Opioid Analgesics
Conversions
Adjuvants
Principles of Pain Management
100
The medication that we use to compare all others to in terms of dosing. IE: 24 hour_________ equivalent
What is Morphine?
100
These two opioids are equianalgesic (mg for mg).
What are Morphine and Hydrocodone?
100
This over the counter analgesic is often given on a scheduled basis because it is relatively safe for most patients and actually potentiates the effect of opioid analgesics.
What is Acetaminophen?
100
When you start a patient on an opioid, you should always also be initiating this.
What is a preventive bowel regimen?
100
Any past reactions to analgesics
What are allergies/sensitivities?
200
This is a gastrointestinal side effect of every opioid in every patient.
What is Constipation?
200
Parenteral Morphine (SQ, IV,) is this many times more potent than po Morphine.
What is 3 times?
200
This anesthetic may be used orally in a single dose for depression, orally on a scheduled basis to lower pain threshold, or topically for neuropathic pain.
What is Ketamine?
200
The reason you should, when possible, use the same class of opioid analgesic for long-acting (ie, 24-hour scheduled doses) and short-acting (ie, PRN doses for breakthrough pain) pain relief.
What is minimizing side effects?
200
Those whose input into the analgesic regimen must be considered
What are decision makers/ "shareholders"?
300
These 2 opioid analgesics would be considered safest in renal failure/ESRD?
What are Methadone and Fentanyl?
300
This principle explains why we typically reduce opioid doses when converting from one opioid to another.
What is Incomplete Cross Tolerance?
300
An adjuvant commonly used in hospice and palliative care from the corticosteroid class that can be used to decrease inflammation, subsequently reducing pain in addition to improving energy and appetite.
What is decadron?
300
This...
What is the WHO step model for pain management?
300
A medication that requires especially careful monitoring when analgesics and adjuvants are added/adjusted (NSAIDS, SNRI, SSRI, Phenobarb, and many more...)
What is Coumadin?
400
When your patient is using 4 or more breakthrough doses of a short acting opioid in a 24 hour period, you should think about this.
What is starting a long acting opioid?
400
Your patient has been taking MSSR 30 mg po q 8 hours as well as Norco 10/325 2 tablets every 4 hours as needed. He has taken 2 tablets 6 times in the last 24 hours. He has also taken 4 5 mg doses of oral morphine concentrate for dyspnea in the past 24 hours. He is having trouble swallowing and you want to change the analgesic route. What do you calculate as his oral morphine equivalent?
What is 230?
30X3= 90
20X6= 120
5X4= 20
TOTAL= 230
400
This class of antidepressants includes Effexor and Cymbalta and may be used to treat neuropathic pain as well as depression/anxiety.
What are the SNRI (Serotonin-Norepinephrine Reuptake Inhibitors) antidepressants?
400
Major organ dysfunction: particularly renal and hepatic impairment, but also adrenal insufficiency, hypothyroidism, and abnormal levels of protein binding as well as demography, including race, age, and gender may affect a drug's __________.
What is potency?
400
The data needed by the physician to calculate changes to an opioid regimen
What is the 24 hour use of each opioid analgesic that the patient is taking?
500
There are several conversion tables for this analgesic. Because of it's long half life, it is important to start low and go slow.
What is Methadone?
500
Your newly admitted patient is on MSSR 90 mg q 12 hours and has used 7 20 mg doses of oral Morphine concentrate in the past 24 hours. He appears comfortable, but is now choking on food and fluids. Looking at the conversion chart, you guess that the MD might prescribe which dose of Fentanyl patch?
90X2=180
7X20 =140
Total is 320 oral morphine equiv.
**What is a 75 mcg Fentanyl Patch?
500
This medication is a poor anticonvulsant (and as such is rarely used) but works well for treating neuropathic pain.
What is Neurontin
500
Intolerable side effects, inadequate analgesia and/or suspected tolerance may signal that it is time for_________ ________________.
What is Opioid rotation?
500
When nurses act as detectives and have suspicions about _____ a patient is having more pain, it is easier to treat the cause.
What is WHY?