Meperidine for renal colic?

[ChessMaster3000]

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I came across a practice questions in usmlerx that described a patient with a renal stone and asked for the best pain medication. the answer was meperidine, because specifically meperidine is used for renal colic, or so they say. I had never come across this, and did a search showing that it had been in the past used relatively often for this indication. However, is this a common thing that students read and/or expected to know these days? I cant imagine that being on the real test, seems like an outdated question.

 

[thehundredthone]

Did it ask you to pick between opioids? Meperidine used to be thought to have antispasmodic activity but it was found to be true only in vitro. In fact it's has more adverse effects, notably sertonin syndrome and a toxic metabolite. You should know that opioids (morphine sulphate for the most part) can be used for renal colic usually as a second line after intravenous NSAIDs. Meperidine is deinitely not preferred.

 

[ChessMaster3000]

Did it ask you to pick between opioids? Meperidine used to be thought to have antispasmodic activity but it was found to be true only in vitro. In fact it's has more adverse effects, notably sertonin syndrome and a toxic metabolite. You should know that opioids (morphine sulphate for the most part) can be used for renal colic usually as a second line after intravenous NSAIDs. Meperidine is deinitely not preferred.

Ha, ok. It did offer morphine as an option. It also offered iv ketorolac as an option and said that it was too strong for this pain. your post is helpful, thanks. cant really trust usmlerx with that kind of specificity

 

[thehundredthone]

I wasn't aware that NSAIDs were "too strong" for any pain. That's a new one.

 

[Phloston]

I saw this question too but I can't remember the specifics. I believe the answer being meperidine wasn't because of the anti-spasmodic effects though. It had something to do with acute renal failure and/or metabolism.

 

[Phloston]

As far as what I can remember about keterolac, I think that's the answer for acute pain in the emergency department if opioids are contrindicated. One of the explanations had said something about how keterolac is still used by some EDs to treat severe pain caused by kidney stones.

 

[ChessMaster3000]

I saw this question too but I can't remember the specifics. I believe the answer being meperidine wasn't because of the anti-spasmodic effects though. It had something to do with acute renal failure and/or metabolism.

you may be correct, although meperidine is also "indicated" for biliary colic, according to this question's answer