Pain in Palliative Care: Methadone

Question 1

list the 7 long acting opioid agents

Answer 1

codeine
morphine
hydromorphone
fentanyl
oxycodone
tramadol
methadone

Question 2

kadian is ____ release

Answer 2

24hr

Question 3

which morphine formulation is more for addictions than pain

Answer 3

kadian

Question 4

T or F: kadian is not interchangeable with MS Contin or M-Eslon

Answer 4

T

Question 5

MS contin or M-elson have ____ release

Answer 5

12hr

Question 6

methadone is dosed q_h

Answer 6

8

Question 7

can you use long acting opioids to titrate dose

Answer 7

no- use IR until pain is stabilized

Question 8

what injectable long acting opioids are available without compounding

Answer 8

morphine, hydromorphone, fentanyl

Question 9

which injectable long acting opioids must be compounded

Answer 9

methadone, oxycodone

Question 10

injectable dose = ___ PO dose

Answer 10

50%

Question 11

what is the point of opioid rotation

Answer 11

to achieve improved balance between analgesia and AEs

Question 12

opioid rotation may be done due to 3 reasons

Answer 12

inadequate pain control due to disease progression, tolerance, neuropathic pain
toxicities (n/V, constipation, drowsiness)
opioid induced neurotoxicity

Question 13

sx of opioid induced neurotoxicity

Answer 13

intractable N/V, agitation, delirium, myoclonus, hallucinations, bad dreams, increased pain, hyperalgesia, allodynia

Question 14

causes of opioid induced neurotoxicity

Answer 14

accumulation of metabolites due to renal failure or dehydration

Question 15

tx of OIN

Answer 15

review other aspects of pain (psych/ overuse/ abuse)
hydration
dose decrease
opioid rotation

Question 16

T or F: you should use more than one long acting opioid to maximize effect without causing OIN

Answer 16

F- use one for easier identification of SEs

Question 17

T or F: methadone rotation is the same as other opioid rotations

Answer 17

F- usually done inpatient for 4 days, or outpatient slowly
+ has to be done by palliative specialist due to variable kinetics

Question 18

what is different between a normal opioid rotation and a methadone rotation

Answer 18

methadone rotation in edmonton is usually done over 4 days, needs a palliative specialist due to variable kinetics
conversion ratio is dose dependent dosing is q8h

Question 19

what is the methadone dose if the oMEDD <1000mg/d

Answer 19

10;1

Question 20

what is the methadone dose if the oMEDD 1000-3000mg

Answer 20

20;1

Question 21

what is the methadone dose if the oMEDD 3000-10000

Answer 21

30;1

Question 22

what is the methadone dose if the oMEDD >10000

Answer 22

50;1

Question 23

when would liquid methadone be prefered

Answer 23

if pt can’t swallow/ has feeding tube

Question 24

why is liquid methadone usually not given for pain

Answer 24

causes nausea + unpleasant taste

Question 25

what is the conversion between PO methadone and FT

Answer 25

1;1

Question 26

what is the conversion between PO methadone and PR

Answer 26

1;1

Question 27

what is the conversion between PO methadone and SC

Answer 27

1: 0.5-0.8

Question 28

compounded methadone and oxycodone have a ___ fridge life unless sterility tested

Answer 28

3day

Question 29

how to admin SQ methadone

Answer 29

While administering dose, flush with NS 60-75mL/h, then flush with 30mL saline post dose to perfuse tissue and avoid irritation
Rotate sites as necessary

Question 30

T or F: methadone SQ is given as a continuous infusion

Answer 30

F- intermittently q8h