PALLIATIVE

Question 1

PAIN MANAGEMENT

Answer 1

TITRATION OF OPIOIDS

1. Maintenance Dose
   Schedule IR Opioid q4-6 hr routine until pain is controlled and dosing stabilized
2. Convert to SR
3. Breakthrough Dose
   10% of total daily dose, prescribed q1-2 hr PRN

If require >3 BT/day consistently over several days, adjust maintenance dose by adding sum of BT dose to 24 hrs total, except if induces sedation

4. Reassessment
   Titrate IR opioids no more than every 24 hrs, and SR opioids every 2-3 days

IMMEDIATE RELEASE (IR) OPIOIDS
Hydromorphone IR:
1, 2, 4, 8 mg PO
2 mg PO = 1 mg SC / IV

Morphine:
5, 10, 25 mg PO
10 mg PO = 5 mg SC / IV

SUSTAINED RELASE (SR) OPIOIDS

Hydromorph Contin:
3, 6, 9, 12 & 18 mg PO q 12 hrs

MS Contin:
15, 30, 60 & 100 mg PO q 12 hrs

Kadian:
10, 20, 50 & 100 mg PO q 24 hrs