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 effective
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
ANS: A
Transdermal fentanyl is indicated only for persistent, severe pain in patients already opioid tolerant. Hydrocodone, a combination product, has actions similar to codeine and is not used for severe, 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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