opioid prescribing

Question 1

morphine starting dose in opioid naive patient

Answer 1

7.5mg PO (15mg pill cut in 1/2)

2mg IV

Question 2

hydromorphone starting dose in opioid naive patient

Answer 2

1mg PO(2mg pill cut in 1/2)
0.2mg IV

Question 3

Oxycodone does in opioid naive patient

Answer 3

2.5mg PO

Question 4

hydrocodone dose in opiate naive patient

Answer 4

5mg PO

Question 5

A patient is considered opioid tolerant if taking daily doses, for 1 week or longer of at least

Answer 5

60mg PO morphine/24 hours
30mg PO oxycodone/24 hours
8mg hydromorphone/24 hours

Question 6

Strategy for prescribing short acting opioid for breakthrough pain

Answer 6

1) add up totoal opioid dose/24 hours
2) use 10% of the total 24 hour dose for the rescure dose
3) schedule frequency of rescue dose by time to peak concentration (60 min for oral dose, 15 min for IV dose)

Question 7

Potency ratio

Oral morphine: oral hydromorhone

Answer 7

5:1
(oral morphine dose divided by 5 = equianalgesic hydromorphone dose)
(oral hydromorphone X 5 to find equianalgesic morphine dose, ** oral hydromorphone is 5 times as potent as oral morphine)

Question 8

Potency ratio

oral morphine: oral oxycodone

Answer 8

1.25:1

Oral oxycodone is 1.25 times as potent as oral morphine

Question 9

Potency ratio

Oral morphine: IV hydromorphone

Answer 9

12.5: 1

IV hydromorphone is 12.5 times as potent as oral morphine

Question 10

Potency ratio

oral morphine: transdermal fentanyl

Answer 10

2:1

50mg/24 hours of oral morphine: 25mcg/hour of transdermal fentanyl

Question 11

Dose reduction during opioid rotation

Answer 11

Decrease dose by 50% in patient with moderate or controlled pain

Decrease by 25% for patient with severe pain

Question 12

Meperidine/demerol

Answer 12

Dont ever order this for shivers or pain !!

Toxic metabolites, neurotoxicity, especiañly in renal disease