Demerol

Ms. dimes, an 80-year-old woman, is receiving a lower dose of Demerol, a narcotic analgesic, postoperatively for pain. Her family questions the use of a lower dose Determine what information you would give her family when they voice concerns that the dosage will not adequately relieve their mother s pain. Analyze what... 

Roger Baccus, age 23 years, is prescribed Demerol for postoperative pain. You discover in his health history on the chart that he has a history of alcohol and drug use. Determine what further assessments you would need to make Explain how Roger s answers would influence the actions that you as a nurse would take. 

Administration of atropine with meperidine (Demerol), flurazepam (Dalmane), diphenhydramine (Benadryl), phenothiazines, and the tricyclic antidepressants may increase the effects of atropine. There is a decreased effectiveness of haloperidol when administered with the anticholinergic dragp. 

Patients who are acutely intoxicated with an opioid usually present with miosis, euphoria, slow breathing and slow heart rate, low blood pressure, and constipation. Seizures may occur with certain agents such as meperidine (Demerol ). It is critically important to monitor patients carefully to avoid cardiac/ respiratory depression and death from an excessive dose of opioids. One strategy is to reverse the intoxication by utilizing naloxone (Narcan ) 0.4 to 2 mg IV every 2 to 3 minutes up to 10 mg. Alternatively, the IM/SC route may be used if IV access is not available. Because naloxone is shorter-acting than most abused opioids, it may need to be readministered at periodic intervals otherwise the patient could lapse into cardiopulmonary arrest after a symptom-free interval of reversed... 

Tarpey, W. Source of the N-Methyl Group in the Preparation of Demerol. 

Phenylpiperidines (meperidine-like agonists) Meperidine (Demerol, various) Synthetic ++ +... 

Opiates (Heroin, Demerol, morphine, opium, etc.), non-hal-lucinogenic amphetamines (Methedrine, Preludin, "bennies," etc.) and barbituates ("reds," "yellows," etc.) are all addictive, lend... 

The average adult dose of Demerol is 100 mg q3h. For a child weighing 28 kg, what should be the recommended dose ... 

Many commonly used medications also contain substances that are eliminated by the MAOIs and must not be taken by these patients. The list of medications to be avoided inclndes the narcotic pain reliever meperidine (Demerol), and many over-the-connter cold remedies containing dextromethorphan or pseudoephedrine. Finally, patients taking MAOIs must also avoid medications that elevate serotonin levels. This inclndes certain appetite snppressants and antidepressants including the SSRIs, venlafaxine, duloxetine, mirtazapine, nefazodone, and trazodone. Medications that interact with the MAOIs cannot be taken until at least 2 weeks after the MAOI has been stopped. 

Isonicotinic Acid Methochloride. To a slurry of 246 g of isonicotinic acid in 3.2 liters of methanol and 300 ml of water containing 88 g of sodium hydroxide has 355 g of methyl iodide added to it. Note Isonicotinic acid can be replaced with nicotinic acid, thus producing B-pethidine, instead of demerol. There is very little difference in potency between these two dmgs and the formula does not change Oust use an equimolar amount of nicotinic acid), so you may use either acid. Stir and reflux the above mixture for 60 hours, then remove the methanol with vacuo. Use sodium thiosulfate to reduce iodine to iodide and add water to give a volume of 1.5 liters. Use hydrochloric acid (coned) to get a ph of 2.0. 

Take the above hydrochloride salt and reflux it in ethanolic hydrogen chloride to get Demerol or analog. 

The two most common analogs of meperidine used as recreational drugs are l-methyl-4-phenyl-4-propionoxypiperidine (MPPP) and l-[2-phenylethyl]-4-acetyloxypiperdine (PEPAP). These compounds have a number of street names, including new heroin, synthetic heroin, synthetic Demerol, and China White. MPPP and PEPAP have pharmacological effects similar to those of heroin, hut more pronounced, producing a sense of euphoria and release from the real world. MPPP, for example, is three times as potent has heroin. 

---