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Equianalgesia Opioid Calculator: JHH Applications

This opioid calculator app helps in converting opioid doses, determining equianalgesic conversions, and recommending changes in pain management regimens. It provides accurate and efficient calculations to ensure optimal pain relief for patients.

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Equianalgesia Opioid Calculator: JHH Applications

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  1. Equianalgesia Opioid Calculator: JHH Applications Suzanne A Nesbit, PharmD, CPE Clinical Pharmacy Specialist, Pain Management Department of Pharmacy The Johns Hopkins Hospital

  2. Patient Case • 35 yo comes into the clinic complaining of persistent back pain. He has been taking Percocet (7.5mg oxycodone /324mg APAP) 2 tablets every 2-4 hours for his pain. He currently rates his pain 7/10. • Would you recommend any changes to his regimen? • Long acting opioid + short acting for breakthrough pain

  3. Equianalgesia • Different dose of two opioids that approximately provide the same pain relief • convert route and drug • morphine 10mg parenterally standard • decrease dose by up to 50% in tolerant patient

  4. Equianalgesic Conversion • usually convert to morphine equivalents • patient taking 18 Percocet (7.5mg/325mg) per day • 18 X 7.5mg = 135 mg oxycodone • 135 = 20 X = 202.5 mg oral morphine • decrease dose for incomplete cross tolerance X 30

  5. Opioid Rotation • Unresponsiveness • Unmanageable adverse effects • Route of administration • Potency • Cost

  6. Equianalgesic Chart

  7. Current Equianalgesia Tables • Single dose studies • Broad guidelines • Calculated dose reduced due to incomplete cross tolerance • Clinical status of the patient considered • Titrate and reassess

  8. Equianalgesia Studies • Single Dose • Usually acute pain ; opioid naïve patients • Retrospective • Chart review of patients with opioid rotation • Cross-over • Stable patients on an opioid; switched to another to determine dose and analgesic effect

  9. Dose Reduction • Large interpatient variability in potencies to opioids • Clinical status of patient: age, organ function, comorbidities, pain control • Relative potencies for chronic dosing unknown • Cross-tolerance: incomplete • start with 50%–75% of published equianalgesic dose • more if pain, less if adverse effects • Methadone • start with 10%–25% of published equianalgesic dose

  10. Challenging Conversions • Fentanyl • Methadone • Oxycodone • Hydromorphone

  11. Johns Hopkins Opioid Conversion Software and Applications • Floppy disc 1989 • PDAs 2002 • Tungsten Palm Version • Windows CE Version • Hopkins Opioid Program • Web-based version 2005 • www.hopweb.org • www.hopontheweb.org

  12. iPhone Application 2012

  13. Main Conversion Screen

  14. Drug and Dose Entry

  15. Final Output Screen

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