Opioids

Question 1

Morphine IV to PO

Answer 1

10mg to 30mg

Question 2

Fentanyl IV to PO

Answer 2

IV 0.1mg (NO PO)

Question 3

Hydromorphone IV to PO

Answer 3

1.5mg IV to 7.5mg PO

Question 4

Oxycodone IV to PO

Answer 4

(NO IV) 20mg PO

Question 5

Methadone IV to PO

Answer 5

5mg IV to 10mg PO

Question 6

Meperidine IV to PO

Answer 6

75mg IV to 300mg PO

Question 7

Codeine IV to PO

Answer 7

120mg IV to 200mg PO

Question 8

DOC for severe pain

Answer 8

Morphine IR 5-30mg PO q4h

Question 9

Morphine brand name (SR)

Answer 9

MS Contin; Oramorph SR; Avinza; Kadian)

Question 10

Hydromorphone brand name

Answer 10

Dilaudid; Exalgo

Question 11

Hydromorphone dosing opioid naive patients

Answer 11

0.4mg IV

Question 12

Hydromorphone dosing opioid tolerant patients

Answer 12

1mg IV

Question 13

Fentanyl patch brand name

Answer 13

Sublimaze

Question 14

Fentanyl transmucosal brand names

Answer 14

Buccal lozenges— Actiq
Buccal tablet— Fentora
Buccal soluble film— Onsolis

Question 15

Meperidine brand name

Answer 15

Demerol

Question 16

Tramadol brand name

Answer 16

Ultram; Ryzolt

Question 17

Tramadol dosing

Answer 17

50-100mg PO q4-6h
Max: 400mg
Ryzolt Max: 300mg

Question 18

Tapentadol brand name

Answer 18

Nucynta

Question 19

Tapentadol dosing

Answer 19

50-100mg q4-6h

Max: 700mg/d

Question 20

Methadone brand name

Answer 20

Dolophine; Methadose

Question 21

Opioids counseling points

Answer 21

Metabolized by liver (DDI w/ 2D6)
Sedation: caution when operating heavy machinery
Constipation (Senna and MOM)
Pruritus

Question 22

Opioid antagonists

Answer 22

Alvimopan (Entereg)
Methylnaltrexone (Relistor)
Naloxone (Narcan)

Question 23

What opioid antagonist is used for opioid induced constipation

Answer 23

Methylnaltrexone (Relistor)

Question 24

What TCA drugs are adjunctive for pain

Answer 24

Amitriptyline

Nortriptyline

Question 25

What SSRNI is used as adjunctive therapy for pain

Answer 25

Duloxetine

Question 26

What anticonvulsants are used as adjunctive therapy for pain

Answer 26

Gabapentin Pregabalin Carbamazepine Lamotrigine

Question 27

What corticosteroids are adjunctive for pain

Answer 27

Dexamethasone | Prednisone

Question 28

What anesthetics are adjunctive for pain

Answer 28

Lidocaine | Bupivacaine

Question 29

Rule of thumb: Morphine PO to oxycodone

Answer 29

30mg Morphine to 20mg Oxycodone

Question 30

Rule of thumb: Morphine PO to Fentanyl patch

Answer 30

200mg Morphine to 100mcg Fentanyl

Question 31

Cross tolerance reduction accounted for when changing from morphine to another drug

Answer 31

25-33% total daily dose | ONLY for CONTROLLED pain

Question 32

Dose adjustments required for uncontrolled pain

Answer 32

``` Severe pain (7-10)— increase total daily dose Moderate pain (4-6)— smaller increase Breakthrough needs to be changed as well (10-15% TDD) ```

Question 33

Abuse-deterrent opioids

Answer 33

``` OxyContin (oxycodone ER) Targiniq (oxycodone and naloxone ER) Embeda (morphine and naltrexone) Hysingla (hydromorphone ER) MorphaBond (morphine ER) Xtampza (oxycodone ER) ```

Question 34

Opioids used q4h interval

Answer 34

Morphine PO Oxycodone PO Hydromorphone PO

Question 35

Opioids used q6-8h intervals

Answer 35

Methadone PO

Question 36

Opioids used q1-2h interval

Answer 36

Fentanyl transmucosal

Question 37

Opioids used q8-12h intervals

Answer 37

MS Contin

Question 38

Opioids used daily intervals

Answer 38

Avinza | Kadian (daily or q12h)

Question 39

Opioids used q12h interval

Answer 39

OxyContin

Question 40

Opioids used q72h interval

Answer 40

Fentanyl patch