Bpm2011_flyer_print3.indd

BEDSIDE PAIN MANAGER Conversions & Information
for Pain and Symptom Control
Here’s a look at partial contents of some of the sections in the 2011 BEDSIDE PAIN MANAGER.
.6
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01*0*%

# Tabs or mLs
Equivalent
ANALGESIC CHART
to convert to
duragesic
duration: Onset:
Information in columns to the right is based on the ÀUVW GRVDJH LQ EROG
morphine 25 mcg patch
6000 mg Cost
OXYCODONE: (not available for injection)
2[\,5 JHQHULF ² oxycodone 5 mg (5, 10, 15, 20, 30 mg)
2[\&RQWLQ ² CR ² oxycodone 10 mg (10, 15, 20, 30, 40, 60, 80, mg ER)
Combunox, generic - oxycodone 5 mg/ibuprofen 400 mg
*710
&26*"/"-(&4*$
$)"35
analgesic
Starting
Duration:
Values are approximate; use only as a guideline.
HYDROMORPHONE: IV/IM/SC
'LODXGLG ² liquid ² 1 mg/1 mL
generic ² suppository ²  PJ
NSAID CHART
Generic name in bold (Brand name and how supplied in parentheses;
starting
schedule:
Half-life:
brands in color are discontinued, left in to aid with recognition) naproxen/esomeprazole DR (Vimovo 375/20, Vimovo 500/20) BID AC
esomeprazole (Nexium) is gastroprotective SELECTIVE COX-2 AGENT: less effect on bleeding mechanisms than
non-COX-2 drugs celecoxib (Celebrex 50, 100, 200, 400 mg)
Starting
ADJUVANT MEDS:
Transmucosal Fentanyl Products
‡ tapentadol (Nucynta 50, 75, 100 mg) 50-100 mg q 4-6 h; also
available Nucynta ER 50, 100, 150, 200, 250 mg BID.$$$$ Onsolis - buccal strip200, 400, 600, 800, 1200 mcg PAIN MANAGEMENT PEARLS
1. “Pain is whatever the experiencing person says it is, existing whenever CAUTION: See pkg insert for individual dosing instructions. Half-life is dose related. Transmucosal fentanyl products are not bioequivalent; use
he says it does.” Margo McCaffery 3-McCaffery, p. 17
caution if switching between products. Strongly contraindicated for use 10. Hydromorphone (Dilaudid): better drug choice for patients with outside clinical setting for opioid-naive patients; respiratory depression may be severe and persist longer than analgesia.
UHQDO LQVXIÀFLHQF\ GXH WR LW·V VKRUW KDOIOLIH  KUV DQG QR DFWLYH
metabolites. 3-McCaffery, p. 226
Naloxone (Narcan) Guidelines
36. Steady state is achieved when the rate of excretion of a drug equals the rate of intake, usually after 5 doses. Half-life must be considered. ‡ naloxone (0.4 mg/mL, 1 mg/mL) - give 0.4 -2 mg IV q2-3 min prn The full effects of a change in dose will not be seen until 4-5 half-lifes up to 10 mg; give IM/SC if IV route not available; supplemental have occurred. Patients must be monitored closely during this time for IM doses last longer; may dilute 0.4 mg in 10 mL and give 0.5 mL signs of overdose: sedation and respiratory depression. 3-McCaffery, pp.
in q 1 minute increments to avoid abrupt cessation of pain control 169-170; 7-Wrede-Seaman, p. 183
NAUSEA – Consider:
40. Non-drug approaches to pain, consider: TENS unit (not recommended with pacemaker), heat or cold, or alternating heat and cold, massage, ‡ granisetron (Kytril).parenteral, liquid
bath/hot tub, changing position, meditation, acupuncture .
3. The Hopkins Opioid Program has a free and easy to use online transdermal (Sancuso 3.1 mg) 1 patch q 24 h.$$$$ opioid conversion tool. Sign-in is required. www.hopweb.org "/"-(&4*$
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t

1304

$0/4
0'
"7"*-"#-&
3065&4
Oral – Long-Acting
PRO CON
‡ (DV\ WR WDNH SDWLHQW KDV WRWDO FRQWURO ‡ )UHTXHQWO\ FDXVHV QDXVHD DQG YRPLWLQJ IRU ÀUVW IHZ GD\V ‡ (YHQ DQDOJHVLD OHVV SHDN DQG WURXJK HIIHFW ‡ &DQ YDU\ WKH GRVH RQ D UHJXODU EDVLV ² ‡ &DQ EH XVHG UHFWDOO\ KHOSIXO LQ FULVHV

Source: http://www.pain-management.org/PDFS/BPM2011_flyerpg2.pdf