Demerol Question?

[divinewind_007]

Okay...i was reading through my protocols today just to brush up on them. Hadn't read them in a while. Under Chest Pain protocols it was aspirin, nitro, then morphine(demerol if allergic to morphine)

Here is my question:

Does Demerol act the same way as morphine on chest pain patients? If not then please tell me eactly how it works. Please list how each works since i can't think of the appropriate words to describe morphines effects at this time. I am currently having a brain fart. Thank you.

 

[RedZone]

Morphine used to be thought of as the drug of choice for AMI. It supposedly reduces myocardial oxygen demand. An AMI is myocardial tissue dying from lack of oxygen supply. So, you can probably figure out the philosophy.

Then nitrates became regarded as more important.

Then aspirin was considered even more important.

Before long, morphine was pretty much regarded as a last ditch effort to relieve chest pain. I was even informed by an emergency medicine specialist that NTG was eventually believed to be useful only for pain management, and did little, if anything, as far as treating the AMI.

So, ASA is the only real "treatment". NTG helps relieve pain, and morphine relieves pain when NTG fails to do that.

Now, studies are showing that morphine might actually be harmful and may be linked to increased mortality of AMI.

Demerol... I haven't heard of that being used to treat AMI, or prehospitally at all. But, if morphine is merely relieving pain, demerol is also a narcotic pain reliever. Whether or not it was also believed to reduce myocardial oxygen demand, I can't answer that.

 

[Ridryder911]

Here is my answer from another EMS forum a couple of years ago Morphine versus Demerol for pain control .

It all depends on the clinical problem
Morphine or Demeroanalgesics work as follows:
The opioid analgesics are "mu-agonist" drugs. The term "agonist" refers to a drug that binds to pain receptors to produce analgesia. Opioid analgesics include Morphine and Demerol & other drugs that relieve pain by binding to mu receptors in the nervous system.
The term "mu agonist" is used interchangeably with the terms full agonist, pure agonist and morphine-like drugs.

Examples of opioid analgesics are:

Codeine
Oxycodone
Meperidine (Demerol)
Propoxyphene (Darvon)
Fentanyl
Hydrocodone
Tramadol (Ultram)
Morphine
Hydromorphone (Dilaudid)
Methadone
Levorphanol (Levo-Dromoran)
Oxymorphone (Numorphan)

Of the three groups of analgesics – opioids, nonopioids, and coanalgesic drugs, only the morphine-like opioids have no analgesic ceiling. In other words, higher doses increase analgesia and only adverse effects limit how high the dose can be. Thus, there is no set maximum dose for morphine and morphine-like opioids

Morphine is a smooth muscle relaxer similar in action as NTG, however action works differently. Morphine is an excellent analgesic and works well in acute AMI's however; as recently discussed can as well be detrimental in some AMI's as well. Inferior wall AMI and some lateral wall can be actually increased due to excessive preload actions.

Morphine was thought as a good "venous pooler" action in CHF, but recent research has determined it is not as effective as good old NTG. This is why many services is beginning to carry NTG cream, and IV form.

Demerol is an old analgesic, however does not perform the actions as Morhine. As well many new studies has determined the side effects of Demerol is more detrimental than had been expected. Many ER's have totally removed it from the choice of analgesics.

R/r 911

 

[Bongy]

In addition to what Rid and RedZone said,I would like to add,that I wouldn't try any synthetic opioid on someone that have an ALLERGIC reacting to morphine... The common morphine allergic reaction,is activation,secondary to mu-receptors ,histamine release...So in case of usage of Demerol,I thing that allergic reaction will be just same... (may be less but probably will be)... you should consider an evacuation time,because what REALLY AMI pt needs is a re-perfusion. If pain can not be revealed by high doses of NTG(or BP doesn't allow you to use them),probably opiates will not help eather... But on the other hand,pain is very strong factor of general "well being" of the pt and should be revealed as soon as possible... One of my trainers,said me once that "bringing AMI pt to ED with pain is malpractice... So,I thing that I would give an Morphine with steroids..(BTW-ani-remodeling effect also)... Did I completely confuse you?:wacko:

 

[divinewind_007]

i appreciate the answers, and no bongy you didnt confues me. I have just been trying to learn a few things and my medics here couldnt really explain how demerol eactly worked. I was just looking for more specific answers. Trying to brush up as much as possible before next year when i start medic school. Thanks everyone for the clearer picture.

 

[Bongy]

Allways wellcome!!
Good Luck!

 

[TKO]

go with your protocols... but if they aren't to your satisfaction, then go BLS. I give entonox for pain relief with MI. But do what you are comfortable with... not what it says on paper. I may catch hell for saying that, but better to do what you believe is right than do something wrong that was written in stone.