A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer ef-fective
The nurse will suggest discussing which medication with the provider? a. Fentanyl [Duragesic] transdermal patch
b. Hydrocodone [Vicodin] PO
c. Meperidine [Demerol] PO
d. Pentazocine [Talwin] PO
A
Transdermal fentanyl is indicated only for persistent, severe pain in patients already opioid tole-rant. Hydrocodone, a combination product, has actions similar to codeine and is not used for se-vere, chronic pain. Meperidine is not recommended for continued use because of the risk of harm caused by the accumulation of a toxic metabolite. Pentazocine is an agonist-antagonist opioid and is less effective for pain; moreover, when given to a patient who is already opioid tolerant, it can precipitate an acute withdrawal syndrome.
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