Pharmacological Approaches in Pain Management. Ryan J. Bickel, Pharm.D., BCPS updated by David G. Curry, PhD, APRN for NUR344, Fall, 2009 Used with permission. Learning Objectives. Review common non-opioid, opioid, and adjuvant analgesic medications
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Ryan J. Bickel, Pharm.D., BCPS
David G. Curry, PhD, APRN for
NUR344, Fall, 2009
Used with permission
Effective as APAP for acute pain at similar doses
Worse side effect profile than APAP
Safer than ASA
No platelet effects
Magnesium salicylate (Doan’s)Salicylates
constipation, physical dependence
Not a first line agent!
Note: Heat increases rate of release from patch
than APAP alone
causes withdrawal in patients on opioids
ceiling effect on analgesia
psychotomimetic adverse effects
Lower abuse potential
Pentazocine (Talwin, Talwin NX)
Buprenorphine (Buprenex)Mixed Agonist-Antagonists
“drugs that are used primarily for treating conditions other than pain, but may be analgesic in selected circumstances”
MJ is a 56 YOM with prostate cancer admitted to hospital for pain control. He was started on a morphine PCA. In the last 24 hours the patient has received 34 mg and his pain has been adequately control. The physician discontinued the PCA and started the patient on MSContin 30 mg PO BID. Is this an equivalent regimen?
Table IV dose
Table PO dose
Pt 24 hr IV dose
X amount of PO
10 mg IV
30 mg PO
30 mg PO
34 mg IV
34 mg IV
XEquianalgesic Case 1
Set up proportion
10X = 1020
Divide each side by the number in front of X:
Select Reasonable Regimen
MS Contin 45 mg PO BID
X = 102
Calculate the oral morphine dose needed for breakthrough pain
Answer: Morphine 5 – 15 mg PO every 4 hours prn pain
PJ is a 47 YO female who is receiving morphine 2-6 mg IV q2h prn post-op. In the last 24 hours, the patient has received 24 mg IV morphine. Surgery just dc’d the morphine & ordered Lortab 5/500 mg 1-2 tabs PO q6h PRN pain. What do you think of this regimen?
X = 72 mg PO morphineEquinalagesic Case 2
Convert to oral morphine:
10 mg IV
30 mg PO
24 mg IV
X = 48 mg hydrocodoneEquinalagesic Case 2
Convert to hydrocodone:
30 mg MS
20 mg HC
72 mg MS
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