Practical pain management is a remedy health media, llc web property. Covers the spectrum of opioid analgenics used in the management of patients with moderate to severe pain and seriouslifelimiting illnesses. Calculating total daily dose of opioids for safer dosage cdc. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old. It should not be used to determine doses when converting a patient from one opioid to another. Demystifying opioid conversion calculations by mary lynn m. Kathryn shaw, pharmd, rph staff pharmacist vernak farms compounding pharmacy skaneateles, new york postgraduate year 1 pharmacy resident at time of study.
Introduction a variety of published conversion tables exist to provide clinicians a rough guide for making calculations when switching between different opioid routes or preparations. 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. Equianalgesic opioid dosing calculation isnt simple math. Convert the calculated 24 hour equianalgesic dose of oral morphine to the 24 hour equianalgesic dose of the new opioid. Higher dosages of opioids are associated with higher risk of overdose and. Equianalgesic opioid dosing adapted from mcpherson, m.
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. A guide to effective dosing am j hosp palliat care june 2011 vol. July 2019 supportive institute upmc palliative and. Listed below are methods for common conversions using standard published conversion ratios. 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.
Introduction to opioid conversion calculations 1 chapter 2 converting among routes and formulations of the same opioid. Opioid conversions and opioid dosing calculator disclaimer. About the author b mary lynn mcpherson pharmd bcps cpe b p dr. Calculating total daily dose of opioids for safer dosage, centers for disease control and prevention, cdc, u. For this reason the date of birth field is mandatory. It carefully walks clinicians through a fivestep process for performing opioid conversion calculations in the realworld situations they often see. The dose is calculated by using a conversion factor opioid dose multiplied or divided by factor. Opioid manager switching opioids morphine equivalence table. Mcpherson, 9781585281985, available at book depository with free delivery worldwide.
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. Therefore when converting morphine iv to enteral multiply the iv dose by 3. Item detail demystifying opioid conversion calculations. A guide for effective dosing, has long been the goto guide for learning how to calculate opioid conversions.
Identify important drug interactions that can affect opioid serum levels. Opioid calculator opioid conversions and opioid dosing. I needed this book for my aquaculture courses for advanced calculations involving metric conversion factors where i would always end up getting stuck and not be able to finish a problem. A guide for effective dosing mcpherson, demystifying opioid conversion calculations 1st edition. Titrate no faster than every 24 hours first, calculate previous 24 hour ome total if response is inadequate consider increasing 2550% for moderate pain and 50100% for severe pain. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Opioid conversion tips changing to another oral opioid. A userfriendly guide on opioid conversion calculations. Equianalgesic doses of oral opioids oral opioid conversion factor opioid dose x or. Tables of this general type are also available for nsaids, benzodiazepines, depressants, stimulants, anticholinergics and. Equianalgesic conversion methods are commonly used to switch patients from one opioid to another due to suboptimal pain relief or adverse events. 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. What happens when a patients opioid dosage is wrong. The examples assume a change in drug or route at a time of stable pain control using equianalgesic doses.
Explain opioid conversion and calculation strategies when developing a care plan for patients with chronic pain. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. A guide for effective dosing, american society of healthsystem pharmacists, inc, bethesda, md. Describe how pharmacogenetic differences can effect opioid. A guide for effective dosing by mcpherson, mary lynn created date. Demystifying opioid conversion calculations a guide for effective dosing is a thorough synopsis of opioid pharmacotherapy. In most patients, morphine is the favored drug, however.
From there, you can view and download your ashp ebooks to the reader of your choice. Offer pdf demystifying opioid conversion calculations. 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. Steps and methods for the conversions of various opioids are provided. Evaluation and comparison of online equianalgesic opioid dose. Mcpherson has published extensively on the topic of opioid conversion calculations. Determine doses when converting a patient from one opioid to another. Calculation of morphine milligram equivalents per day main sources consulted for mme conversion factors as listed by the cdc 1. The usual method of converting one opioid to another is to. A guide for effective dosing, has long been the goto. Jan 16, 20 a comparison of the reliability of smartphone apps for opioid conversion.
Convert current opioid to oral morphine equivalents, i. Opioid conversion guide these conversions are a guide only. 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. Department of health and human services, higher dosage, higher risk, why is it important to calculate the total daily dosage of opioids, how much is 50 or 90 mmeday for commonly prescribed opioids, how should the total daily dose of. State the pros and cons of different opioids list the steps to convert the dose of one opioid to another opioid perform the calculations to convert the dose of one opioid to another opioid simple conversion, fentanyl patch, methadone and iv infusion doses communicate the important counseling points of methadone to patientscaregivers. Drug equianalgesic oral dose morphine 30 mg hydromorphone 7.
Then change to the other opioid using the conversion guide below. Conversions with methadone methadone is inexpensive and effective in certain patient populations. We performed manual calculations referencing the opioid analgesic comparison tables sanctioned by the american pain society guidelines and pereira et al. Patients may vary in their response to different opioids. Calculating opioid dose conversions palliative care. Calculate the total daily dose of current opioid add the longacting and rescue doses.
Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f. Establish frequent patient follow up and reassessment 11 mcpherson, mary lynn demystifying opioid conversion calculation. The book concentrates on the important mathematical, pharmacokinetic, pharmacodynamic, and patient parameters that a pain medicine clinician needs to safely administer opioids. Advanced opioid conversion calculator morphine equivalents. Demystifying opioid conversion calculations youtube. 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. Variability in opioid equivalence calculations request pdf. Since we used the same reference tables to compare all. 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. Ideally, methadone conversions especially patients who were previously receiving high doses of an opioid should only be attempted in cooperation with a pain specialist or a specialist in palliative medicine.
For patients under this age consult with a pain or palliative care specialist. A comprehensive revision and update of this unique and popular reference. Asking the right questions to find the best answers cheryl k genord, r. Calculate an opioid starting dose for an opioid naive patient. An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics drugs used to relieve pain. Harness the trade secrets from this acclaimed industry insider, veteran of hundreds of. Nov 02, 2014 opioid conversion ratios guide to practice 20 updated as version 2 november 2014 20. A guide for effective dosing mcpherson, demystifying opioid conversion calculations drug. In this segment, she speaks to why this is an important skill set for prescribing clinicians, and summarizes. The authors attempted to convert various opioids to their morphineequivalent daily dose medd while comparing different online opioid conversion calculators with manual calculations to identify the major disparities among them, as well as the potential dangers those disparities could cause.
Equianalgesic charts are used for calculation of an equivalent dose a dose which would offer an equal amount of analgesia between different analgesics. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative. Opioid conversion ratios guide to practice 2010 released december 2010. She would like to try an immediaterelease opioid agent, hydromorphone. A guide for effective dosing, second edition, 2018 isbn. However, as prescribing of opioids has become more prevalent and deaths from opioid overdoses have increased congruently, so too does the con. Table of contents for 9781585281985 demystifying opioid conversion calculations. Assess patientspecific factors that warrant adjustment to an opioid regimen. Pain control is a complex process that requires multiple titratio. Increasing conversion rates on a website represents one of the fastest revenue growth opportunities for marketers and business owners but few people really understand how to make websites convert.
We read with great interest the recent study by reddy et al. Learn best practices for managing pain without opioids. The information outlined below is intended as a guide only. There are differences in the literature regarding opioid conversion ratios. 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. The use of high but ineffective doses of a previous opioid may result in overestimation of the converted opioid. 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. Opioid conversion tutorial use the concepts in this animated tutorial with caution. This easytounderstand and often humorous book is the most comprehensive todate on opioid calculations for pain management and palliative care.
Mcpherson, demystifying opioid conversion calculations metric units and conversion charts many many many gods of hinduism. There is no universally accepted opioid conversion method, however, and there is often significant variability between conversion resources. Demystifying opioid conversion calculations r2 digital. Opioid conversion tips changing to another oral opioid question. Opioid conversion calculator for morphine equivalents. A guide for effective dosing mcpherson, mary lynn isbn. E4306, 2018, 288 pages praised by practitioners, students and instructors for its engaging approach to teaching a very complex subject, demystifying opioid conversion calculations.
Calculating total daily dose of opioids for safer dosage. This comprehensive yet practical guidebook is a mustread for health professionals involved in pain management, hospice, and palliative care. Pdf a comparison of the reliability of smartphone apps for. Transdermal and parenteral fentanyl dosage calculations. Oxycodone is the preferred drug in this case as it is renally safer than morphine. Walden explains investigation into pain pill manufacturers. 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. If the address matches an existing account you will receive an email with instructions to reset your password. 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. Drug dose calculations the ordered dose is the most simple dosage calculation for the prehospital care in many cases, patients require medication to be infused on a continual base. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Advanced opioid conversion calculator morphine equivalents opioid conversions advanced equianalgesic pain relief the opioid equianalgesic conversions calculator allows a clinician to generate an equivalent dose equal amount of analgesia when switching between different opioid analgesics. However, the book is not simply a stepbystep guide.
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