Shared Flashcard Set

Details

CLPH 471
Pain Management-Part 2
26
Pharmacology
Graduate
04/23/2012

Additional Pharmacology Flashcards

 


 

Cards

Term

 

Poor Opioid Responsiveness

If dose escalation results in adverse effects

(4)

Definition

Better side effect management

Pcol strategy to low opioid requirement

Opioid Rotation

Non-pcol strategu to low opioid requirement

Term

 

Opioid Rotation

 

When is it Used?

Medication Dose (6)

Definition

 

Used when doses become excessive or when SE are intolerable

 

1.  Reduce equianalgesic dose by 25-50% with provisos

2.  Reduce less if pain is severe

3.  Reduce more if medically frail

4.  Reduce less if same drug by different route

5.  Reduce fentanyl less

6.  Reduce methadone more:  75-90%

 

 

Term

 

Opioid Equivalents Calculation

4 steps

Definition

1.  Calculate total daily dose of current opioid

2.  Look up equivalent ratio of new opioid

3.  convert to new opioid using ratio

4.  Divide total daily dose of the new opioid based on dosing frequency of product selected

Term

 

Individual Agents and Dosage Forms

 

Immediate Release Morphine

Concentrated Liquid

Hydromorphone

Oxycodone

Methadone

Definition

 

MSIR, Roxanol (10mg/5mL, 20mg/5mL)

Roxanol-T (20mg/mL)

Dilaudid-5 (5mg/5mL)

Roxicodone (5mg/5mL, 20mg/mL)

Methadone (5mg/5mL, 10mg/mL)

Term

 

Immediate-release Morphine

Use (2)

Definition

 

Ideal for treating breakthrough pain

Start with 10-15% of daily dose

Term

 

Controlled Release Morphine

Dosing

MS-Contin

Duramorph SR

Kadian

Definition

 

15, 30, 60, 100, 200 mg tab q8-12 hrs

 

30, 60, 100 mg tabletsq8-12 hrs

 

10, 20, 30, 50, 60, 80, 100, 200 mg capsules q 24 hrs

Term

 

Controlled Release Morphine

Avinze Capsules

Definition

Contains both IR and ER beads

30, 60, 90, 120 mg capsules

Every 24 hours dosing ONLY

Contents of capsules can be sprinkled in applesauce

Beads should NOT be chewed, crushed, or dissolved

Term

 

Embeda

Contents

Dosing

Definition

 

Morphine + Naltrexone

 

20, 30, 50, 60, 80, 100 mg ER capsules

Every 12-24 hours dosing

Contents of capsules can be sprinkled on applesauce

Naltrexone ONLY ACTIVE WHEN CRUSHED

Term

 

Controlled Realse Oxycodone

OxyContin Tablets

 

Immediate Release Oxycodone

OxyIR Capsules

 

Definition

 

10, 20, 40, 80, 160 mg tablets q 12 hrs

 

5 mg q 4 hours

Term

 

Oxycontin Toxicity

Definition

 

No known build up of toxic metabolites in patients with decreased GFR

Term

 

Controlled Released Oxymorphone

Opana ER

 

Immediate Released Oxymorphone

Opana

Definition

 

5, 10, 20, 40 mg q 12 hours (Adjust dose q 3-7 days)

 

5, 10 mg q 4 hours

Term

 

Fentanyl (Duragesic)

Dosing

Application Technique

Definition

 

12, 25, 50, 75, 100 mcg/hr

Patch applied every 72 hours (some patients q 48 hrs)

 

Clip, do NOT shave hair

Press and hold patch in place for 30 seconds

Rotate application sites

Only one layer of clothing should cover the patch

Dispose of patches properly

Term

 

Fentanyl (Duragesic)

Risk of Abuse

Definition

 

80% of drug left in patch

"Chiclets"

Term

 

Fentanyl (Duragesic)

Special Dosing

 

Definition

 

Start elderly/debilitated patients on 25 mcg uncless > 135 mg of MS per day

 

Increase dose no more frequently than q 6 days

 

May be less risk of constipation d/t bypass of opiate receptors in GI tract

Term


Buccal/SL/Nasal Fentanyl

 

Definition

 

Dosages for different products NOT equivalent

Term

 

Actiq-Oral Fentanyl

Indication

Dosing

 

Definition

 

Indicated for breakthrough pain in cancer patients already on chronic opioids

100, 200, 300, 400 mcg

Start with 200 mcg

 

Strict packaging, storage, and disposal requirements

Term

 

Fentora-Buccal Fentanyl tablet

Definition

 

Approximate 1/2 is absorbed directly from buccal mucosa

100-800 mcg strengths

indicated for breakthrough pain

Start with 100 mcg strength

 At 30 minutes, swallow any remaining tablet with water

Re-dosing may occur after 30 minutes

 

DO NOT PUSH THROUGH BLISTER PAK

Term

 

Lazanda-Fentanyl Nasal Spray (CII)

Definition

 

Management of breakthrough pain in opioid tolerant cancer patients

 

1 dose no more than every 2 hours (1 spray in 1 nostril = dose)

 

There are signals to indicate a complete-dose delivery of a full spray

A visual signal appears on dosing counting window, showing the number of doses taken

An audilble signal provides a click sound when complete dose is given

Term

 

Abstral-Fentanyl SL tablets

 

Definition

 

For breakthrough pain

100, 200, 300, 400, 600 mcg

Re-dosing may occur after 30 minutes

 

Term

 

Onsolis-Fentanyl Buccal Soluble Film

Definition

 

For breakthrough pain

200, 400, 600, 800, 1200 mcg

Re-dosing may occur after 30 minutes

 

ONLY available in speciality pharmacy

 

Press and hold to side of cheek for 5 seconds

May consume liquids after 5 minutes

May repeat dose after 2 hours

Term

 

Methadone

MOA (4)

Definition

 

Bind to mu opioid receptors

Antagonist at the NMDA receptor (blocking reuptake of NE and serotonin)

Highly lipophilic and protein bound

Metabolism varies greatly between patients

 

Term

 

Methadone

Dosing

Definition

 

Delayed onset of SE up to 1 week

TCAs and SSRIs can slow metabolism

 

Duration of analgesic effect = 6-12 hours

Some patients can be dosed q 8 hours at lower cost

Term

 

Methadone

Avoid in Patients (5)

Definition

w/ very limited prognosis (< 1 week)

w/ numerous DIs

at risk for syncope or arrhythmias

w/ history of undpredictable adherence

who live alone, poor cognition

Term

 

Methadone

Consider for patients (6)

Definition

 

w/ true morphine allergy

w/ significant renal impairment

w/ opioid-induced ADRs

w/ pain refractory to other opioids

w/ neuropathic pain

who need long acting oral dosage forms at a low costr

Term

 

Tapentadol-Nucynta (CII)

MOA

Dosing

 

Tepentadol-Nucynta ER

Dosing

Definition

 

Weak mu agonist + inhibits NE reuptake

50, 75, 100 mg IR tablets q 4-6 hours (600 mg max)

 

50, 100, 200, 250 mg ER tablets q 12 hours (500 mg max)

Term

 

Buprenorphine Patch

MOA

Toxicity

Dosing

Administration

 

Definition

5, 10, 20 mcg/hr

High dose associated with QT prolongation

Partial agonist at mu receptor antagonist at kappa receptor

Indicated for moderate to severe chronic pain

 

Taper pt on ATC opioids no more than 30 mg morphine prior to starting Butran

Patch worn for 7 days

Apply to same site no more than q 3 weeks

Dose adjustment no more than q 3 days

Serum concentration decrease 50% in 24 hours once removed

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