Hydromorphone is an opioid analgesic used to treat cancer pain. It works by binding to opioid receptors in the brain to increase pain tolerance. Common side effects include nausea, vomiting, dizziness, and constipation. It can interact with other CNS depressants and cause respiratory depression. Careful monitoring is needed when prescribing to patients with liver or kidney impairment or those taking interacting medications.

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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