Lecture 4.4 - Pain Management (Opioids) Flashcards
CDC Guidelines for Opioid Prescribing
suggest only 3-7 day supply in many cases
careful to not exceed >50mg/day MME for chronic pain
Give naloxone w/ opioids
General Dosing guide opioids
Start minimal dose and alter based on pain response/ SE
Avoid or careful dosing opioids in….
Renal, hepatic dysfunction Elderly > 65 Pregnant Meds w/ additive CNS adverse effects Other disease ie Severe COPD, sleep apnea
Oral Onset + Duration
Onset ~ 30-45min
Duration: IR = 4-6hrs, SR = 8-12hrs
IR Oral Onset, Peak, Duration
30min
1-2hrs
4-5hrs
SR oral Onset, Peak, Duration
30-45min
3.5hrs
8-12hrs
Rectal Onset, Peak, Duration
30min
1-2hrs
4-5hrs
SC Onset, Peak, Duration
10-30min
50-90min
4-5hrs
IM Onset, Peak, Duration
10-30min
30-60min
4-5hrs
IV bolus Onset, Peak, Duration
5min
20min
2-4hrs
When are IR tabs used?
Used as needed
usually for short duration (post-surgical, post-trauma)
Used prn to control breakout pain
Dispense amount should be limited to duration expected to have pain severe enough to require opioids
When not to use IR tabs?
do not use on scheduled basis for chronic pain
increased risk for abuse & pill burden
ER preparations used for…
Severe chronic pain
Usually start on IR, then convert to ER
** Dosing is q12hrs **
Usual Fentanyl Patch dosing?
Q 3 days
Switching from IR to ER dosing
Use same med if possible
- calc total daily dose in 24hrs for IR
- divide total dose into appropriate intervals of ER (q12hrs)
- monitor and reassess for effectiveness and tolerability
Morphine IV to oral equivalent
10mg = 30mg
Dilaudid IV to oral equivalent
1.5mg = 7.5mg
Codeine IV to oral equivalent
130mg = 200mg
Oxycodone IV to oral equivalent
NA = 20mg (so 20mg is equivalent to other opioids)
Hydrocone IV to oral equivalent
NA = 30mg ( so 30mg is equivalent to other opioids)
Switching 1 opioid to another
- calculate 24hrs total
- use analogies conversion table
- reduce by 50% to help offset incomplete cross tolerance
- divide daily dose based on duration of actions of drug/dosage form
Opioid Patient counseling
- follow instructions, don’t increase w/o calling Dr.
- explain what “AS NEEDED” means
- don’t drive
- don’t use alc or take sedatives unless approved
- Discuss switching from 1 to another
- Potential SE
- Dispose left overs
Most common opioid SE
Constipation
Nausea/vomiting
Pruritis (itchy)
Sedation
Other: Respiratory depression Drug interactions Accumulation urinary retention
Tolerance
larger doses needed for same effect
