Guest guest Posted May 6, 2005 Report Share Posted May 6, 2005 Thanks Kristian, your experience seems to echo the norm. Gerry --- KReninger@... wrote: > Hello, > As far as this drug causing a rigid chest, I've > never seen it in 9 years > of emergency room and EMS practice. I've use it > frequently without any > complications in our ED since we are a regional > trauma center and get most of the > people who are " worse off from the injuries " in our > area. I have however > encountered a few nurses who have seen it from time > to time in their practice > setting of either an adult or pediatric ICU. The > common threads seem to be: > > 1) on a long term fentanyl gtt > 2) the patient is usually already intubated (hence > the above) > 3) for adults - some sort of ARD component which may > contribute all in its > own > 4) the pediatric ICU nurses who have experienced it > outnumber the adult ICU > nurses > > In terms of dealing with the problem, > paralyzation is the answer. Some > long acting agent like veuronium seems to be the > drug of choice. This is > fine if the patient is already intubated, but if you > were to have this happen to > an otherwise awake and alert patient, your best > response would probably be an > elective RSI. I have no knowledge if giving lots > of Narcan would reverse > the rigid chest or not. That is a question I'd > like to ask of an > anesthesiologist next time I encounter one. > > All in all, a great drug, powerful, short acting, > lower risk of allergic > reaction than morphine and it has less of an effect > on blood pressure. > > > Kristian Reninger > RN, BSN, CEN, NREMT-P > Syracuse, NY > > > [Non-text portions of this message have been > removed] > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2005 Report Share Posted May 6, 2005 > --- KReninger@... wrote: > > Hello, > > As far as this drug causing a rigid chest, I've > > never seen it in 9 years > > of emergency room and EMS practice. I've use it > > frequently without any > > complications in our ED since we are a regional > > trauma center and get most of the > > people who are " worse off from the injuries " in our > > area. I have however > > encountered a few nurses who have seen it from time > > to time in their practice > > setting of either an adult or pediatric ICU. The > > common threads seem to be: > > > > 1) on a long term fentanyl gtt > > 2) the patient is usually already intubated (hence > > the above) > > 3) for adults - some sort of ARD component which may > > contribute all in its > > own > > 4) the pediatric ICU nurses who have experienced it > > outnumber the adult ICU nurses > > > > In terms of dealing with the problem, > > paralyzation is the answer. Some > > long acting agent like veuronium seems to be the > > drug of choice. We are normaly cautious in paralysing neonates (premie especially & pancuronium is the worst agent) It reduces the thoracic muscular elasticity (Not much elasticity/spring in their rib cages yet) So their No matter where you step And how many PDR notes... Giving meds Will always cause problems And may very well result in death !!! ))) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 <<There have been deaths due to misuse,>> Now that, I believe. But it is not the medication itself that is the problem. If the general public has all the things taken away from them that can be abused/misused, we won't have guns, cars, airplanes, tools, vitamins, herbs, credit cards, etc. Even pencils and pens would be outlawed in our schools! Debbie Dahl Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 <<There have been deaths due to misuse,>> Now that, I believe. But it is not the medication itself that is the problem. If the general public has all the things taken away from them that can be abused/misused, we won't have guns, cars, airplanes, tools, vitamins, herbs, credit cards, etc. Even pencils and pens would be outlawed in our schools! Debbie Dahl Oklahoma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 Thanks Carolyn, That's exactly what I thought. As far as changing doctors goes, I have always been treated wonderfully by my docs and love them...if I were to try to change now I'd still be in trouble because of medicare insurance and the referral process, it would take me a month or two to do this because I'd not only need to find a good pain doc but then I'd have to change my primary as well to find one that would refer to that doctor...it was such a headache getting to where I am...regardless I'm in for the rug being pulled out from under me for a while. Thanks for all that information! Debbie C. > > Fentanyl transdermal patches or Duragesics are still on the market and are not being removed. The FDA has release several warnings and has encouraged the manufactures to clearly indicate the warnings in their packaging. There have been deaths due to misuse, and there is a problem with medical providers prescribing them inappropriately to people with post op pain, headaches and stuff like that. While the FDA has not in anyway pulled them from the market, and one could argue that their have been deaths from many different narcotic pain relievers due to misuse, some physicians may be afraid to use them due to the warnings. I cannot imagine a doctor suddenly stopping someone who has already been on them for a long time, and 75mg Q 72 hours is a normal, reasonable dose. If the doctor persists, I would try to find someone else. I know, that may be easier said then done, but if they are not willing to provide appropriate pain control, then there is no > point in staying with them. > > Here is a link to the most current comments I could find from the FDA regarding fentanyl patches... > http://www.fda.gov/cder/drug/advisory/fentanyl_2007.htm > > > ______________________________________________________________________ ______________ > Never miss a thing. Make your home page. > http://www./r/hs > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 Thanks Carolyn, That's exactly what I thought. As far as changing doctors goes, I have always been treated wonderfully by my docs and love them...if I were to try to change now I'd still be in trouble because of medicare insurance and the referral process, it would take me a month or two to do this because I'd not only need to find a good pain doc but then I'd have to change my primary as well to find one that would refer to that doctor...it was such a headache getting to where I am...regardless I'm in for the rug being pulled out from under me for a while. Thanks for all that information! Debbie C. > > Fentanyl transdermal patches or Duragesics are still on the market and are not being removed. The FDA has release several warnings and has encouraged the manufactures to clearly indicate the warnings in their packaging. There have been deaths due to misuse, and there is a problem with medical providers prescribing them inappropriately to people with post op pain, headaches and stuff like that. While the FDA has not in anyway pulled them from the market, and one could argue that their have been deaths from many different narcotic pain relievers due to misuse, some physicians may be afraid to use them due to the warnings. I cannot imagine a doctor suddenly stopping someone who has already been on them for a long time, and 75mg Q 72 hours is a normal, reasonable dose. If the doctor persists, I would try to find someone else. I know, that may be easier said then done, but if they are not willing to provide appropriate pain control, then there is no > point in staying with them. > > Here is a link to the most current comments I could find from the FDA regarding fentanyl patches... > http://www.fda.gov/cder/drug/advisory/fentanyl_2007.htm > > > ______________________________________________________________________ ______________ > Never miss a thing. Make your home page. > http://www./r/hs > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 Amen! > > <<There have been deaths due to misuse,>> > > Now that, I believe. But it is not the medication itself that is the problem. If the general public has all the things taken away from them that can be abused/misused, we won't have guns, cars, airplanes, tools, vitamins, herbs, credit cards, etc. Even pencils and pens would be outlawed in our schools! > > Debbie Dahl > Oklahoma > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2008 Report Share Posted March 5, 2008 Amen! > > <<There have been deaths due to misuse,>> > > Now that, I believe. But it is not the medication itself that is the problem. If the general public has all the things taken away from them that can be abused/misused, we won't have guns, cars, airplanes, tools, vitamins, herbs, credit cards, etc. Even pencils and pens would be outlawed in our schools! > > Debbie Dahl > Oklahoma > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2008 Report Share Posted December 18, 2008 Hello everyone... I've been going to a pain clinic for my RA since my Remicade infusions haven't worked (yet). The doctor started me on Vicodin three times a day, and now, instead, he has prescribed Fentanyl in a patch. I just put the first one on. It's an opiate narcotic. The patch will be on for three days and then be replaced by another one. Does anyone have any experience with this drug? If so, how did you feel on it; did you have any bad side effects, etc.? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2008 Report Share Posted December 19, 2008 Dear - I have a friend on a patch. It is in the morphine family and very addicting. It can cause nausea and severe constipation. Unfortunately, the more you take the more you need as its time threshold for stopping pain wears off more quickly as time goes one and you feel the pain sharply right away. TNF based biologics may not work for you. They do work for me but everyone is different. I would look into Rituxan which is a B-Cell blocker. Make sure your Methotrexate is high enough and if after two infusions you see no benefit from Remicade I doubt you will. There is an interlukin-6 RA drug coming also. Ask your doctor about alternatives. Ridura is also an option. Also give Cyclosporine a whirl. Its old but it might just help you. I know it was a miracle that remicade worked straight away and for now going on 8 years!!!!!!!!! Good Luck!!!!!! Deborah On Thu, Dec 18, 2008 at 7:52 PM, shearjoy333 <shearjoy333@...> wrote: Hello everyone... I've been going to a pain clinic for my RA since my Remicade infusions haven't worked (yet). The doctor started me on Vicodin three times a day, and now, instead, he has prescribed Fentanyl in a patch. I just put the first one on. It's an opiate narcotic. The patch will be on for three days and then be replaced by another one. Does anyone have any experience with this drug? If so, how did you feel on it; did you have any bad side effects, etc.? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2008 Report Share Posted December 19, 2008 , I have no experience with either Vicodin or Fentanyl but I have been on Remicade for over 6 years with good success. I started with 3 mg/kg and then increased to 6 mg/kg. It took about 4 infusions before I noticed appreciable benefit and after about 6 infusions I was able to finally get off Prednisone. When I first got RA I needed 40 mg Prednisone daily to be able to function at all. Neither Arava nor Methotrexate alone allowed me to get below about 25 mg Prednisone but finally the Remicade allowed me to get completely off it except for flares. Prednisone is a strong anti-inflammatory that many people with RA use to alleviate most of the symptoms even though it has some bad side effects when taken at high dose for long periods, and is not greatly effective at slowing or stopping permanent joint damage. For me it did permit me to function till the more specific and slower-acting RA medications took effect. Prednisone usually is effective within a few days and is used instead of pain killers. I hope something works well for you. God bless. From: Rheumatoid Arthritis [mailto:Rheumatoid Arthritis ] On Behalf Of shearjoy333 Sent: Thursday, December 18, 2008 3:53 PM Rheumatoid Arthritis Subject: fentanyl Hello everyone... I've been going to a pain clinic for my RA since my Remicade infusions haven't worked (yet). The doctor started me on Vicodin three times a day, and now, instead, he has prescribed Fentanyl in a patch. I just put the first one on. It's an opiate narcotic. The patch will be on for three days and then be replaced by another one. Does anyone have any experience with this drug? If so, how did you feel on it; did you have any bad side effects, etc.? Thanks! No virus found in this incoming message. Checked by AVG - http://www.avg.com Version: 8.0.176 / Virus Database: 270.9.19/1855 - Release Date: 12/18/2008 10:16 AM Quote Link to comment Share on other sites More sharing options...
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