MUSC Opioid Analgesic Comparison Chart

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "MUSC Opioid Analgesic Comparison Chart"

Transcription

1 MUSC Opioid Analgesic Comparison Chart Approved by the Pharmacy and Therapeutics Committee (February 2006, November 2009, March 2010, December 2011) Prepared by the MUSC Department of Pharmacy Services and the Pain Management Service Available online at Disclaimer: This document is a guideline, and not a policy statement. This conversion chart is designed to facilitate the rational conversion of one opioid regimen to an approximately equianalgesic dose of another opioid. The authors have strived to ensure that the information included in the chart reflects the current level of knowledge regarding opioid conversions. As a result, it is the user s responsibility to examine all available information on opioid conversions and to integrate with knowledge about the patient. Always use clinical judgment when making decisions for an individual patient. COMMONLY USED OPIOID ANALGESICS

2 Medication Fentanyl (Sublimaze, Duragesic, Actiq, Fentora ) HYDROmorphONE (Dilaudid ) Methadone (Dolophine, various) Route Onset of Duration of Usual Dosing Interval Appropriate for PCA Concentration for PCA Equi-analgesic Dosing IV immediate 30 to 60 min 1 to 2 hr Yes 50 micrograms/ml 100 micrograms IV (0.1 mg IV) See page 4 for details SC ** 15 min 30 min to 2 hr 3 to 6 hr N/A N/A 100 micrograms SC (0.1 mg SC) See page 4 for details TM 5 to 15 min highly variable See page 4 N/A N/A See page 4 See page 4 for details TD 12 to 24 hr 72 hr per patch 72 hr N/A N/A See page 4 See page 4 for details PO 15 to 30 min 4 to 6 hr 3 to 6 hr N/A N/A 7.5 mg PO HYDROmorphONE is not IV/SC 15 min 4 to 6 hr 3 to 6 hr Yes 1 mg/ml 1.5 mg IV equivalent to morphine PO 30 to 60 min > 8 hr (chronic use) 8 to 12 hr (chronic use) N/A N/A See page 5 Notes **See page 5 for details** Equianalgesic dosing is variable with chronic dosing MorphINE immediate release (MSIR, Roxanol, various) MorphINE extended release (MS Contin, various) MorphINE extended release (Kadian, Avniza )^ OxyCODdone immediate release (Roxicodone, OxyIR, various) OxyCODone controlled release (OxyContin, various) PO 30 to 60 min 3 to 6 hr 3 to 6 hr N/A N/A 30 mg PO IV 5 to 10 min 3 to 6 hr 3 to 6 hr Yes 1 mg/ml 5 mg/ml 10 mg IV SC 15 to 30 min 3 to 6 hr 3 to 6 hr Yes N/A 10 mg IM/SC PO 30 to 90 min 8 to 12 hr 8 to 12 hr N/A N/A 30 mg PO PO 30 to 90 min 12 to 24 hr 12 to 24 hr (Kadian ) 24 hr (Avniza ) N/A N/A 30 mg PO PO 10 to 15 min 4 to 6 hr 4 to 6 hr N/A N/A 20 mg PO PO 1 hr 12 hr 12 hr N/A N/A 20 mg PO OxyMORphone immediate release (Opana, various)^ PO N/A N/A 10 mg OxyMORphone extended release PO N/A N/A 10 mg (Opana ER, various)^ Equi-analgesic dosing is based on morphine 10 mg administered parenterally (ie, IV/SC). Calculation example on page 3. ^ Nonformulary status ** Subcutaneous use of fentanyl has not been well-studied; data presented are from a small pharmacokinetic study and a review of a subcutaneous infusion of fentanyl IV = intravenous; SC = subcutaneous; TM = transmucosal; TD = transdermal; PO = oral morphine is not equivalent to HYDROmorphONE morphine is not equivalent to HYDROmorphONE Do not crush, chew, or break. morphine is not equivalent to HYDROmorphONE Do not crush, chew, or break. oxycodone is not equivalent to OxyMORphone oxycodone is not equivalent to OxyMORphone Do not crush, chew, or break. OxyMORphone is not equivalent to oxycodone OxyMORphone is not equivalent to oxycodone Do not crush, chew, or break. 1 COMMONLY USED COMBINATION OPIOID ANALGESICS

3 Medication Route Onset of Duration of Usual Dosing Interval Equi-analgesic Dosing HydroCODONE combinations (see below) PO 30 to 60 min 4 to 6 hr 4 to 6 hr 30 mg PO Oxycodone combinations (see below) PO 10 to 15 min 4 to 6 hr 4 to 6 hr 20 mg PO Codeine combinations (see below) PO 30 to 60 min 4 to 6 hr 4 to 6 hr 200 mg PO Equi-analgesic dosing is based on morphine 10 mg administered parenterally (ie, IV/SC). Calculation example on page 3. Notes Maximum dose of hydrocodone is 40 mg/day Doses should not exceed 120 mg/day in opiate naïve patients ** The FDA does not recommend combination products with an acetaminophen content > 325 mg. These products will be phased out and may not be available after 2011** Acetaminophen Aspirin Opioid Brand Names Opioid Content Ibuprofen Content Content Lortab 167 mg (elixir) Lorcet 300 mg Maxidone * 2.5 mg 325 mg Norco * 5 mg 400 mg** Vicodin 7.5 mg 500 mg** Hydrocodone Xodol * 10 mg 650 mg** Zydone * 660 mg** 750 mg** Oxycodone Codeine Ibudone Reprexain Vicoprofen Percocet Roxicet * Roxilox * Tylox * 2.5 mg 5 mg 7.5 mg 10 mg 2.5 mg 5 mg 7.5 mg 10 mg mg 300 mg 325 mg 400 mg** 500 mg** 650 mg** Percodan * Roxiprin * 4.5 mg mg Combunox Capsules * 5 mg mg Tylenol with Codeine Elixir Tylenol with Codeine No. 2 Tylenol with Codeine No. 3 Tylenol with Codeine No. 4 Aspirin with Codeine Empirin with Codeine No. 3 Empirin with Codeine No mg 15 mg 30 mg 60 mg 15 mg 30 mg 60 mg 120 mg 300 mg 650 mg** mg Comments Maximum dose of acetaminophen is 4 g/day Maximum dose of acetaminophen is 4 g/day Maximum dose of acetaminophen is 4 g/day This chart is not considered all-inclusive. All orders/prescriptions must specify dose based on opioid content and acetaminophen, aspirin or ibuprofen content. * Nonformulary status HIGH-RISK, NON-PREFERRED OPIOID PRODUCTS 2

4 Medication Codeine phosphate (various) Codeine sulfate (various) Meperidine (Demerol ) Route Onset of Duration of Usual Dosing Interval Appropriate for PCA Concentration for PCA Equi-analgesic Dosing PO 30 to 60 min 4 to 6 hr 4 to 6 hr N/A N/A 200 mg PO Doses should not exceed 120 mg/day in opiate naïve IV 10 to 30 min 4 to 6 hr 4 to 6 hr N/A N/A 120 mg IV patients PO 30 to 60 min 4 to 6 hr 4 to 6 hr N/A N/A 200 mg PO PO 10 to 15 min 2 to 4 hr 3 to 4 hr N/A N/A 300 mg PO IV 1 to 5 min 2 to 4 hr 3 to 4 hr NO N/A mg IV Notes See meperidine use guidelines on the MUSC Formulary and Drug Information Resources Web page Nalbuphine (Nubain ) IV 2 to 3 min 3 to 6 hr 3 to 6 hr N/A N/A -- SC/IM < 15 min 3 to 6 hr 3 to 6 hr N/A N/A -- Equi-analgesic dosing is based on morphine 10 mg administered parenterally (ie, IV/SC). IV = intravenous; SC = subcutaneous; PO = oral EQUIANALGESIC CONVERSION EQUATION Current opioid (single conversion dose & route) New opioid (single conversion dose & route) = Total 24 dose of current opioid Total 24 dose of new opioid Equianalagesic conversions should not be considered a simple straightforward calculation. Significant 'inter/intra' patient variability exists depending on the selected opiate, dose, and expected response. See information regarding cross- tolerance. Example: Patient is receiving morphine, with a 24-hr-dose total of 180 mg PO. What is the equivalent 24-hr dose of hydromorphone? Equianalgesic Dose morphine 30 mg PO hydromorphone 7.5 mg PO Total 24-hr dose morphine 180 mg PO hydromorphone X mg X = hydromorphone 45 mg PO/24 hrs. Accounting for cross tolerance of 50% = hydromorphone 22.5 mg PO/24 hrs Recommended dose = hydromorphone 2 4 mg PO every 3 hrs (2 mg for moderate pain; 4 mg for severe pain) OPIOID CROSS-TOLERANCE Incomplete cross-tolerance relates to tolerance to a currently administered opiate that does not extend completely to other opioids. This will tend to lower the required dose of the second opioid. It is importance to view the calculated data as approximations. A 50% reduction in calculated dose is recommended. Dose should be re-titrated to patient response. In all cases, repeated comprehensive assessments of pain are necessary in order to successfully control the pain while minimizing adverse effects. This dose not include conversions for methadone (see page 5) or transdermal fentanyl (reduction is built into the conversion see page 4). RECOMMENDATIONS FOR FENTANYL USE 3

5 Fentanyl to Fentanyl Conversion: 1:1 conversion Conversion between Fentanyl Transdermal System and Morphine To convert therapy to fentanyl transdermal system (Duragesic ), calculate the 24-hr ORAL morphine dose and select the appropriate transdermal system strength using the following chart: Oral 24-hr morphine (mg/day) < to to to to to to to to to to to to 1124 *12.5-microgram patch is nonformulary Fentanyl transdermal system (Duragesic ) (micrograms/hr) 12.5* Conversion for Transmucosal Fentanyl Actiq (lozenge on a stick) 800 micrograms = 10 mg IV morphine Fentora (buccal tablet - nonformulary) 200 micrograms = 10 mg IV morphine Transmucosal Conversions Current Lozenge Dose (Actiq ) Initial Buccal Dose (Fentora ) 200 micrograms 100 micrograms 400 micrograms 100 micrograms 600 micrograms 200 micrograms 800 micrograms 200 micrograms 1200 micrograms 400 micrograms 1600 micrograms 400 micrograms Clinical Practice Points for Fentanyl Use Transdermal fentanyl should not be used in opioid naïve patients Re-consider analgesic option when transition from ICU to floor, especially with fentanyl Buccal tablet: Place above rear molar between the upper check and gum. Tablet should not be split, sucked, chewed, or swallowed. Disintegration usually takes up to 25 minutes. After 30 minutes, if remnants from the tablet remain, they may be swallowed with a glass of water. Lozenge: Place between cheek and lower gum, moving from one side to the other using the handle. Patient should suck, not chew, the lozenge. Lozenge should be consumed over 15 minutes. 4 RECOMMENDATIONS FOR METHADONE USE

6 NOTE: HIGHLY recommended that practitioners NOT FAMILIAR with prescribing or monitoring methadone call either pain management or pharmacy services for recommendations and guidelines for initiation, dose escalation and follow-up. Methadone conversion ratio: When switching from an opioid to methadone, the equianalgesic dose ration of methadone depends on the ORAL morphine-equivalent daily dose (MEDD) of the preceding opioid. Oral MEDD (mg/day) Methadone Dose Conversion Ratio 0 to 99 4:1 100 to 299 8:1 300 to :1 500 to :1 > :1 Steps for conversion of opioid to methadone: 1. Convert to ORAL morphine equivalent (24 hr total dose) 2. Divide by ratio above 3. Divide by 50% to account for incomplete cross-tolerance 4. Divide by 3 for frequency (every 8 hr dosing) 5. Round down to the nearest tablet size 2.5-mg intervals Example: Patient receiving 860 mg morphine PO equivalent. 860 mg Recommended starting dose: methadone 7.5 mg every 8 hours (dose rounded down based on available tables) Clinical Practice Points for Methadone Use ANY prescriber that can prescribe a C-II medication can prescribe methadone for PAIN Half-life can be as long as 130 hours; therefore, steady-state concentrations are reached in 4 7 days. Dose adjustments for pain management should not happen more frequently than every 4 7 days. Of note: Considerable inter-individual variability in elimination half-life; generally reported as 8 59 hours, but values have ranged from 9 87 hours in postoperative patients, from hours in opiate-dependent patients, and up to 120 hours in outpatients receiving therapy for chronic malignant pain Once daily methadone is reserved for maintenance therapy in patients with opioid addiction and should not be used for treatment of pain. If naloxone is required, multiple intermittent doses or a continuous infusion may be required. US Boxed Warning for patients at risk for QT prolongation, with medications known to prolong the QT interval (eg, haloperidol), or for patients with a history of conduction abnormalities. QT interval prolongation and torsade de pointe may be associated with doses > 200 mg/day, but have been associated with lower doses. Correct potassium and magnesium abnormalities prior to initiation. Methadone is a substrate for the cytochrome P450 enzyme system; therefore, plasma concentrations may be inhibited or induced by certain concomitant medications. The dose may need to be adjusted based on any potential interaction. For questions regarding drug interactions, contact pharmacy or pain management service. GENERAL CLINICAL PRACTICE POINTS FOR OPIOID USE 5

7 The equianalgesic opioid doses are for severe pain in patients that are opioid naïve. When converting from one opioid to another, the calculated equianalgesic dose is an estimate, not the usual starting dose. Individualize and titrate the dose according to crosstolerance, patient age, condition, history (eg, chronic pain), response, and the clinical situation. Reduce dose by 25 to 50% in the elderly; by 25% in hepatic or renal dysfunction. Re-consider analgesic option when transition from ICU to floor, especially with fentanyl Cross allergenicity between opioids varies greatly between patients. Alternative analgesics such as acetaminophen, aspirin, and non-steroidal anti-inflammatory medications (eg, ibuprofen, naproxen) should be considered in a patient who has experienced a life-threatening reaction. Structural Class Phenanthrenes Piperidine/phenylpiperadine Diphenylheptanes Morphine Hydromorphone* Oxymorphone* Codeine Hydrocodone Oxycodone* Fentanyl* Meperidine Methadone* Propoxyphene For patients with Type I hypersensitivity reactions, all opioids must be used with caution. Selecting an opioid in a different structural class may result in the lowest chance of cross-sensitivity. For patients with non-allergic histamine-mediated adverse reactions, selecting an agent with lower potential for histamine release (denoted by *) may reduce symptoms. Tramadol (Ultram ) is contraindicated in patients who have a true opioid allergy. USE OF NALOXONE FOR REVERSAL OF APNEA/HYPOVENTILATION (POLICY C-154) Clinical Practice Points: Can be administered IV, IM, SC, or intratracheally (ETT), with the most rapid onset of action achieved following IV administration Can reverse some of the symptoms of opioid overdose which include respiratory depression, sedation, and hypotension. It is important to note that the analgesic effect of the opioid will also be reversed See page 7 for dosing and administration. 6 Dosing and Administration of Naloxone for Reversal of Opioid Sedation (Policy C-154)

8 Mix naloxone (0.4 mg/ml) with 9 ml of 0.9% sodium chloride for a total volume of 10 ml (unless otherwise stated). Dilution concentration will be 0.04 mg/ml. Patients with IV Access Patients without IV Access (IM, SC, ETT) Patients in the Neonatal ICU Patients 20 kg Dilute and give 0.02 mg (0.5 ml) IV every 3 minutes until desired respiratory rate is established NOT until return of desired sensorium. Patients > 20 kg Dilute and give 0.08 mg (2 ml) IV every 3 minutes until desired respiratory rate is established NOT until return of desired sensorium. Patients 20 kg Give undiluted (0.4 mg/ml) naloxone 0.01 mg/kg SC/IM/ETT every 2 minutes until desired respiratory rate is established NOT until return of desired sensorium. Patients > 20 kg Give undiluted (0.4 mg/ml) naloxone at 0.2 mg (0.5 ml) SC/IM/ETT every 2 minutes until desired respiratory rate is established NOT until return of desired sensorium. Patients 2 kg Dilute and give 0.01 mg/kg IV/SC every 3 minutes until desired respiratory rate is established NOT until return of desired sensorium. Patients > 2 kg Give undiluted (0.4 mg/ml) naloxone 0.01 mg/kg IV/SC every 3 minutes until desired respiratory rate is established NOT until return of desired sensorium. Naloxone Continuous Infusion To initiate a continuous intravenous Naloxone drip, a separate physician order is required. Recommended only after initial IV or IM administration for prolonged respiratory depression, when the patient has been subject to sustained release or long acting opioid (eg, Oxycontin, MS Contin, Oramorph, methadone) or has epidural opioid. Pharmacy will prepare the infusion. Start infusion at a rate of 2.5 micrograms/kg/hr. Titrate as needed to maintain analgesia and adequate respiratory drive. Cautions with naloxone administration Return to full alertness is often accompanied by withdrawal and return of pain. Giving a full undiluted ampule (1 ml = 0.4 mg/ml) of naloxone in a patient who has received opioids but is not in respiratory arrest may cause ischemia, heart attack, hypertension, stroke, heart failure, and/or pulmonary edema. Do not assume compatibility with any other medications. DO NOT use to reverse hypotension, nausea or vomiting from opioids. DO NOT use to reverse seizures from meperidine (Demerol ). When naloxone is given, there is a risk of acute withdrawal syndrome in habituated patients and infants of opioid-habituated mothers. Use cautiously in patients with known renal insufficiency as it may have a prolonged effect. 7

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential

More information

Blueprint for Prescriber Continuing Education Program

Blueprint for Prescriber Continuing Education Program CDER Final 10/25/11 Blueprint for Prescriber Continuing Education Program I. Introduction: Why Prescriber Education is Important Health care professionals who prescribe extended-release (ER) and long-acting

More information

Naloxone treatment of opioid overdose

Naloxone treatment of opioid overdose Naloxone treatment of opioid overdose Opioids Chemicals that act in the brain to relieve pain, often use to suppress cough, treat addiction, and provide comfort After prolonged use of opioids, increasing

More information

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: Frenchay 0117 340 6692 Southmead 0117 323

More information

OPIOIDS CONVERSION GUIDELINES 2007

OPIOIDS CONVERSION GUIDELINES 2007 Opioid analgesics vary in potency, side effect and pharmacokinetic profile. Therefore the Opioid Conversion Guidelines has been developed to assist when changing opioid drug therapy. When opioid rotating

More information

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

New Jersey EMS Response to an Opiate Overdose Naloxone (Narcan ) Program **Updated March 26, 2015**

New Jersey EMS Response to an Opiate Overdose Naloxone (Narcan ) Program **Updated March 26, 2015** New Jersey EMS Response to an Opiate Overdose Naloxone (Narcan ) Program **Updated March 26, 2015** Disclaimer This presentation was created to assist in the education of EMTs in Naloxone administration.

More information

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Developed by the Mid Atlantic Renal Coalition and the Kidney End of Life Coalition September 2009 This project was supported,

More information

Medication Assisted Therapy and Pregnancy: An Introduction

Medication Assisted Therapy and Pregnancy: An Introduction Medication Assisted Therapy and Pregnancy: An Introduction Deborah A. Orr, Ph.D. The Center For Drug Free Living Adapted from the NIDA Blending Initiative Curriculum Presentation Objectives Define opioids

More information

Narcotic drugs used for pain treatment Version 4.3

Narcotic drugs used for pain treatment Version 4.3 Narcotic drugs used for pain treatment Version 4.3 Strategy to restrict the pack sizes or the type of packaging available in public pharmacies. 1. Introduction The document describing the strategy of the

More information

Nurses Self Paced Learning Module on Pain Management

Nurses Self Paced Learning Module on Pain Management Nurses Self Paced Learning Module on Pain Management Dominican Santa Cruz Hospital Santa Cruz, California Developed by: Strategic Planning Committee Dominican Santa Cruz Hospital 1555 Soquel Drive Santa

More information

Opioid Analgesics. Week 19

Opioid Analgesics. Week 19 Opioid Analgesics Week 19 Analgesic Vocabulary Analgesia Narcotic Opiate Opioid Agonist Antagonist Narcotic Analgesics Controlled substances Opioid analgesics derived from poppy Opiates include morphine,

More information

Opioid Conversion Ratios - Guide to Practice 2013

Opioid Conversion Ratios - Guide to Practice 2013 Opioid s - Guide to Practice 2013 Released 1 st October 2013 2013. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that the Eastern

More information

SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC

SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC SELECTED OPIATES TOXICITY A MODERN DAY EPIDEMIC Learning Objectives: 1. Identify the names and reasons/circumstances for additional toxicity of SELECTED OPIATES hydromorphone DILAUDID Methadone Fentanyl/DURAGESIC

More information

Opioids to Minors and Drug Donation Programs Objectives By completing the lesson, the pharmacist will be able to:

Opioids to Minors and Drug Donation Programs Objectives By completing the lesson, the pharmacist will be able to: 1 1 1 1 1 1 0 1 0 1 Opioids to Minors and Drug Donation Programs Objectives By completing the lesson, the pharmacist will be able to: Discuss Ohio s new laws concerning use of opioids in minors Describe

More information

Opioid Conversion Ratios - Guide to Practice 2013 Updated as Version 2 - November 2014

Opioid Conversion Ratios - Guide to Practice 2013 Updated as Version 2 - November 2014 Opioid s - Guide to Practice 2013 Updated as Version 2 - November 2014 2013. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that the

More information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

Opioid Conversion Ratios - Guide to Practice 2010

Opioid Conversion Ratios - Guide to Practice 2010 Opioid Conversion Ratios - Guide to Practice 2010 Released December 2010. 2010. The EMR PCC grants permission to reproduce parts of this publication for clinical and educational use only, provided that

More information

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool

The Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline

More information

UNIT VIII NARCOTIC ANALGESIA

UNIT VIII NARCOTIC ANALGESIA UNIT VIII NARCOTIC ANALGESIA Objective Review the definitions of Analgesic, Narcotic and Antagonistic. List characteristics of Opioid analgesics in terms of mechanism of action, indications for use and

More information

Lumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.

Lumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes. Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical

More information

SAFE PAIN MEDICATION PRESCRIBING GUIDELINES

SAFE PAIN MEDICATION PRESCRIBING GUIDELINES Prescription drug abuse has been declared an epidemic by the Centers for Disease Control. According to 2012 San Diego Medical Examiner data, the number one cause of non-natural death is due to drug overdoses

More information

Education Program for Prescribers and Pharmacists

Education Program for Prescribers and Pharmacists Transmucosal Immediate Release Fentanyl (TIRF) Products Risk Evaluation and Mitigation Strategy (REMS) Education Program for Prescribers and Pharmacists Products Covered Under This Program Abstral (fentanyl)

More information

AGS. PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less)

AGS. PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less) AGS PAIN MANAGEMENT FOR THE SURGICAL RESIDENT (in 30 min or less) THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults. CASE PRESENTATION 46-year-old

More information

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications Primary Care & Specialist Prescribing Guidelines Introduction Partnership HealthPlan is a County Organized Health System covering

More information

Naloxone Hydrochloride Injection PRODUCT INFORMATION

Naloxone Hydrochloride Injection PRODUCT INFORMATION Naloxone Hydrochloride Injection PRODUCT INFORMATION DESCRIPTION Naloxone hydrochloride is 17-allyl-4,5α-epoxy-3,14-dihydroxymorphinan-6-one hydrochloride; C 19 H 21 NO 4.HCl. It is an off-white powder

More information

Outpatient Detoxification

Outpatient Detoxification Opioid dependence is a challenging and complicated condition, but it can be treated. If you re working to overcome opioid dependence, you know the experience can sometimes be overwhelming. That s why the

More information

Pain Control Aims. General principles of pain control. Basic pharmacokinetics. Case history demo. Opioids renal failure John Welsh 8/4/2010

Pain Control Aims. General principles of pain control. Basic pharmacokinetics. Case history demo. Opioids renal failure John Welsh 8/4/2010 Pain Control Aims General principles of pain control Basic pharmacokinetics Case history demo Opioids renal failure John Welsh 8/4/2010 Pain Control Morphine is gold standard treatment for moderate to

More information

Care Guide: Cancer Pain

Care Guide: Cancer Pain Care Guide: Cancer Pain Key Points: Cancer Pain Specific Pain Problems 1. Pain is defined as an independent and emotional experience associated with actual or potential tissue damage or described in terms

More information

Equianalgesic Dosing of Opioids for Pain Management

Equianalgesic Dosing of Opioids for Pain Management PL Detail-Document #280801 This PL Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER August 2012 Equianalgesic Dosing of Opioids for Pain Management

More information

Frequently Asked Questions: HB 341 Mandatory OARRS Registration and Requests

Frequently Asked Questions: HB 341 Mandatory OARRS Registration and Requests Frequently Asked Questions: HB 341 Mandatory OARRS Registration and Requests Q1) What is OARRS? Updated 12-18-2014 OARRS stands for the Ohio Automated Rx Reporting System. Established in 2006, OARRS is

More information

GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR

GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR INTRODUCTION Intravenous (IV) Fentanyl is a good option for pain management during labour and should be administered in a safe and competent

More information

New England Pediatric Sickle Cell Consortium

New England Pediatric Sickle Cell Consortium New England Pediatric Sickle Cell Consortium Management of Acute Pain in Pediatric Patients with Sickle Cell Disease (Vaso-Occlusive Episodes) Disclaimer Statement: Hospital clinical pathways are designed

More information

Management of Patients with Narcotic Bowel Syndrome(1)

Management of Patients with Narcotic Bowel Syndrome(1) Management of Patients with Narcotic Bowel Syndrome(1) Ademola Aderoju MD, Jacob Kurlander MD, Christina Davis, Patrick Barrett MD, Douglas A. Drossman MD Patients on chronic narcotics who have been diagnosed

More information

Cancer Pain Role Model Program Case Studies and Faculty Guides. Wisconsin Cancer Pain Initiative Madison, Wisconsin

Cancer Pain Role Model Program Case Studies and Faculty Guides. Wisconsin Cancer Pain Initiative Madison, Wisconsin Cancer Pain Role Model Program Case Studies and Faculty Guides Wisconsin Cancer Pain Initiative Madison, Wisconsin Developed by: David Weissman, MD June L. Dahl, PhD WISCONSIN CANCER PAIN INITIATIVE CANCER

More information

CASE STUDIES - HOME HEALTH

CASE STUDIES - HOME HEALTH WISCONSIN CANCER PAIN INITIATIVE CASE STUDIES - HOME HEALTH CASE STUDIES AND FACULTY GUIDE Table of Contents Case 1...1 Case 2...1 Case 3...2 Case 4...2 Case 5...3 Case 1: Faculty Guide...4 Case 2: Faculty

More information

Opioid Addiction & Methadone Maintenance Treatment. What is Methadone? What is an Opioid?

Opioid Addiction & Methadone Maintenance Treatment. What is Methadone? What is an Opioid? Opioid Addiction & Methadone Maintenance Treatment Dr. Nick Wong MD, CCFP AADAC Edmonton ODP AADAC AHMB Concurrent Disorder Series September 13, 2007 1 What is Methadone? What is methadone? Synthetic opioid.

More information

OPIOID CONVERSIONS. 2. Add a rescue doses (IR) of same opioid if possible should be~10 20% of total daily opioid dose

OPIOID CONVERSIONS. 2. Add a rescue doses (IR) of same opioid if possible should be~10 20% of total daily opioid dose OPIOID CONVERSIONS 1. Converting Short acting Long Acting (IR SR) when pain is well controlled *Use for : CHRONIC pain Pts on scheduled IR opioids pain that recurs before the next dose PP: Can use equianalgesic

More information

WITHDRAWAL OF ANALGESIA AND SEDATION

WITHDRAWAL OF ANALGESIA AND SEDATION WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening drug doses

More information

Understanding Your Pain

Understanding Your Pain Toll Free: 800-462-3636 Web: www.endo.com Understanding Your Pain This brochure was developed by Margo McCaffery, RN, MS, FAAN, and Chris Pasero, RN, MS, FAAN authors of Pain: Clinical Manual (2nd ed.

More information

UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE DEPARTMENT OF FAMILY MEDICINE PAIN MANAGEMENT GUIDELINES

UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE DEPARTMENT OF FAMILY MEDICINE PAIN MANAGEMENT GUIDELINES UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE DEPARTMENT OF FAMILY MEDICINE PAIN MANAGEMENT GUIDELINES I. OVERVIEW Detailed narcotic prescribing guidelines are outlined in this chapter, but the basic

More information

U.S. Food and Drug Administration

U.S. Food and Drug Administration U.S. Food and Drug Administration Notice: Archived Document The content in this document is provided on the FDA s website for reference purposes only. It was current when produced, but is no longer maintained

More information

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen

More information

Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (CNCP)

Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (CNCP) Appendix D: Urine Drug Testing for Monitoring Opioid Therapy i. Monitoring opioid therapy with urine drug testing (UDT) ii. UDT algorithm for monitoring opioid therapy iii. UDT clinical vignettes iv. Frequently

More information

Information for Vermont Prescribers of Prescription Drugs (Long Form)

Information for Vermont Prescribers of Prescription Drugs (Long Form) The information on this form is provided pursuant to Vermont law 33 V.S.A. section 2005a which requires this disclosure by pharmaceutical marketers. Information for Vermont Prescribers of Prescription

More information

Upstate University Health System Medication Exam - Version A

Upstate University Health System Medication Exam - Version A Upstate University Health System Medication Exam - Version A Name: ID Number: Date: Unit: Directions: Please read each question below. Choose the best response for each of the Multiple Choice and Medication

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D. Opiate Substitution Therapy for Opiate Dependence Alan Shein, M.D. OH #1-1 STATISTICS Prevalence of Specific Drug Abuse and Vulnerability to Develop Addictions National Household Survey and Related Surveys

More information

Package leaflet: Information for the patient. Naloxone Hydrochloride 20 micrograms / ml Solution for Injection Naloxone hydrochloride

Package leaflet: Information for the patient. Naloxone Hydrochloride 20 micrograms / ml Solution for Injection Naloxone hydrochloride A leaflet will be included in each pack. The leaflet will consist of a Technical Information Leaflet and a Patient Information Leaflet. The two leaflets will be easily separatable. The text of the Technical

More information

Basic End of Life Drugs for Qualified Nurses

Basic End of Life Drugs for Qualified Nurses Basic End of Life Drugs for Qualified Nurses (Please note that this booklet is intended as a training resource and therefore the information contained within it should not replace the medical advice of

More information

10 MG OXYCODONE WITHDRAWAL ZIJA NEW YEAR NEW YOU KIT

10 MG OXYCODONE WITHDRAWAL ZIJA NEW YEAR NEW YOU KIT 10 MG OXYCODONE WITHDRAWAL ZIJA NEW YEAR NEW YOU KIT 10 Mg Oxycodone Withdrawal Zija New Year New You Kit how much is oxycodone per mg why does oxycodone make u itch 2 cold water extraction oxycodone iv

More information

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for

More information

Practice Protocol. Buprenorphine Guidance Protocol

Practice Protocol. Buprenorphine Guidance Protocol Practice Protocol Buprenorphine Guidance Protocol Developed by the Arizona Department of Health Services Division of Behavioral Health Services Effective Date: 02/23/11 Title Buprenorphine Guidance Protocol

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

Reducing Narcotics Misuse and Abuse in Workers Compensation

Reducing Narcotics Misuse and Abuse in Workers Compensation Reducing Narcotics Misuse and Abuse in Workers Compensation Trusted. Reliable. Sustainable. Page 2 Introduction Narcotics have a long history of being used to therapeutically treat pain resulting from

More information

October 2012. We hope that our tool will be a useful aid in your efforts to improve pain management in your setting. Sincerely,

October 2012. We hope that our tool will be a useful aid in your efforts to improve pain management in your setting. Sincerely, October 2012 he Knowledge and Attitudes Survey Regarding Pain tool can be used to assess nurses and other professionals in your setting and as a pre and post test evaluation measure for educational programs.

More information

Acute pain management for opioid tolerant patients CLASSIFICATION OF OPIOID TOLERANT PATIENTS

Acute pain management for opioid tolerant patients CLASSIFICATION OF OPIOID TOLERANT PATIENTS Update in Anaesthesia Acute pain management for opioid tolerant patients Simon Marshall and Mark Jackson* *Correspondence email: mark.jackson@rdeft.nhs.uk INTRODUCTION Opioid tolerance is usually encountered

More information

1. Which of the following would NOT be an appropriate choice for postoperative pain. C. Oral oxycodone 5 mg po every 4 to 6 hours as needed for pain

1. Which of the following would NOT be an appropriate choice for postoperative pain. C. Oral oxycodone 5 mg po every 4 to 6 hours as needed for pain Pain Management 1 Chapter 34. Pain Management, Self-Assessment Questions 1. Which of the following would NOT be an appropriate choice for postoperative pain management in a patient dependent on opioids?

More information

The Challenges of Narcotic Tapering in Chronic Pain Treatment

The Challenges of Narcotic Tapering in Chronic Pain Treatment The Challenges of Narcotic Tapering in Chronic Pain Treatment Speakers: Medical Director, Rosomoff Comprehensive Pain Center, Miami Jewish Health Systems Stuart Sweetser SVP, Clinical Pain Programs, Paradigm

More information

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues www.drugabusedialogues.com Barbara Carter, Manager MN Board of Pharmacy www.pmp.pharmacy.state.mn.us

More information

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Chairman Lee, members of the Senate Human Services Committee,

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction

More information

Weaning off your pain medicine

Weaning off your pain medicine Weaning off your pain medicine UHN Information for patients taking opioid pain medicines Read this booklet to learn about: why you need to wean off your pain medicine how to wean off slowly how to control

More information

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation A Healthesystems Clinical Analysis Insidious Incrementalism of Opioid Use in Workers Compensation Prescription opioid use in the United States has grown significantly over the past 20 years. In 1991, there

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San

More information

Case Studies: Acute pain management in patients with opioid addiction. Shannon Levesque, PharmD Clinical Pharmacist

Case Studies: Acute pain management in patients with opioid addiction. Shannon Levesque, PharmD Clinical Pharmacist Case Studies: Acute pain management in patients with opioid addiction Shannon Levesque, PharmD Clinical Pharmacist Disclosure I have no financial relationships with industry to disclose Objectives Misconceptions

More information

PALLIATIVE CARE PAIN MANAGEMENT AND NON-PAIN SYMPTOMS ONLY

PALLIATIVE CARE PAIN MANAGEMENT AND NON-PAIN SYMPTOMS ONLY AN EXAMINATION OF KNOWLEDGE IN: PALLIATIVE CARE PAIN MANAGEMENT AND NON-PAIN SYMPTOMS ONLY (EPERC TEST #1) 40 QUESTIONS; MULTIPLE CHOICE; SINGLE-BEST ANSWER Supplied by: End of Life Physician Education

More information

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC Acute Pain Management in the Opioid Dependent Patient Maripat Welz-Bosna MSN, CRNP-BC Relieving Pain in America (IOM) More then 116 Million Americans have pain the persists for weeks to years $560-635

More information

Pain Management Case Studies. Adapted from: IMPROVING END-OF-LIFE CARE A RESOURCE GUIDE FOR PHYSICIAN EDUCATION

Pain Management Case Studies. Adapted from: IMPROVING END-OF-LIFE CARE A RESOURCE GUIDE FOR PHYSICIAN EDUCATION Pain Management Case Studies Adapted from: IMPROVING END-OF-LIFE CARE A RESOURCE GUIDE FOR PHYSICIAN EDUCATION 3rd Edition David E. Weissman, MD Director, Palliative Care Program Medical College of Wisconsin

More information

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids

More information

Pain Management in Palliative and Hospice Care

Pain Management in Palliative and Hospice Care Pain Management in Palliative and Hospice Care Donna Butler, MSN, ANP-BC, OCN, ACHPN, FAAPM Current Status of Pain Cancer patients at EOL- 54% have pain AIDS with prognosis < 6mons- intense pain Less research

More information

CORONER S REPORT REPORT

CORONER S REPORT REPORT CORONER S REPORT 26 THE CORONER HAS RECOMMENDED THAT THE ONTARIO COLLEGE OF PHARMACISTS EDUCATE CLINICIANS ON THE DEFINITION OF OPIOID TOLERANCE, AND REVIEW THE PATIENT CONDITIONS AND COMORBIDITIES THAT

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PDP IBT Inj - Vivitrol Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Opiate Antagonist Client: 2007 PDP IBT Inj Approval Date: 2/20/2007

More information

Pain management. The WHO analgesic ladder

Pain management. The WHO analgesic ladder Pain management Successful treatment requires an accurate diagnosis of the cause and a rational approach to therapy. Most pains arise by stimulation of nociceptive nerve endings; the characteristics may

More information

Dr Christine Amakye Motec Life - UK June 2009

Dr Christine Amakye Motec Life - UK June 2009 Dr Christine Amakye Motec Life - UK June 2009 POST-OPERATIVE PAIN RELIEF Pre-operative/Pre-emptive analgesia Intra-operative analgesia Post-operative analgesia Pre-emptive analgesia Oral Intravenous Intramuscular

More information

Best Practices for Patients With Pain. Commonly Used Over the Counter (OTC) Pain Relievers 5/15/2015

Best Practices for Patients With Pain. Commonly Used Over the Counter (OTC) Pain Relievers 5/15/2015 Faculty Best Practices for Patients With Pain Nancy Bishop, RPh Assistant State Pharmacy Director Alabama Department of Public Health Satellite Conference and Live Webcast Wednesday, May 20, 2015 2:00

More information

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients

Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential

More information

9/16/2010. Contact Information. Objectives. Analgesic Ketamine (Ketalar )

9/16/2010. Contact Information. Objectives. Analgesic Ketamine (Ketalar ) Analgesic Ketamine (Ketalar )..the long and winding road to clinical practice Contact Information Lois Pizzi BSN, RN-BC Inpatient Pain Management Clinician UPMC Presbyterian Shadyside pizzilj@upmc.edu

More information

Arkansas Emergency Department Opioid Prescribing Guidelines

Arkansas Emergency Department Opioid Prescribing Guidelines Arkansas Emergency Department Opioid Prescribing Guidelines 1. One medical provider should provide all opioids to treat a patient s chronic pain. 2. The administration of intravenous and intramuscular

More information

Drug Utilization Is On The Rise

Drug Utilization Is On The Rise Objectives Identify the clinical issues related to opioid prescribing for chronic pain indications Define the clinical needs and expectations of urine drug testing in pain management Address preanalytical

More information

10/19/15. Stephen Loyd, M.D., F.A.C.P Healthy Kingsport Meadowview Convention Center Kingsport, Tennessee October 17, 2015

10/19/15. Stephen Loyd, M.D., F.A.C.P Healthy Kingsport Meadowview Convention Center Kingsport, Tennessee October 17, 2015 Stephen Loyd, M.D., F.A.C.P Healthy Kingsport Meadowview Convention Center Kingsport, Tennessee October 17, 2015 Receives no commercial support, in any form, from pharmaceutical companies or anyone else

More information

GUIDELINES FOR PRESCRIBING AT THE END OF LIFE FOR PATIENTS WITH RENAL IMPAIRMENT (estimated glomerular filtration rate<30)

GUIDELINES FOR PRESCRIBING AT THE END OF LIFE FOR PATIENTS WITH RENAL IMPAIRMENT (estimated glomerular filtration rate<30) GUIDELINES FOR PRESCRIBING AT THE END OF LIFE FOR PATIENTS WITH RENAL IMPAIRMENT (estimated glomerular filtration rate

More information

Considerations when Using Controlled Substances to Treat Chronic Pain

Considerations when Using Controlled Substances to Treat Chronic Pain Considerations when Using Controlled Substances to Treat Chronic Pain By Mary-Beth F. Plum, Pharm.D. Impact of Chronic Pain Acute pain is the body s response to environmental dangers, and it helps protect

More information

RESEARCH UPDATE. Prescribing Patterns of Schedule II Opioids in California Workers Compensation. executive summary. March 2011

RESEARCH UPDATE. Prescribing Patterns of Schedule II Opioids in California Workers Compensation. executive summary. March 2011 RESEARCH UPDATE Prescribing Patterns of Schedule II Opioids in California Workers Compensation by Alex Swedlow, MHSA, John Ireland, MHSA, and Gregory Johnson, Ph.D. executive summary March 2011 Recent

More information

Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu. Barriers to effective pain relief

Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu. Barriers to effective pain relief Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu Barriers to effective pain relief Freedom from pain is a basic human right -WHO Pain is whatever the experiencing person says it is and exists

More information

Basic Medication Administration Exam LPN/LVN (BMAE-LPN/LVN) Study Guide

Basic Medication Administration Exam LPN/LVN (BMAE-LPN/LVN) Study Guide Basic Medication Administration Exam LPN/LVN (BMAE-LPN/LVN) Study Guide Review correct procedure and precautions for the following routes of administration: Ear drops Enteral feeding tube Eye drops IM,

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

This module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists,

This module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists, BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module II Opioids 101 Goals for Module II This module reviews the following: Opioid addiction and the brain Descriptions

More information

Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal

Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal Use of opioids in Patients with Impaired Renal Function Dr Jane Neerkin, Dr Mary Brennan, Dr Humeira Jamal Great care is required when prescribing opioids to patients with impaired renal function. Many

More information

Opioids and the Injured Worker Tools for Successful Outcomes

Opioids and the Injured Worker Tools for Successful Outcomes Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,

More information

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Date Approved by Network Governance May 2012 Date for Review May 2015 Changes between Version 1 and 2 1. Guideline background 2.

More information

ROYAL HOSPITAL FOR WOMEN

ROYAL HOSPITAL FOR WOMEN NEURAXIAL (intrathecal and/or epidural) OPIOID ANALGESIA This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges

More information

MEDICATIONS USED IN THE MANAGEMENT OF SUBSTANCE USE DISORDERS

MEDICATIONS USED IN THE MANAGEMENT OF SUBSTANCE USE DISORDERS MEDIATIONS USED IN THE MANAGEMENT OF SUBSTANE USE DISORDERS Opioid Agonist Therapy (OAT) for Opioid Dependence Methadone (Dolophine, Methadose) Specialty consultation advised. Titrate carefully, consider

More information

Transdermal and Parenteral Fentanyl Dosage Calculations and Conversions

Transdermal and Parenteral Fentanyl Dosage Calculations and Conversions Transdermal and Parenteral Fentanyl Dosage Calculations and Conversions Chapter 5 Objectives After reading this chapter and completing all practice problems, the participant will be able to: 1. Describe

More information

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No. M07 Medications 2015-07-15 All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam

More information

Opioid Use in the Elderly

Opioid Use in the Elderly Opioid Use in the Elderly CRIT in the Care of Older Adults Mellissa Ubbens, PharmD, BCPS Clinical Pharmacist, Duke University Hospital Acknowledgements Thank you to Jason Moss, PharmD, CGP and Jen Gommer,

More information

Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment

Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment I ve had breast cancer treatment, and now I m having pain. Does this mean the cancer

More information

Paramedic Pediatric Medical Math Test

Paramedic Pediatric Medical Math Test Paramedic Pediatric Medical Math Test Name: Date: Problem 1 Your 4 year old pediatric patient weighs 40 pounds. She is febrile. You need to administer acetaminophen (Tylenol) 15mg/kg. How many mg will

More information