A guide for effective dosing ebook written by mary lynn mcpherson. The amount of residual drug in the patients system must be accounted for. Transdermal and parenteral fentanyl dosage calculations. Calculate the total daily dose of current opioid add the longacting and rescue doses. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative.
When switching patients to a different opioid agent, equivalence tables are used to estimate an equipotent dose of the target opioid. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Calculate opioid dose adjustments and opioid starting doses. Offer pdf demystifying opioid conversion calculations. Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to.
To reduce the risk of unintentional overdose, the conversion ratio calculated for a patient undergoing opioid rotation should be adjusted based on clinical. A guide for effective dosing, has long been the goto guide for learning how to calculate opioid conversions. There are differences in the literature regarding opioid conversion ratios. From there, you can view and download your ashp ebooks to the reader of your choice. A guide to effective dosing am j hosp palliat care june 2011 vol. Equianalgesic charts are used for calculation of an equivalent dose a dose which would offer an equal amount of analgesia between different analgesics. Prescribers are often faced with an option to rotate therapy to a different opioid, switching between variable chemical classes of opioids to enhance efficacy and improve patient outcomes with consideration to adverse event profile, analgesic benefits, and patient adherence. Written in a conversational tone with a splash of humor, the book covers key areas of opioid conversions unlike any other book. Demystifying opioid conversion calculations, guide for effective dosing. Pain control is a complex process that requires multiple titrations of drug doses over time. Recommend an appropriate dose of transdermal fentanyl when switching from other opioids, including rescue opioid dosing. Calculating total daily dose of opioids for safer dosage higher dosage, higher risk.
Demystifying opioid conversion calculations, a guide for. Opioid dose equianalgesic oral morphine dose for pain wa health. E4306, 2018, 288 pages praised by practitioners, students and instructors for its engaging approach to teaching a very complex subject, demystifying opioid conversion calculations. This easytounderstand and often humorous book is the most comprehensive todate on opioid calculations for pain management and palliative care. In the case of converting morphine to methadone, methadone has a relative potency of 4. Since we used the same reference tables to compare all. Opioid conversions and opioid dosing calculator disclaimer. Use the dosing and conversion chart for opioid analgesics to convert original opioid to an alter.
Calculate the total shortacting opioid ir used in 24 hours convert this total to a longacting opioid 2. Individualize the dosage based on assessment and ensure adequate access to breakthrough medication 5. Opioid dose equivalence faculty of pain medicine anzca. Explain opioid conversion and calculation strategies when. Calculate the rescue dose 1020% of tdd based on new daily opioid dose case 1 mj is a 47yearold hispanic female with chronic back pain. An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics drugs used to relieve pain. Ashp ebooks sign in with your ashp username and password to access purchased ebooks in my library. Though several such conversion charts exist, they generally lack simplicity and uniformity in their ease of use across the spectrum of palliative care professionals. Opioid conversion tips changing to another oral opioid. However, variation among patients in bioavailability of oral opioids, unpredictable or incomplete tolerance between opioids and other patientspecific. Describe how pharmacogenetic differences can effect opioid. Metric conversion chart 2 documents tire conversion chart 3 documents dog years chart 2 documents measurements chart 1 documents class attendance sheet 2 documents seating chart template 3 documents sample attendance sheet 7 documents html color code chart 4 documents urine color chart 4 documents color wheel chart 4 documents. Opioid conversion calculator morphine equivalents advanced. It carefully walks clinicians through a fivestep process for performing opioid conversion calculations in the realworld situations they often see.
Another proposed model for converting morphine to methadone was presented in 1990 in the form of an algorithm fig. Demystifying opioid conversion calculations, a guide for effective dosing by mary lynn mcpherson article in journal of palliative medicine 145. Patients may vary in their response to different opioids. Table of contents for 9781585281985 demystifying opioid conversion calculations. Determine doses when converting a patient from one opioid to another. After 5 days of administration, the total daily methadone doses required on days 4 and 5 are averaged. Evaluation and comparison of online equianalgesic opioid dose. Establish frequent patient follow up and reassessment 11 mcpherson, mary lynn demystifying opioid conversion calculation. Equianalgesic dosing of opioids for pain management. Different conversions may be suggested if converting to opioids other. Explain opioid conversion and calculation strategies when developing a care plan for patients with chronic pain. Demystifying opioid conversion calculations youtube.
After converting from one opioid to another, the derived dose should be used as a starting point. Use the dosing and conversion chart for opioid analgesics to convert from an oral to iv dose. There may be several possible reasons to switch analgesics including. Divide the 24 hour dose of the equianalgesic dose of the new opioid to determine the unit doses and frequency. Demystifying opioid conversion calculations new york state. American society of healthsystem pharmacists, 2010.
Opioid conversions calc single agent equianalgesic. Equianalgesic dosing of opioids for pain management equianalgesic doses contained in this chart are approximate, and should be used only as a guideline. Participants identified using personal knowledge 46%, an online calculator 31%, textbook table 17%, and conversion table from a journal 6% to properly calculate the conversions. Practical pain management is a remedy health media, llc web property.
The dose is calculated by using a conversion factor opioid dose multiplied or divided by factor. There is no universally accepted opioid conversion method, however, and there is often significant variability between conversion resources. It is, therefore, recommended to begin with a 50% lower dose than the equianalgesic. Subscribers to the letter can get pl detaildocuments, like this one, on any topic.
Drug equianalgesic oral dose morphine 30 mg hydromorphone 7. Demystifying opioid conversion calculations, 2nd edition, is designed to help practitioners including pharmacists, physicians, nurses, and others develop a high level of skill in performing the required mathematical calculations associated with opioid conversions, plus the confidence to safely and effectively manage their patients needs for pain relief. Higher dosages havent been shown to reduce pain over the long term. Demystifying opioid conversion calculations 83 chapter 5 transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. University of maryland school of pharmacy, baltimore publisher. Higher dosages of opioids are associated with higher risk of overdose and deatheven relatively low dosages 2050 morphine milligram equivalents mme per day increase risk. Mary lynn mcpherson is the author of demystifying opioid conversion calculations 4. Meet mary lynn mcpherson, author of ashps demystifying opioid conversion calculations, who tells us the idea behind her book and how it has helped countless healthcare professionals over the years. Opioid oral morphine milligram equivalent mme conversion factorsi,ii. Opioid conversion guide these conversions are a guide only. Identify important drug interactions that can affect opioid serum levels. The examples assume a change in drug or route at a time of stable pain control using equianalgesic doses. She would like to try an immediaterelease opioid agent, hydromorphone.
Transdermal and parenteral fentanyl dosage calculations and. Aug 24, 2009 demystifying opioid conversion calculations. Demystifying opioid conversion calculations a guide to effective dosing this title has been archived. Switching from current opioid to morphine equivalent. Variability in opioid equivalence calculations request pdf. In most patients, morphine is the favored drug, however. The free opioid calculator the calculator provided by remedy health media llc the company, and all information contained therein, is solely for use by trained medical professionals who are experienced in the calculation of doses of opioids based on currently published conversion factors and. Request pdf on may 1, 2011, lauren shaiova and others published demystifying opioid conversion calculations, a guide for effective dosing by mary lynn mcpherson find, read and cite all the. The opioid equianalgesic conversions calculator allows a clinician to generate an equivalent dose equal amount of analgesia when switching between different opioid analgesics. Evaluation and comparison of online equianalgesic opioid. There is often incomplete crosstolerance among these drugs.
The information outlined below is intended as a guide only. Treatment of chronic noncancer pain cncp with longterm opioid use is a challenging task for all health care providers. Increase the newlyconverted longacting opioid by 50% 3. There are many opioids and many formulations available e. A guide for effective dosing by mcpherson, mary lynn created date 8152011 5.
Table 1 lists the online opioid conversion calculators that were compared in this project and elucidates several disparate features among them. Mcpherson, mary lynn demystifying opioid conversion calculation. Nov 02, 2014 opioid conversion ratios guide to practice 20 updated as version 2 november 2014 20. Equianalgesic opioid dosing calculation isnt simple math. Opioid manager switching opioids morphine equivalence table. In this segment, she speaks to why this is an important skill set for prescribing clinicians, and summarizes. This book is a concise, practical guide to the mathematical equations necessary to do opioid drug calculation conversions conversions are explained using a variety of teaching methods. Convert current opioid to oral morphine equivalents, i. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. This site is like a library, use search box in the widget to get ebook that you want. Mcpherson has published extensively on the topic of opioid conversion calculations. Similar to morphine, oxycodone is available in a sustained acting preparation oxycodone oxycontin that can be dosed every 12 hours. Opioid dose conversion is an integral part of palliative care services.
Calculation of oral morphine equivalent daily dose omedd. Mary lynn mcpherson, pharmd, ma, mde, bcps, a professor of pharmacy practice and science at the university of maryland school of pharmacy in baltimore, md, has released the second edition of her book, demystifying opioid conversion calculations. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative care consortium is acknowledged. Demystifying opioid conversion calculations r2 digital. Demystifying opioid conversion calculations journal of. Equianalgesic conversion methods are commonly used to switch patients from one opioid to another due to suboptimal pain relief or adverse events. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Then change to the other opioid using the conversion guide below. Mcpherson, 9781585281985, available at book depository with free delivery worldwide. Assess patientspecific factors that warrant adjustment to an opioid regimen. A userfriendly guide on opioid conversion calculations. Calculate the total daily dose of the original opioid add longacting and rescue doses. Equianalgesic doses of oral opioids oral opioid conversion factor opioid dose x or.
Calculating total daily dose of opioids for safer dosage. A guide for effective dosing, at the start of her painweek 20 session on opioid conversions, mcpherson explained that although the proportion of 30 mg of oral morphine equaling 10 mg of parenteral. Calculate an opioid starting dose for an opioid naive patient. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The textbook includes easytofollow case studies, charts, tables and realworld practice examples to give clinicians the principles they need to conduct opioid conversion calculations. Strength per unit x number of unitsdays supply x mme conversion factor mmeday. The morleymakin model directs the clinician to offer a methadone dose equal to 10% of the daily oral morphine dose but not to exceed 30 mg as needed every 3 hours. Policy gaining expertise with the use of morphine, and other related opioids, for pain management should be the primary goal of those managing pain in the patient with advanced illness. Jun 20, 2014 meet mary lynn mcpherson, author of ashps demystifying opioid conversion calculations, who tells us the idea behind her book and how it has helped countless healthcare professionals over the years.
Download for offline reading, highlight, bookmark or take notes while you read demystifying opioid conversion calculations. Demystifying opioid conversion calculations r2 digital library. After distributing copies of an equianalgesic opioid dosing chart published in her 2008 medical book, demystifying opioid conversion calculations. Calculating opioid dose conversions palliative care. Demystifying opioid conversion calculations download. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. If the address matches an existing account you will receive an email with instructions to reset your password. Steps and methods for the conversions of various opioids are provided. Demystifying opioid conversion calculations, 2nd edition, is designed to help practitioners including pharmacists, physicians, nurses, and others develop a high level of skill in performing the required mathematical calculations associated with opioid conversions, plus the confidence to safely and effectively manage their patients needs for. In this segment, she speaks to why this is an important.
The usual method of converting one opioid to another is to. A guide for effective dosing, american society of healthsystem pharmacists, inc, bethesda, md. Conversion algorithm for instructions on converting from one opioid to another. A variety of additional sources were consulted for drugs not included in these publications. How to bring out the best in people at their worst by rick kirschner, rick brinkman. Demystifying opioid conversion calculations by mary lynn m. However, the book is not simply a stepbystep guide. American society of healthsystem pharmacists publication date. We performed manual calculations referencing the opioid analgesic comparison tables sanctioned by the american pain society guidelines and pereira et al. After changing opioid, close assessment should follow and the dose altered as necessary. Click download or read online button to get demystifying opioid conversion calculations book now.
To develop a simple, easily understandable and userfriendly opiate conversion chart. Strength per unit x number of unitsdays supply x mme conversion factor mmeday the number of units and days supply comes. High moderate or low 50% or less of previous opioid converted to morphine equivalent 6075% of the previous opioid converted to morphine equivalent switching opioids opioid withdrawal symptoms are unpleasant, but not lifethreatening. Therefore the opioid conversion guidelines have been developed to assist when changing opioid drug therapy. Introduction to opioid conversion calculations 1 chapter 2 converting among routes and formulations of the same opioid. A guide for effective dosing mcpherson, mary lynn isbn. Listed below are methods for common conversions using standard published conversion ratios.
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