Pharmacology
The organ responsible for excretion of opioids.
Kidney
The IV equivalent dose of oral morphine 15 mg.
What is morphine 5 mg IV? (PO:IV 3:1)
The half-life of MSContin and OxyContin.
What is ~12 hours?
Most common side effect of opioids.
What is constipation?
A chronic disease with genetic factors causing obsessive use of a drug, loss of control and use despite harm.
What is addiction?
The time to maximum effect (Cmax) of short-acting IV opioids.
What is ~ 6-10 minutes?
The oral hydromorphone dose equivalent to oral morphine 15 mg.
What is oral hydromorphone 3 mg (H:M = 1:5)
Percentage of daily opioid requirement (includes long + short-acting opioids) to estimate prn dose for breakthrough pain.
What is ~10-15% (of daily opioid requirement)? Ex: MS Contin 30 q12h?
Most effective laxative for opioid-induced constipation.
What is senna (stimulant)?
A normal physiologic response that results in withdrawal if chronic opioids abruptly discontinued.
What is dependence?
The half-life of short-acting oral opioids.
What is ~4 hours?
FDA may ban this subgroup due to toxicity and risks of abuse.
What are acetaminophen-opioid agents?
Opioid that can prolong QTc interval.
What is methadone?
Opioid-induced syndrome of myoclonus, hyperalgesia, delirium, seizures.
What is opioid-induced neurotoxicity?
The need for an increased dose to achieve the same effect.
What is tolerance?
The onset of action of a fentanyl TD patch.
What is ~12 hours?
DAILY DOUBLE! This would be the parenteral dose for a pt who was on MS Contin 90mg BID who can no longer swallow.
morphine 2.5mg/hr (180mg OME/3 = 60mg IV/24h = 2.5mg)
These are three factors that can affect fentanyl patch absorption.
What is fever/vascularity/sweating/body hair/adipose tissue/skin condition & breakdown
"Safer" opioids in renal failure due to lack of active metabolites, with lower risk of neurotoxicity.
What are fentanyl and methadone?
This team can counsel patients struggling with both pain and addiction, with the goal to get patients entered into an outpatient addiction program.
What is addiction psychiatry consult team?
The ceiling effect (maximum threshold) of opioids.
What is none - there isn't a ceiling effect.
Pro-drug of morphine; ineffective in non-metabolizers; overdoses in rapid metabolizers.
What is codeine?
Opioid with NMDA antagonism; more potent if previous opioid exposure.
What is methadone?
Your elderly patient is exhibiting myoclonus and you suspect opioid-induced neurotoxicity from frequent morphine boluses. These are your next 3 steps.
What is: stop the current opioid, administer lorazepam, and rotate opioid at reduced dose.
This is the period of analgesia for methadone and buprenorphine.
What is 4-8 hours?