Thrp - Opioids

Question 1

Morphine

Answer 1

Natural: Gold Standard
IV, IM, PO (IR, SR), Transdermal
PO: q4hr (MS Contin q8hr)

Parenteral 10; Oral 30

Starting IV Dose: 2-4mg q4hr
Starting PO Dose: 15mg q4hr

(Kadian (daily), MS Contin (q8h), MSIR, Avinza (daily))

DO not choose in renal failure pt

PCA Go to Rx:
On Demand Dose: 0.2mg/kg 8 min lockout

Question 2

Codeine

Answer 2

Natural

IM, PO

Question 3

Oxycodone

Answer 3

Semi-Synthetic
PO (IR q4hr, SR)

Parenteral NA; Oral 20

OK in renal failure

Question 4

Oxymorphone

Answer 4

Semi-Synthetic

IV, IM, PO (IR, SR ex Opana, Opana ER)

Question 5

Hydrocodone

Answer 5

Semi-Synthetic
PO (IR q4hr)

Parenteral NA; Oral 30

Question 6

Hydromorphone

Answer 6

Semi-Synthetic
IV, IM, PO (IR, SR)

Parenteral 1.5; Oral 7.5

Starting IV Dose: 0.2mg q46hr
Starting PO Dose: 1-2mg q4hr

PCA
On Demand Dose: 0.005mg/kg 8 min lockout

(Dilaudid)

Question 7

Fentanyl

Answer 7

Synthetic
IV, IM, Transdermal (q72hr), Transmucosal (q1-2hr), Intranasal

Parenteral 0.1; Oral NA (do not use chart here)
(100X more potent then morphine)
ONLY use conversion chart for injectable products
Rx of choice in renal / liver Dz

Starting IV dose: 50mcg q2-4hr

PCA
On Demand Dose: 0.3mcg/kg 6 min lockout

Question 8

Methadone

Answer 8

Synthetic
IM, PO (q6-8hr)

DO NOT use conversion charts
Good Rx: rapid onset, lont t1/2 BUT alot of side-effects due to accumulation

Question 9

Meperidine

Answer 9

Synthetic NO role in pain management
IV, IM

(demerol)

Question 10

Nalbuphine

Answer 10

Synthetic

IV, IM

Question 11

Prochlorperazine

Answer 11

10mg PO/IV q6h for opioid-induced N/V

Question 12

Promethazine

Answer 12

25mg PO/IV q6h for opioid-induced N/V

Question 13

Ondansetron

Answer 13

4-8mg PO/ODT/IV q4-8hr (better than prometh) for opioid-induced N/V

Question 14

Naloxone

Answer 14

Pure opioid ANTagonist

Dose: 0.4-2mg q few minutes
(0.4mg/10mL)

Onset 1-2min (IV) t1/2=30-80min