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O pioids

O pioids. Clinical Case.

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O pioids

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  1. Opioids

  2. Clinical Case 78 YO F with no PMH was admitted to the hospital for newly diagnosed pancreatic cancer. The patient has been requiring large amounts of Dilaudid (hydromorphone) IV during (totaling 8.1mg / 24 hrs). The patient is ready for discharge. What oral regimen should you send her home on?

  3. Objective • Learn some key opioid facts • Learn to convert common inpatient opioids to common outpatient opioids

  4. Key opioid Facts • Renal Failure – Avoid morphine • Choose: Fentanyl or Dilaudid • Fentanyl patches • Cachexia, body temperature, delay in onset • Short vs Long Acting • Dilaudid = Short only • Morphine = Short or long (MS Contin) • Constipation

  5. Opioid Conversion Chart

  6. Chronic Pain Opioid Conversions • Total Amounts • Convert • Cross-Tolerance? • Choose appropriate PO • PRN’s/breakthrough pain • Bowel regimen

  7. Clinical Follow up • 8.8 mg IV Dilaudid to PO morphine = • 8.8 x 20 = 176 mg PO Morphine • Cross tolerance? • YES! Reduce by 15% • PO Morphine = 150mg • MS CONTIN = BID Dosing. 150mg in BID dosing = • 150/2 = 75mg MS Contin BID • Breakthrough dosing = minimum of 50% total = • 150 * 0.50 = 75mg / day • 75mg divided into q4h dosing = • 75 / 6 = ~12 mg q4h PRN

  8. But that’s so many numbers! How can I keep track of all that?!

  9. Don’t you worry little intern/resident, the internet is here to help!

  10. Global RPH • http://www.globalrph.com/narcoticonv.htm • This is a great resource, but does not take the thinking out of your conversions. This, however, can help you if you don’t have an opioid conversion chart handy.

  11. And if you have any questions… • Please contact your local Palliative Care / Pain specialist.

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