Opioids Flashcards
Which type of morphine should be offered to pts when starting pain relief (in those with advanced and progressive disease)?
- Modified-release (MR) or oral immediate-release morphine
- Depending on pt preference
- Oral immediate release morphine for breakthrough pain
What else should be prescribed alongside opioids?
- Laxatives for all
- Antiemetics if nausea
Drowsiness is transient, and if it doesn’t settle then adjust dose
What is the breakthrough dose of morphine?
1/6th of total daily dose
What is the preferred opioid in pts w/ mild-moderate renal impairment?
Oxycodone
What is the preferred opioid in severe renal impairment?
- Alfentanil
- Buprenorphine
- Fentanyl
What should be used for metastatic bone pain?
- Opioids (best relief)
- Bisphosphonates
- Radiotherapy
- Denosumab
What are 3 key side effects of opioids?
- Nausea
- Drowsiness
- Constipation
What is the conversion factor between oral codeine and oral morphine?
Morphine is x10 stronger
What is the conversion factor between oral tramadol and oral morphine?
- Morphine is x10 stronger
- 10mg morphine = 100mg tramadol
What is the conversion factor between oral morphine and oral oxycodone?
- Oxycodone 1.5 times stronger so divide morphine by 1.5 to get oxycodone dose
- It causes less sedation, vomiting and pruritus than morphine but more constipation
Transdermal preparations and conversions
- Transdermal fentanyl 12 mcg = 30 mg oral morphine daily
- Transdermal buprenorphine 10 mcg = 24 mg oral morphine daily
Oral to subcut opioid conversions
- Oral morphine → subcut morphine: divide by 2
- Oral morphine → subcut diamorphine: divide by 3
- Oral oxycodone → subcut diamorphine: divide by 1.5
What is an adequate dose of morphine for most patients?
- Morphine immediate-release 30mg 4-hrly, OR
- Morphine modified-release 100mg 12-hrly
