Meperdine [Demerol]
Therapeutic Effects Meperdine [Demerol]
Control of moderate to severe pain.
Interactions Meperdine [Demerol]
Drug: Alcohol and other CNS DEPRESSANTS, cimetidine cause additive sedation and CNS depression; AMPHETAMINES may potentiate CNS stimulation; MAO INHIBITORS, selegiline, furazolidone may cause excessive and prolonged CNS depression, convulsions, cardiovascular collapse; phenytoin may increase toxic meperidine metabolites. Herbal: St. John's wort may increase sedation.
Oral Meperdine [Demerol]
Give syrup formulation in half a glass of water. Undiluted syrup may cause topical anesthesia of mucous membranes.
Cautious Use Meperdine [Demerol]
Head injuries, increased intracranial pressure; asthma and other respiratory conditions; supraventricular tachycardias; prostatic hypertrophy; urethral stricture; glaucoma; older adult or debilitated patients; impaired kidney or liver function, hypothyroidism, Addison's disease.
Diagnostic Test Interference Meperdine [Demerol]
High doses of meperidine may interfere with gastric emptying studies by causing delay in gastric emptying.
Contraindications Meperdine [Demerol]
Hypersensitivity to meperidine; convulsive disorders; acute abdominal conditions prior to diagnosis; pregnancy prior to labor [category B], at term [category D], lactation.
MUST KNOW FOR EXAM Meperdine [Demerol]
Meperidine is useful in POST OPERATIVE SHIVER reduction
Route Meperdine [Demerol]
PO SC IM
Uses Meperdine [Demerol]
Relief of moderate to severe pain, for preoperative medication, for support of anesthesia, and for obstetric analgesia.
INCOMPATIBILITIES . Meperdine [Demerol]
Solution/additive: Aminophylline, BARBITURATES, floxacillin, furosemide, heparin, methicillin, morphine, phenytoin, sodium bi-carbonate. Y-site: Allopurinol, amphotericin B cholesteryl complex, cefepime, cefoperazone, doxorubicin liposome, furosemide, heparin, idarubicin, imipenemcilastatin, mezlocillin, minocycline, tetracycline
MOA Meperdine [Demerol]
Synthetic morphine-like compound. Also, unlike morphine, has little or no antidiarrheic or antitussive action. Produces CNS stimulation in toxic doses.
Patient & Family Education Meperdine [Demerol]
-Do not smoke -Do not walk without assistance after receiving the drug. -Bed side rails may be advisable. -Be aware nausea, vomiting, dizziness, and faintness associated with fall in BP are more pronounced when walking than when lying down (these symptoms may also occur in patients without pain who are given meperidine). -Symptoms are aggravated by the head-up position. -Do not drive or engage in potentially hazardous activities until any drowsiness and dizziness have passed. -Do not take other CNS depressants or drink alcohol because of their additive effects. -Do not breast feed while using this drug.
Adverse Effects (1%) Meperdine [Demerol]
Body as a Whole: Allergic (Pruritus, urticaria, skin rashes, wheal and flare over IV site), profuse perspiration. CNS: Dizziness, weakness, euphoria, dysphoria, sedation, headache, uncoordinated muscle movements, disorientation, decreased cough reflex, miosis, corneal anesthesia, respiratory depression. Toxic doses: muscle twitching, tremors, hyperactive reflexes, excitement, hypersensitivity to external stimuli, agitation, confusion, hallucinations, dilated pupils, convulsions. CV: Facial flushing, light-headedness, hypotension, syncope, palpitation, bradycardia, tachycardia, cardiovascular collapse, cardiac arrest (toxic doses). GI: Dry mouth, nausea, vomiting, constipation, biliary tract spasm. Urogenital: Oliguria, urinary retention. Respiratory: Respiratory depression in newborn, bronchoconstriction (large doses). Skin: Phlebitis (following IV use), pain, tissue irritation and induration, particularly following subcutaneous injection. Metabolic: Increased levels of serum amylase, BSP retention, bilirubin, AST, ALT.
Classification Meperdine [Demerol]
CENTRAL NERVOUS SYSTEM AGENT; NARCOTIC [OPIATE] AGONIST ANALGESIC
Nursing Implications Meperdine [Demerol]
-Give narcotic analgesics in the smallest effective dose and for the least period of time compatible with patient's needs. -Assess patient's need for prn medication. Record time of onset, duration, and quality of pain. -Note respiratory rate, depth, and rhythm and size of pupils in patients receiving repeated doses. If respirations are 12/min or below and pupils are constricted or dilated (see ACTIONS AND USES) or breathing is shallow, or if signs of CNS hyperactivity are present, consult physician before administering drug. -Monitor vital signs closely. Heart rate may increase markedly, and hypotension may occur. Meperidine may cause severe hypotension in postoperative patients and those with depleted blood volume. -Schedule deep breathing, coughing (unless contraindicated), and changes in position at intervals to help to overcome respiratory depressant effects. -Chart patient's response to drug and evaluate continued need. -Repeated use can lead to tolerance as well as psychic and physical dependence of the morphine type. -Be aware that abrupt discontinuation following repeated use results in morphine-like withdrawal symptoms. -Symptoms develop more rapidly (within 3 h, peaking in 8-12 h) and are of shorter duration than with morphine. -Nausea, vomiting, diarrhea, and pupillary dilatation are less prominent, but muscle twitching, restlessness, and nervousness are greater than produced by morphine.
Pharmacokinetics Meperdine [Demerol]
Absorption: 50-60% absorbed from GI tract. Onset: 15 min PO; 10 min IM, SC; 5 min IV. Peak: 1 h PO, IM, SC. Duration: 2-4 h PO, IM, SC; 2 h IV. Distribution: Crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: excreted in urine. Half-Life: 3-5 h.
Subcutaneous and Intramuscular Injections Meperdine [Demerol]
Be aware that SC route is painful and can cause local irritation. IM route is generally preferred when repeated doses are required. Aspirate carefully before giving IM injection to avoid inadvertent IV administration. IV injection of undiluted drug can cause a marked increase in heart rate and syncope.