Hydromorphone (dilaudid)

1. Hydromorphone
(dilaudid)
By: Erica S. Harris
MSNE 5356: Advanced Pharmacology
Fall 2016

2. Pain
• Pain among cancer patients
• The presence of pain is predictive of increased morbidity and
mortality among cancer patients.
• Cancer pain is pain associated with malignancy and can result from
the disease itself or damage to secondary tissue.
• Cancer pain symptoms can be associated with treatment
interventions or just the cancer in general.

3. Intended Drug Response
• Opioids such as hydromorphone bind to mu, kappa or delta opioid receptors
which then causes an analgesic effect.
• Hydromorphone works on the brain (crosses the blood brain barrier) to
increase the ability to tolerate pain
• Hydromorphone begins to work within thirty minutes if given in oral form,
or within five minutes if given intravenously

4. Potential Interactions
• The associated use of other central nervous system depressants such as
sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers and
alcohol may produce depressant effects.
• Opioid analgesics may enhance the action of neuromuscular blocking agents
and produce an excessive degree of respiratory depression.
• Dilaudid should not be taken with alcohol.
• Respiratory depression, hypotension, sedation or coma may occur.

5. Adverse Drug Reactions
Less Common
• On a lesser basis, potential adverse
reactions are:
respiratory depression and apnea
circulatory depression, respiratory
arrest, shock and cardiac arrest
Most Common
• The most frequently observed
adverse reactions are:
light-headedness, dizziness,
sedation, nausea, vomiting, sweating,
flushing, dysphoria, euphoria, and
dry mouth

6. Side Effects
Common Side Effects of
Dilaudid
• Nausea or vomiting
• Constipation
• Dizziness or lightheadedness
• Drowsiness
• Anxiety
• Restlessness
• Nervousness
• Insomnia
Serious Side Effects of
Dilaudid
• Rash or hives
• Difficulty swallowing
• Swelling of the eyes, face, lips, tongue,
mouth, or throat
• Seizures
• Fainting
• Hypotension

7. Pharmacokinetics
When given orally, it is absorbed by the gastrointestinal tract. It is
then extensively metabolized in the liver by a process called
glucuronidation where it is metabolized into its metabolite
hydromorphone 3-glucoronide and then excreted by the kidneys.

8. Drug Binding
Issues
• Medications that inhibit the metabolism
process of hydromorphone: amitriptyline,
benzodiazepines such as lorazepam,
clonazepam, diazepam, and the seizure
medication valproic acid
• Medications that induce the metabolism
process of hydromorphone: rifampin,
phenobarbital, and nicotine that is found in
tobacco.

9. Improving
Communication
• Implement
interdisciplinary team
rounds
• Understand the
perspectives of others
• Discover common goals
and collaborate in care
while keeping the patient
as the central focus

10. Application to Practice Setting
• Important actions to prevent complications and adverse reactions
• Identify high risk patients
• Monitor patients who have multiple prescriptions (ie. Benzos or antihistamines)
• Obtain routine vital signs
• Assess patients for over sedation (ie. Respirations, oxygen saturation, and arousal level)
• Stay alert for acute changes
• Monitor patients with liver or renal impairment and report any critical laboratory
values
• Think critically!

11. References
• Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for Advanced Practice: A Practical Approach (3rd ed.).
Philadelphia, PA Lippincott William, & Wilkins
• Fda.gov. (2009). Dilaudid and Dilaudid-HP injection. Retrieved from
http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019034s018lbl.pdf
• Jarzyna, D., Jungquist, C. R., Pasero, C., Willens, J. S., Nisbet, A., Oakes, L., … Polomano R. C. (2011). American
society for pain management nursing guidelines on monitoring for opioid induced sedation and respiratory
depression. Pain Management Nursing, 12 (3), 118-145. doi:10.1016/j.pmn.2011.06.008
• Johnson, S. J. (2007). Opioid safety in patients with renal or hepatic dysfunction. Retrieved from
http://paincommunity.org/blog/wp-content/uploads/Opioids-Renal-Hepatic-Dysfunction.pdf
• Lindeke, L., & Sieckert, A. (2005). Nurse-Physician workplace collaboration. OJIN: The Online Journal of Issues in
Nursing, 10 (1). doi: 10.3912/OJIN.Vol10No01Man04
• PG Medical. (2016). Pharmacogenomics and Pain. Retrieved from http://www.pgxmed.com/pharmacogenomics-
and-pain-2/
• Timmons, T. R. (2016). Managing pain with opioids and sedation monitoring. Oncology Nurse Advisor, 7(4), 21-22.

12. References Cont.
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