Opioids

Question 1

MORPHINE
Sedation/analgesia dosing

adult & peds

Answer 1

• Adults: 2-20 mg q2-4h IV, IM, SC
• Peds: 0.02-0.1 mg/kg IV

Question 2

HYDROMORPHONE
Analgesic dosing

adult & peds

Answer 2

• Adults: 0.4-2 mg IV
• Peds: 0.005-0.02 mg/kg

Question 3

MEPERIDINE
Sedation/analgesia dosing

adult & peds

Answer 3

• Adult: 50-150 mg IV, IM q3-4h
• Peds: 0.5-2 mg/kg IV, IM

Question 4

MEPERIDINE
Adult Postoperative Shivering dosing

Answer 4

• 12.5-25 mg IV

remember - this is NORMOTHERMIC shivering related to volatile agents

Question 5

FENTANYL
Sedation/analgesia dosing

Answer 5

• Bolus: 0.25-5 mcg/kg
• Infusion: 0.01-0.04 mcg/kg/hr

Question 6

FENTANYL
General anesthesia adjunct dosing

Answer 6

• Bolus: 2-20 mcg/kg
• Infusion: 2-10 mcg/kg/hr

Question 7

REMIFENTANIL
General anesthesia adjunct dosing

Answer 7

General anesthesia

• Bolus: 0.5-1 mcg/kg
• Maintenance: 0.05-2 mcg/kg/min (Dr. C likes 0.1 mcg/kg/min)

Slow push to avoid profound bradycardia

more often used in specialty cases

Question 8

REMIFENTANIL
Sedation dosing

Answer 8

Sedation:

• Load: 0.5-1 mcg/kg over 30-60 seconds
• Maintenance: 0.025-0.2 mcg/kg/min

Slow push to avoid profound bradycardia

more often used in specialty cases

Question 9

METHADONE
PO, IV/IM/SC dosing

Answer 9

• PO: 2.5-10 mg
• IV/IM/SC: 2.5-5 mg q8-12h

titrate up q3-5 days

Question 10

OXYCODONE
Immediate release, Controlled release dosing

Answer 10

• IR: 5-15 mg q4-6h PO
• CR: 10 mg q8-12h

titrate up 25-50% q1-2 days

Question 11

HYDROCODONE
PO dosing

Answer 11

• 2.5-10 mg q4h

similar in potency to oral morphine (10mg = 5-10 mg Hydrocodone)

Question 12

CODEINE
Adult Antitussive dosing

Answer 12

• 15-60 mg PO q4-6h
  (max 120 mg/day)

15mg is often an effective dose

Question 13

BUPRENORPHINE
Adult IV/IM dosing

Answer 13

Adults:

• 0.3-0.4 mg q6-8h IV, IM
• May repeat inital dose in 30-60 min x 1
• doses > 0.3 mg should only be given IM

0.3-0.4 mg is equianalgesic to 10 mg IV morphine

Question 14

BUPRENORPHINE
Peds IV/IM dosing

Answer 14

Peds:

• 2-12 years: 2-6 mcg/kg IV, IM q 4-6h
• ≥ 13 years: 0.3 mg IV, IM q6-8h (max 300 mcg/dose)

0.3-0.4 mg is equianalgesic to 10 mg IV morphine