Opioid Rotation Handout - FreeCE

Page 5Opioids and Opioid Rotation – What Pharmacists Need to Know© 2010 Pharmaceutical Education Consultants, Inc. unless otherwise noted. All rights reserved.Reproduction in whole or in part without permission is prohibited.Case 3TDD current opioid X EAF new opioid =EAF current opioid120 mg oral morphine X 10 mg IV morphine =30 mg oral morphine40 mg TDD IV morphine25-50% increase - MS 7.5 or 10 IV q4h (TDD 45-60 mg)Case 4• BJ is an 82 year old woman with severe osteoarthritis ofthe knees. She has been receiving morphine 5 mg po q4h(during waking hours) for the past several years.Unfortunately she suffered a stroke recently and shecannot swallow tablets or even oral solution.• Her physician wants to switch her to rectal morphinesuppositories.• Available as 5, 10, 20, 30 mg suppositories.• What do you recommend?– A. 2.5 mg pr q4h during waking hours– B. 2.5 mg pr q6h during waking hours– C. 5 mg pr q4h during waking hours– D. 10 mg pr q4h during waking hoursEAF – equianalgesic factorCase 5• Mrs. Claytor is a 62 year old woman withpancreatic cancer.• Her pain is well controlled, but she is unable toswallow the MS Contin tablets (200 mg po q12h)or even the oral morphine solution (40 mg q3hprn breakthrough pain, she uses about one doseper day).• Her physician would like to switch her to aparenteral SQ morphine infusion.Recommendation?Case 5“x” mg SQ morphine = 10 mg SQ morphine440 mg oral morphine 30 mg oral morphine• Cross multiply and solve for “x” as follows:– (30)(x) = (10)(440)– 30x = 4400– x = 146.7 mg SQ morphine per day– 146.7 / 24 hours = 6.1 mg/hour– Recommend 5 mg/hour– What about a bolus? What do you recommend?