I'm an Opioid
MJ is a 47-year-old Hispanic female with chronic back pain. She was prescribed oxycodone/APAP 10-325mg 3 weeks ago, and is returning to the clinic for a follow-up appointment. She states that her pain is generally well-controlled, but that it tends to reoccur around 1 hour before her next scheduled dose. She is currently taking 2 oxycodone/APAP 10-325mg tablets every 4 hours around-the-clock.
How much APAP is MJ taking and is this okay?
Max dose is 3g/24H....but some people say 4g/24H
SOCRATES
QISS TAPED
MJ is a 47-year-old Hispanic female with chronic back pain. She was prescribed oxycodone/APAP 10-325mg 3 weeks ago, and is returning to the clinic for a follow-up appointment. She states that her pain is generally well-controlled, but that it tends to reoccur around 1 hour before her next scheduled dose. She is currently taking 2 oxycodone/APAP 10-325mg tablets every 4 hours around-the-clock.
Calculate the total short-acting (IR) opioid dose used in 24 hours
20mg oxycodone (2 tablets x 10mg) x 6 times/day = 120mg oxycodone IR in 24 hours
Quick! A nurse calls and states your patient can no longer take their oral pain medications and needs to be switched to an IV. This website will help you!
What is www.globalrph.com
RL is a 56-year old white male with chronic pain in shoulder following multiple shoulder surgeries. Following his most recent surgery, he was placed on hydromorphone IR 2mg. He states he is currently taking 1 tablet q3h around-the-clock, however he is still rating his pain level a 7/10 (down from a 10/10).
Calculate the total short-acting opioid (IR) used in 24 hours
Hydromorphone IR 2mg x Q3H = 16mg hydromorphone IR in 24 hours
A 65y/o male with PMH significant for renal failure and liver failure presents to the ICU after a fall with traumatic compression fracture of L4. This might be the best medication to use.
What is fentanyl with a 50% dose reduction and decreased PRN frequency
RL is a 56-year old white male with chronic pain in shoulder following multiple shoulder surgeries. Following his most recent surgery, he was placed on hydromorphone IR 2mg. He states he is currently taking 1 tablet q3h around-the-clock, however he is still rating his pain level a 7/10 (down from a 10/10).
What is the equivalent dose of PO morphine over 24 hours?
Total 24H dose 16mg hydromorphone
16mg x (30/7.5) = 64mg
Incomplete Cross Tolerance --> 64mg x .75 = 48mg
A 36 y/o female with PMH significant for lupus presents to the ER with acute renal failure (GFR 15) of unknown etiology and complains of severe pain in her back. And by the way, I'm allergic to fentanyl with anaphylactic reaction. This opioid would be a good place to start.
What is dilaudid with a 50% dose reduction
But all opioids really
RL is a 56-year old white male with chronic pain in shoulder following multiple shoulder surgeries. Following his most recent surgery, he was placed on hydromorphone IR 2mg. He states he is currently taking 1 tablet q3h around-the-clock, however he is still rating his pain level a 7/10 (down from a 10/10).
Say RL was admitted to the hospital and unable to take PO (epiglottitis). You don't want him to withdrawal.
Convert his PO hydromorphone dose to IV hydromorphone and write the order for scheduled dosing in the hospital.
(7.5/1.5) x 16mg PO hydromorphone
3.2mg IV hydromorphone for 24 hour total
0.4mg IV hydromorphone Q3H
0.8mg IV hydromorphone Q6H
A 97-year old woman is evaluated in the emergency department for acute abdominal pain radiating to her back. She is found to have a ruptured AAA. Medical history is significant for hypertension, and her only medication prior to admission was felodipine. On physical examination, temperature is normal, BP is 90/48 mmHg, pulse is 115/min, and RR is 24/min. BMI is 22. She is awake, alert, and able to answer questions. She appears frail and is in obvious pain. Her abdomen is tender to palpation with guarding. No bowel sounds are detected. Laboratory studies are significant for a hemoglobin level of 8.0 g/dL and serum creatinine of 5.9 mg/dL. Which of the following is the most appropriate treatment for this patient’s pain?
A. Fentanyl, transdermally
B. Hydromorphone, IV
C. Morphine, IV
D. Tramadol, PO
B. Hydromorphone, IV