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Cases for Pain Lecture

Cases for Pain Lecture. edited 9/5/11 ESW. Case 1. An 80 year old woman falls and fractures the forearm. You xray it, reduce it, and cast it. She has pain and asks for your advice. Question 1. The best initial analgesic would be : Morphine Contin 30 mg po q12h Ibuprofen 600 mg po bid

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Cases for Pain Lecture

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  1. Cases for Pain Lecture

    edited 9/5/11 ESW
  2. Case 1 An 80 year old woman falls and fractures the forearm. You xray it, reduce it, and cast it. She has pain and asks for your advice.
  3. Question 1 The best initial analgesic would be: Morphine Contin 30 mg po q12h Ibuprofen 600 mg po bid Acetaminophen 650 mg po qid Dilaudid 2 mg po q4h prn pain
  4. Question 2 Your first choice has not worked well. The pain scale rating is 6 to 8. You now try: Morphine Contin 30 mg po bid Hydrocodone 2.5 mg/ APAP 500 qid Dilaudid 2 mg po q4h prn pain Duragesic 25 mcg patch q3d
  5. Case 2 You are caring for a 72 year old man who has become nauseated from the Morphine Contin 30 mg po bid and the hydrocodone/APAP 5/325 q4h prn which he uses about 3 times daily. You decide to switch to oxycodone to address the side effects.
  6. EquiAnalgesic Table
  7. Question 3 The equivalent dose of oral morphine is 25 mg 60 mg 75 mg 90 mg
  8. Question 4 The equivalent dose of oxycodone is 20 mg 30 mg 40 mg 50 mg
  9. Question 5 You order OxyContin 30 mg po q12h OxyContin 20 mg po qd Oxycodone 5 mg po q4h prn pain OxyContin 20 q12h & oxycodone 5 mg po q4h prn pain
  10. Answers C: This woman is just starting on analgesics. The proper place to start is step 1 of the WHO analgesic ladder. B: Step one did not work well, so go to step 2.
  11. Answers C: Convert to oral morphine (60 mg + 15 mg = 75 mg). D: Convert that to oxycodone (30 MS = 20 oxycodone, so 75 of MS = 50 oxycodone) D: This choice has a slight reduction in dose and adequate breakthrough.
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