MEPERIDINE HYDROCHLORIDE

____________________

A Drug Study Presented to the

Faculty of the Nursing Department
Mrs. Josephine B. Magno, RN,MN

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In Partial Fulfillment of
The Requirements NCM 212-RLE
Cancer and Immunology Nursing Rotation

By

Khesler Bernie N. Bacalla

BSN-3D Group 1

December 3, 2020
BRAND NAME: Demerol

GENERIC NAME: Meperidine Hydrochloride

CLASSIFICATION: Opioid agonist analgesics

MODE OF ACTION:

 Binds to opiate receptors in the CNS. Alters the

perception of and response to painful stimuli, while producing generalized CNS
depression.

ROUTE AND DOSE:

 Moderate to severe pain. Adults: 50 to 150 mg P.O., I.M., or S.C. q 3 to 4 hours;

or continuous infusion of 15 to 35 mg/hour.
Children: 1.1 to 1.8 mg/kg P.O., I.M., or S.C. q 3 to 4 hours or 175 mg/m 2 daily in
six divided doses. Maximum single dose for children shouldn’t exceed 100 mg.
 Preoperatively. Adults: 50 to 100 mg I.M. or S.C. 30 to 90 minutes before
surgery.
Children: 1 to 2 mg/kg I.M. or S.C. 30 to 90 minutes before surgery. Don’t exceed
adult dose.
 Support of anesthesia. Adults: Repeated slow I.V. injections of fractional doses
(10 mg/ml) or continuous I.V. infusion of 1 mg/ml. Titrate dose to meet patient’s
needs.
 Obstetric analgesia. Adults: 50 to 100 mg I.M. or S.C. when pain becomes
regular; may repeat at 1- to 3-hour intervals.

INDICATION:

 Oral, parenteral: Relief of moderate to severe acute pain

 Parenteral: Preoperative medication, support of anesthesia, and obstetric

analgesia
CONTRAINDICATION:

 Contraindicated in patients hypersensitive to drug and in those who have

received MAO inhibitors within the past 14 days.
 Use cautiously in geriatric or debilitated patients and in those with increased
intracranial pressure, head injury, asthma, other respiratory conditions,
supraventricular tachycardia, seizures, acute abdominal conditions, renal or
hepatic disease, hypothyroidism, Addison’s disease, urethral stricture, or
prostatic hyperplasia.

SIDE EFFECTS:

 Lightheadedness, dizziness, weakness, headache, extreme calm, mood

changes, nausea, vomiting, stomach pain or cramps, constipation, dry mouth,
flushing, sweating, and changes in vision.

ADVERSE EFFECT:

 CNS: sedation, somnolence, clouded sensorium, euphoria,

dizziness, paradoxical excitement, tremor, seizures (with large doses),
headache, hallucinations, syncope, light-headedness.
 CV: hypotension, bradycardia, tachycardia, cardiac arrest, shock.
 GI: constipation, ileus, dry mouth, nausea, vomiting, biliary tract spasms.
 GU: urine retention.
 Respiratory: respiratory depression, respiratory arrest.
 Skin: pruritus, urticaria, diaphoresis, pain (at injection site); local tissue irritation,
induration (after S.C. injection).
 Other: physical dependence, muscle twitching, phlebitis (after I.V. delivery).

DRUG INTERACTION:

 Anticholinergics: May cause paralytic ileus. Monitor patient closely.

  Cimetidine: May increase respiratory and CNS depression, causing confusion,
disorientation, apnea, or seizures. Reduce meperidine dosage.
 CNS depressants, such as antihistamines, barbiturates, benzodiazepines,
general anesthetics, muscle relaxants, narcotic analgesics, phenothiazines,
sedative-hypnotics, and tricyclic antidepressants: Potentiate respiratory and CNS
depression, sedation, and hypotensive effects of drugs. Use together cautiously.
 General anesthetics: May cause severe CV depression. Use together cautiously.
 Isoniazid: May potentiate adverse effects of isoniazid. Avoid use together.
 MAO inhibitors: May precipitate unpredictable and occasionally fatal reactions,
even in patients who may receive MAO inhibitors within 14 days of receiving
meperidine. Avoid use together.
 Narcotic antagonist: Patients who become physically dependent on drug may
experience acute withdrawal syndrome if given a narcotic antagonist. Avoid use
together.
 Drug-herb. Parsley: May promote or produce serotonin syndrome. Discourage
use together.
 Drug-lifestyle. Alcohol use: Potentiates respiratory and CNS depression,
sedation, and hypotensive effects of drug. Discourage alcohol use.

NURSING RESPONSIBILITIES

 Be alert for new seizures or increased seizure activity, especially at the onset of
drug treatment. Document the number, duration, and severity of seizures, and
report these findings immediately to the physician
 Assess symptoms of respiratory depression, including decreased respiratory rate,
confusion, bluish color of the skin and mucous membranes (cyanosis), and
difficult, labored breathing (dyspnea).
 Monitor pulse oximetry and perform pulmonary function tests to quantify
suspected changes in ventilation and respiratory function. Excessive respiratory
depression requires emergency care.
  Be alert for excessive sedation or changes in mood and behavior (euphoria,
dysphoria, confusion, hallucinations). Notify physician immediately if patient is
unconscious or extremely difficult to arouse.
 Use appropriate pain scales (visual analogue scales, others) to document
whether this drug is successful in helping manage the patient's pain.
 Implement appropriate manual therapy techniques, physical agents, and
therapeutic exercises to reduce pain and help wean patient off opioid analgesics
as soon as possible.
 Help patient explore other non-pharmacologic methods to reduce chronic pain,
such as relaxation techniques, exercise, counseling, and so forth.
 Assess blood pressure periodically and compare to normal values. report low
blood pressure (hypotension), especially if patient experiences dizziness, fainting,
or other symptoms.
  Implement fall prevention strategies especially if patient exhibits sedation,
dizziness, or blurred vision.
 Reduce dosage of meperidine by 25%–50% in patients receiving phenothiazine
or other tranquilizers.
References:

• Hodgson, K.J. and Kizior, R.J. (2014). Saunders Nursing Drug Handbook 2014.
St. Louis Missouri:Elsevier Inc.
• Davis, F.A.(n.d). Meperidine. Retrieved November 30,2020 from
https://fadavispt.mhmedical.com/content.aspx?
bookid=1873&sectionid=139017143
• RNpedia(n.d). meperidine hydrochloride (pethidine) Nursing Considerations &
Management. Retrieved November 30,2020 from
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-
notes/meperidine-hydrochloride-pethidine/