Opiates

Question 1

IV Fentanyl: 
Dose:
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 1

IV Fentanyl: 
Dose: 0.25-1 mcg/kg
Onset: Immediate
Peak: 1-5m
Duration: 30-60m
Metabolism: liver
t1/2: 1-6hr

Question 2

Hydrocodone:
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 2

Dose: 5-10 mg PO q4-6hr
Onset: 60m
Peak: 2 hr
Duration: 4-5hr
Metabolism: Liver
t1/2: 4hr

Question 3

Hydrocodone containing products (2)

Answer 3

Vicodin, Lortab

Question 4

IV Hydromorphone: 
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 4

Dose: 0.2 - 0.6 mg q2-3hr
Onset: 5 min
Peak: 10-20m
Duration: 4-5hr
Metabolism: Liver
t1/2: 2-3 hr

Question 5

PO Hydromorphone: 
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:
Oral dose is \_\_ x IV dose

Answer 5

Dose: 2-4mg q 4-6hr
Onset: 20m
Peak: 30-60m
Duration: 4-5hr
Metabolism: liver
t1/2: 2-3hr
Oral dose is 5-10x IV dose

Question 6

IV Meperidine
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:
max dose in 24 hours

Answer 6

Dose: 25-50 mg q 1-2h
Onset: 2-5m
Peak: 20m
Duration: 2hr
Metabolism: liver
t1/2: 2-3hr
Max dose 600mg/24 hours

Question 7

Contraindications to meperidine (2):

Answer 7

 Not recommended in elderly or patients with renal
dysfunction.
 Not for use in chronic pain.

Question 8

Meperidine dose-limiting side effect (cause, considerations).

Answer 8

 More than 72 hr of continuous use can cause accumulation of normeperidine which can lead to neuro-excitability (seizures).
 Naloxone administration will increase neuroexcitibility.

Question 9

PO Morphine
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 9

Dose: 10-15 q3-4h
Onset:15m
Peak: 1.5-2h
Duration: 4h
Metabolism:liver, renally excreted metabolite
t1/2: 1.5-2h

Question 10

IV morphine
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 10

Dose: 4-10mg q 3-4h
Onset: 15-30m
Peak: 30-60m
Duration: 4-7h
Metabolism: liver
t1/2: 1.5-2h

Question 11

Oxycodone- containing products (2)

Answer 11

Percocet (and Oxycontin)

Question 12

Oxycodone
Dose: 
Onset:
Peak:
Duration:
Metabolism:
t1/2:

Answer 12

Dose: 5-10mg q4-6h
Onset: 15-30m
Peak: 1-2h
Duration: 4-6h
Metabolism: liver
t1/2: 4h

Question 13

Equianalgesic ratios as compared to PO morphine:
PO Hydrocodone
PO Hydromorphone
PO Oxycodone

Answer 13

Hydrocodone 1: 1
Hydromorphone (Divide PO morphine by 4, 4x more potent)
Oxycodone 1: (Multiply PO morphine by 0.66)

Question 14

Equianalgesic ratios as compared to IV morphine:
IV Fentanyl
IV Hydromorphone
IV meperidine

Answer 14

IV Fentanyl 1000x more potent (add 1 zero to mg dose to get the dose in mcg, so 10mg IV morph = 100 mcg IV fent)
IV Hydromorphone (Divide by 7, 7x more potent)
IV meperidine (Multiply by 10, 10x less potent)

Question 15

10mg of IV morphine is ___ PO morphine

Answer 15

30mg

Question 16

1.5 mg IV hydromorphone = ___ PO

Answer 16

7.5mg