in patients with head injury or altered LOC because phenergan masks the LOC changes if they become sedated. The real problem is expense: actual cost to purchase the medicine is about a dollar/dose for phenergan vs. $20/dose for the Zofran. The thing is, Zofran is FDA approved right now only for chemo-related n/v and pregnancy-related n/v. We can be reimbursed for using it in-hospital, but many insurance companies won't pay for it off-label as a prescription at home, so the cost falls entirely on the patient. 'zilla
Ridryder 911 Posted March 14, 2006 Posted March 14, 2006 Doc the $ 20 is usually the hospital costs... the patient may get charged up to >$300. ... We too use Zofran like candy, I too like it for pre-meds.. not the cost for the patients ...wow ! My wife was getting chemo last year and the usual costs for her Zofran 4mg was $200.00..and Zofran readi-tabs p.o. was $1200 for a box of 14. I about fainted... thank god for inusurance... R/R 911
Doczilla Posted March 14, 2006 Posted March 14, 2006 Doc the $ 20 is usually the hospital costs... the patient may get charged up to >$300. ... R/R 911 Sorry, I was making the assumption on the hospital's expense that the patient isn't going to pay for their visit and doesn't have insurance. :wink: 'zilla
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