5.7 non-malignant pain pt3

Question 1

What are SEs of opioids?

Answer 1

• Antitussive
• Constipation
• N/V
• Itching
• Orthostatic hypotension
• Urinary retention
• Sedation
• Respiratory depression

Question 2

What other drug should be considered for pts taking opioids?

Answer 2

Consider starting stool softener and/or stimulant laxative

Question 3

What are the available formulations of codeine?

Answer 3

• Tablet
• Cough syrup

Question 4

What is codeine metabolized to and by what?

Answer 4

Metabolized to morphine via CYP2D6

Question 5

Which pt group should not take codeine?

Answer 5

Not recommended in breastfeeding mothers or children <12

Question 6

What are the available formulations for tramadol?

Answer 6

• Capsule ER 24h (Conzip)
• Tablet IR and ER 24h
• Oral solution
• Combo products w acetaminophen and celecoxib available

Question 7

How is tramadol excreted?

Answer 7

Excreted renally

Question 8

What is the boxed warning for tramadol?

Answer 8

Use of CYP 3A4 inducers and inhibitors, 2D6 inhibitors w tramadol requires careful consideration

Question 9

What are the available formulations of morphine?

Answer 9

• Capsule ER 24h
• Tablet IR and 12h ER
• Oral solution
• Solution for injection
• Suppository

Question 10

What morphine dosage form was d/c?

Answer 10

Abuse-deterrent tablet

Question 11

Which SE is more prominent w the use of morphine?

Answer 11

Itching

Question 12

How is morphine excreted?

Answer 12

Renally excreted and accumulate in renal dysfxn

Question 13

What is the boxed warning for morphine?

Answer 13

Avoid alcohol while taking ER capsules: leads to increased morphine plasma levels and potentially fatal

Question 14

What are the available formulations of hydromorphone (dilaudid)?

Answer 14

• IR and ER tablets
• Oral solution
• Solution for injection
• Suppository

Question 15

What is the boxed w hydromorphone (dilaudid)?

Answer 15

Boxed warning about dosing errors when prescribing, dispensing, and administering

Question 16

What are the available formulations for hydrocodone +/- acetaminophen?

Answer 16

• Oral solution
• ER tablet (Hysingla)
• Tablet (Norco)

Question 17

What is the boxed warning for hydrocodone +/- acetaminophen?

Answer 17

Use w 3A4 inhibitors may increase hydrocodone plasma conc

Question 18

What are the available formulations for oxycodone?

Answer 18

• Tablet IR and ER 12h
• Capsule IR and ER 12h
• Oral solution

Question 19

What is different about oxycodone ER capsule/tablets?

Answer 19

Abuse deterrent

Question 20

What is the boxed warning for oxycodone ?

Answer 20

Use w 3A4 inhibitors may increase oxycodone plasma conc

Question 21

What are the available formulations of fentanyl?

Answer 21

• Buccal tablet
• SL tablet
• Lozenge
• Injectable solution
• Patch

Question 22

What is the boxed warning for fentanyl?

Answer 22

Monitor pts receiving 3A4 inhibitors or inducers

Question 23

Can fentanyl be used in renal impairment?

Answer 23

Yes

Question 24

What is an advantage of fentanyl vs morphine or hydromorphone?

Answer 24

Less hypotension

Question 25

Non-injectable fentanyl is ONLY indicated for which pts?

Answer 25

Pts who are opioid tolerant

Question 26

How is opioid tolerant defined?

Answer 26

Taking morphine 60 mg per day or equivalent for at least 1 week w no effect

Question 27

How is fentanyl patch dosing converted from oral 24h morphine?

Answer 27

Half the 24h morphine dose to get fentanyl transdermal dose

Question 28

Can fentanyl patch dosing be converted w other opioid analgesics other than oral 24h morphine?

Answer 28

NO

Question 29

What are the uses of methadone (mathadose)?

Answer 29

- Last line tx of chronic pain - Opioid detoxification

Question 30

What are the available formulations for methadone (methadose)?

Answer 30

- Oral solution - Injectable solution - Tablet

Question 31

What are the boxed warnings for methadone (methadose)?

Answer 31

- QTc prolongation - Monitor pts receiving inducers/inhibitors

Question 32

What are the available formulations for meperidine (demerol)?

Answer 32

- Injectable solution - Oral solution - Tablet

Question 33

Which pt groups should avoid use of meperidine (demerol)?

Answer 33

Avoid in the elderly, avoid in renal impairment, caution use in hepatic impairment

Question 34

What are the boxed warnings for meperidone (demerol)?

Answer 34

- Monitor pts receiving 3A4 inducers/inhibitors - Do not use within 14 days of MAOIs

Question 35

How is meperidone (demerol) metabolized?

Answer 35

Metabolized by liver into an active metabolite

Question 36

What is the dosing of codeine for opioid naive pts?

Answer 36

15-60 mg PO q4h PRN

Question 37

What is the dosing of tramadol for opioid naive pts?

Answer 37

25-50 mg PO q4-6h prn

Question 38

What is the dosing of morphine for opioid naive pts?

Answer 38

- 5-10 mg PO q4h prn - 2.5-5 mg IV q3-4h prn

Question 39

What is the dosing of hydromorphone for opioid naive pts?

Answer 39

- 2-4 mg PO q4-6h prn - 0.2-1 mg IV q2-3h prn

Question 40

What is the dosing of hydrocodone for opioid naive pts?

Answer 40

2.5-10 mg PO q4-6h prn

Question 41

What is the dosing of oxycodone for opioid naive pts?

Answer 41

5-15 mg PO q4-6h prn

Question 42

What is the dosing of fentanyl for opioid naive pts?

Answer 42

25-50 mcg q30-60min prn

Question 43

Which of the opioids are natural opiates?

Answer 43

- Morphine - Codeine

Question 44

Do natural opiates have an allergic cross rxn?

Answer 44

Yes - Avoid in pts w allergy to other natural opiates and semi-synthetic opioids

Question 45

Which of the opioids are semi-synthetic opioids?

Answer 45

- Hydromorphone - Oxycodone - Oxymorphone - Hydrocodone - Buprenorphine

Question 46

Do semi-synthetic opioids have an allergic cross rxn?

Answer 46

Yes - Avoid in pts w allergy to other semi-synthetic opioids and natural opiates

Question 47

Which of the opioids are synthetic opioids?

Answer 47

- Fentanyl - Methadone - Meperidine - Tramadol

Question 48

Do synthetic opioids have an allergic cross rxn?

Answer 48

No - Can be used if pt has an allergy to another synthetic opioid, semi-synthetic opioid, or natural opiate