Lecture 4.5 - Pain Management (Opioid Dosing)

Question 1

When switching from IR to ER you want to…

Answer 1

use same med if possible

Question 2

How to convert IR to ER?

Answer 2

1. Add up total daily dose in 24hrs of IR
2. Divide total dose by intervals of ER formulation (usually 12)
3. Monitor and reassess for effectiveness and tolerability

Question 3

How to convert opioid to fentanyl patch?

Answer 3

Add up 24hr opioid amount and utilize the conversion table

Question 4

ER opioids + prn IR opioids is…

Answer 4

reserved for sever situations…cancer pain or end of life pain situations

not for typical pain

Question 5

Calculating opioid breakthrough pain dose

Answer 5

Calculate total 24hr dose of opioids

Admin 10-15% of total every 4-6hrs prn

breakthrough med will be IR formulation, preferably same med as Er formulation

Question 6

When should you adjust dosing for new ER + IR dosing severe pain

Answer 6

revise ER dosing when using more than 3 breakthrough doses/day

Question 7

When switching from one opioid to another, calculate dose by….

Answer 7

1. Calc 24hrs total
2. Use analgesic conversion table
3. Reduce by 50% to help offset incomplete cross-tolerance
4. divide daily dose based on duration of actions of drug/dosage form
5. Consider if breakthrough regimen is needed
6. monitor

Question 8

Opioid Patient Counseling

Answer 8

1. Follow directions, don’t increase alone
2. Explain reasoning for breakthrough…AKA… “AS NEEDED”
3. Don’t drive on meds
4. don’t use alc or take sedatives unless approved
5. Discus info act switching..titration + response differing
6. Potential side effects
7. How to dispose of left overs