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What medications would you recommend giving an alcoholic in severe pain?
psiyung said:What medications would you recommend giving an alcoholic in severe pain?
antabusepsiyung said:What medications would you recommend giving an alcoholic in severe pain?
fun8stuff said:antabuse
Don't think that's an analgesic.lmbebo said:librium?
learnmed said:Wow, 6 replies and not even 1 helpful answer.
are you sure that you are amedical student?PiccoloPlaya82 said:Shove a banana down his/her mouth and up his/her rectum to quickly absorb K+ from both ends.
what about Diclophenac?psiyung said:What medications would you recommend giving an alcoholic in severe pain?
but part of the problem is understanding the source of his pain. There is not enough information here to diagnose the problem nor the patient's condition, therefore making it quite impossible to really give a proper answer. But I'd give the tylenol in limited dosages until more information was available. At least tylenol does not cause liver damage.PreMedAdAG said:so if there is kidney or liver damage, and assuming it may be a good idea to keep the patient off of pain narcotics, why not tylenol.. even cirrhotics are given tylenol. You can't just "do nothing".... you can't just let the patient be in pain, that's unethical. The other concern is tolerance and addiction to pain meds.. why not methadone?
PreMedAdAG said:so if there is kidney or liver damage, and assuming it may be a good idea to keep the patient off of pain narcotics, why not tylenol.. even cirrhotics are given tylenol. You can't just "do nothing".... you can't just let the patient be in pain, that's unethical. The other concern is tolerance and addiction to pain meds.. why not methadone?
Psycho Doctor said:but part of the problem is understanding the source of his pain. There is noty enough information here. But I'd give the tylenol in limited dosages until more information was available. Tylenol does not cause liver damage.
banner said:You might as well give them a teaspoon of honey.
um, because i just went through treatment for liver problems and the only med I was allowed to take for severe side effects was tylenol...why? i was told it was the only thing not toxic to my liver. Obviously in this scenario we are not giving out overdosages of tylenol or any other med to our alcoholic patient.banner said:Tylenol does not cause liver damage?
The ICU's are full of people who have OD'ed on tylenol. A good portion die or require liver transplants.
Psycho Doctor said:um, because i just went through treatment for live rproblems and the only med I was allowed to take for severe side effects was tylenol...why? i was told it was the only thing not toxic to my liver
would you prescribe it like M & Ms? I know I wouldn't. For the one or two tablets I'd possibly recommend UNTIL we got a proper work up, it will not cause him to OD or need a liver transplant.Law2Doc said:Do a Google search. See eg. http://www.alkalizeforhealth.net/Ltylenol.htm
Psycho Doctor said:would you prescribe it like M & Ms? I know I wouldn't. For the one or two tablets I'd possibly recommend UNTIL we got a proper work up, it will not cause him to OD or need a liver transplant.
ok, point taken, thanksLaw2Doc said:It all depends on what his pain is due to. If he already has liver damage --perhaps even for a Tyleonol OD -- we don't know, one more tylenol might not be a good idea and could be the straw that breaks the camel's back. But I was just giving a citation in response to your assertion that Tylenol was not toxic to the liver. Clearly in some cases it can be. Also note in the article that the combination of Tylenol and alcohol is not a good thing.
banner said:Why would you assume that it moght be a good idea to keep patient off narcotics if in severe pain? As you point out, it's unethical to undertreat pain, which is what you are doing if you toss tylenol at somebody in severe pain. You might as well give them a teaspoon of honey.
In terms of addiction... This is really a minor issue in treating somebody with severe pain although the lay public is classically misunderstands this issue.
1. Most people don't become addicted when supervised by an MD
2. Addiction is treatable later.
3. Unethical to undertreat pain because of a very low risk of a treatable condition - narcotic addiction.
and many of us already said we'd advice the patient have a complete work up firstdopaminophile said:I've never been one to get on a moral high horse, but this whole thread is a little sketchy. It's completely irresponsible to offer medical advice under the guise that it's a valid opinion when there's no history, examination, or context given at all. And that would be the case even if we were pain management anesthesiologies with specific training in the treatment of alcoholic patients. Not only are we just medical students, many are just 1st years without any pharmacological training at all without even the faintest disclaimer to that effect. The OP might actually intend to use what we say on a patient, God forbid. Again, I don't mean to be a drag on an educational conversation... but consider the weight your words might carry for the OP.
-dope-
PreMedAdAG said:so if there is kidney or liver damage, and assuming it may be a good idea to keep the patient off of pain narcotics, why not tylenol.. even cirrhotics are given tylenol. You can't just "do nothing".... you can't just let the patient be in pain, that's unethical. The other concern is tolerance and addiction to pain meds.. why not methadone?
fun8stuff said:antabuse
trudub said:While it is true that acetaminophen can be used in liver disease, the real point is that it should not be used specifically in alcoholics or in liver disease secondary to alcoholism. Alcohol upregulates the CYP2E1 enzyme. Normally only a small portion of acetaminophen is metabolized by this very same enzyme. When this enzyme metabolizes acetaminophen, it produces a reactive intermediate. Under normal conditions, the cell can take care of this metabolite using glutathione. However, in patients that are chronic alcoholics, the CYP 2E1 enzyme is upregulated. As a result, a larger portion of acetaminophen is not glucuronidated and is rather metabolized by the CYP system and converted to the reactive intermediate. Too much reactive intermediate can overcome the ability of the cell to respond with glutathione. When the cell runs out of glutathione, the reactive intermediate causes damage. So, this is a long winded explanation for why you do not use acetaminophen in patients that are chronic alcoholics. Very small doses can be very toxic in these patients.
tupac_don said:What you took that out of a book
tupac_don said:What you took that out of a book
12R34Y said:In response to many who are opposed to giving tylenol to liver patients. It is done all of the time on the GI/hepatology service by the fellows and attendings routinely.
Got a fever in someone with cirrhosis you give tylenol etc....
Here is a link. It has essentially been disproven that tylenol causes problems in liver patients in therapeutic doses.
Read on.......... there was a meta analysis done of the literature. Read the summary i've posted.
The therapeutic use of acetaminophen in patients with liver disease.
Benson GD, Koff RS, Tolman KG.
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 401 Haddon Avenue, Camden, NJ 08103, USA. [email protected]
Acetaminophen has been used safely and effectively for many years to manage pain and/or fever in patients of all ages. It is commonly recommended as first-line therapy for a variety of patients and conditions, including the elderly, children with viral illnesses, and patients with osteoarthritis, gastrointestinal conditions, bleeding disorders, cardiovascular disease, or renal disease. However, its use is often avoided in patients with chronic liver disease. The perception that acetaminophen should be avoided in such patients arose from awareness of the association between massive acetaminophen overdose and hepatotoxicity, combined with a lack of understanding of the metabolism of acetaminophen in patients with liver disease. There are various theoretical mechanisms of acetaminophen hepatotoxicity in chronic liver disease including: altered metabolism and depleted glutathione stores that would be expected to increase accumulation of the hepatotoxic intermediate, N-acetyl-p-benzoquinone imine (NAPQI). Available studies in patients with chronic liver disease, however, have shown that although the half-life of acetaminophen may be prolonged, cytochrome P-450 activity is not increased and glutathione stores are not depleted to critical levels in those taking recommended doses. Furthermore, acetaminophen has been studied in a variety of liver diseases without evidence of increased risk of hepatotoxicity at currently recommended doses. Therefore, acetaminophen can be used safely in patients with liver disease and is a preferred analgesic/antipyretic because of the absence of the platelet impairment, gastrointestinal toxicity, and nephrotoxicity associated with nonsteroidal antiinflammatory drugs.
Publication Types:
Review
Review, Tutorial
MeSH Terms:
Acetaminophen/adverse effects
Acetaminophen/pharmacokinetics*
Acetaminophen/therapeutic use*
Acute Disease
Analgesics, Non-Narcotic/adverse effects
Analgesics, Non-Narcotic/pharmacokinetics*
Analgesics, Non-Narcotic/therapeutic use*
Chronic Disease
Cytochrome P-450 Enzyme System/metabolism
Humans
Liver Diseases/chemically induced
Liver Diseases/metabolism*
Liver Diseases, Alcoholic/metabolism
Substances:
Analgesics, Non-Narcotic
Acetaminophen
Cytochrome P-450 Enzyme System
UCLA2000 said:Depends on the cause of the pain and the amount! Are we talking chest pain here? Headache? Abd pain?
I'm going to assume it's abd pain consistent with pancreatitis.
I would give fluid, drop an ng tube, possibly 4 of morphine, cbc, chem 7, lft's, amylase/lipase, coags, ct abd, urine dip, ekg.
WIth regards to using tylenol. up to 2g max of tylenol can be given to ppl in liver failure.
psiyung said:What medications would you recommend giving an alcoholic in severe pain?