Protocols - Hemorio

OPIOID ANTAGONISTS:
NALOXONE - Dose for overdose or breathing depression is 0.1 to 2 mg that may be escalated every
Onset of the
action:
1-2 min
Peak:
5-15 min
Action length:
1-4 h
2-3 min if there is no effect.
- Maximum of 10 mg
- In the practice, you must dilute an ampule to 20 ml (where each ml = 0.02) and if
diagnosed a breathing depression by opioid, with FR below 5, start with 5ml (= 0.1).
- Stimulate verbally the subject to take a deep breathe. If there is no increase of the
frequency, make 1-2 ml more.
- Take care with the injection, because the fast injection of an ampule may lead to EAP.
- Remember that the half-life of Naloxone is smaller than the opioid and that it may
depress late. The subject must stay monitored and under vigilance.
- Subjects with a chronic usage may present the abstinence syndrome precipitated by
this drug.
OPIOID CONVERSION:
In order to pass from an opioid to another, you must use a conversion scale with the purpose to avoid the
abstinence crisis and the emergence of a new pain episode.
1 – Determine the total dose of opioid used in the 24h.
2 – Respect the interval of each opioid.
3 – Multiply by the conversion factor of the table. Give 30% - 50% less of the new opioid, in order to avoid
a cross tolerance.
4 – Divide the final quantity by the no. of doses / day, in accordance to the interval of each opioid;
5 – Establish a rescue dosage for the incidental pain.
MORPHI MEPERI CODEINE OXYCODONE
LIST OF OPIOID
EQUIVALENCES
EXAMPLE 1
Subject using
codeine VO pass to
Morphine VO
360mg VO every 6
h
+
7.5 mg extra of
rescue
EXAMPLE 2
Subject using
Morphine VO pass
to IV
20 mg VO every 4
h +
2 mg 4x/day
RESCUE DOSE
(BREAKTHROUGH
PAIN)
209
NE
DINE
Opioid IV / SC for Morphine IV/SC 1 0.13 - -
Morphine VO for Morphine IV or SC 3 - - -
Opioid VO for Morphine VO 1 0.1 0.15 1.5
Morphine VO for Opioid VO 1 10 6 0.6
Morphine SC, IV for Opioid IV/SC 1 7 - -
Total opioid day =
360 mg x 6 (every 4 h) = 2160 mg
+
7.5 mg x 4 =
30 mg
=
2190 mg of codeine at the 24h
Total opioid day =
20 x 6 (every 4 h) = 120 mg
+12 mg (2 mg x 4) =
132 mg of Morphine VO at the 24h
2190 mg x 0.15 (conversion factor)
=
328.5 mg morphine VO day – 30% (in order not to
have cross tolerance) = 230 mg / day
The new regime will be Morphine VO 230 mg
divided at the 24h (6 doses because it is every 4
h) = 40 (38.35) mg every 4 h = 20-30 mg (10-15%
of the 24-h dose) every 2h if necessary for the
rescue dose
132 mg / 3 = 44
- 30% = 30.8 (30) mg of Morphine IV at the 24h,
Would be 30 divided in 6 takes, approximately 6
mg, with 5 to 20% of the dose for Breakthrough
pain.
- It is the dose that may be administered in case of incidental pain among the regular
doses prescribed.
- It is am important component of the control strategy of the pain.
- It is regularly of 5-20% of the total dose of 24h, which may be up to 50%.
- It is usually offered, if requested, in intervals of every 1h.
- If the subject requires more than 3 rescue doses / day, the new prescription of the
previous day must be changed, adding up the dose of 24h to the total of rescue doses
requested at the day.