Info

Common Opioid Medications—Short acting

Medication name

Generic name/ combination name

Usual starting dose—Adidts

Maximum dose

morphine

Morphine immediate release-MSIR Roxanol

5 to 15 milligrams by mouth every 4 hours 5 to 30 milligrams by mouth every 4 hours

Limited by adverse side effects such as respiratory depression, sedation, nausea

methadone

Dolophine

2.5 to 10 milligrams by mouth every 3 to 4 hours

Extreme care with dosing and medication initiation

Half life ranges from 12 to 150 hours

* Acetaminophen dose should be limited to 4000 milligrams per day

Medication information taken from Nursing 2010 Drug Handbook and Opioid Analgesia, Fine & Portnoy, 2007, and APS, 2008

Common Opioid Medications—Extended Release * Not intended to be crushed, chewed, or used when alcohol is being ingested ** For use with opioid tolerant patients on a schedule basis—not prn

Medication Generic name Usual starting dose Maximum dose morphine Oramorph SR

Kadian 20 milligrams every 12 hours or 40

milligrams once daily Avinza 20-30 milligrams by mouth daily

MsContin 15 or 30 milligrams every 12 hours oxycodone oxymorphone tramadol dilaudid morphine sulfate with naltrexone

Oxycontin Opana ER Ultram ER Exalgo

Embeda

10 milligrams every 12 hours

5 milligrams every 12 hours

100 milligrams once daily

8 milligrams to 64 milligrams daily converted from current opioid doses using Exalgo conversion equivalents-give 50% of converted daily dose

Convert the patient's total daily dose of current opioid and rescue dose by 50% when initiating therapy—dose every 12 hours

300 milligrams per day

Medication information taken from Nitrsing2010 DrugHandbook and Opioid Analgesia, Fine & Portnoy, 2007, APS, 2008, and PI for Exalgo, Embeda and Nucynta

In order to be considered opioid tolerant the patients should be taking at least 60 milligrams of oral morphine per day or 25 micrograms of fentanyl patch per hour, 30 milligrams of oxycodone per day

8 milligrams of oral hydromorphone per day, 25 milligrams of oral oxymorphone per day for a week or longer

Source: DArcy, Y., & Bruckenthal, P. (2011). Safe opioid prescribingfor nurse practitioners. New York: Oxford University Press.

medication is appropriate, and the patient will use it intermittently throughout the period of recovery. Once the surgical pain resolves, the patient does not need to take the opioid medication any longer and stops medication use. Patients with chronic pain require a more complex medication regimen to control their pain effectively.

Most short-acting medications are oral, as either pills or elixirs. For surgical pain, a short-acting medication may be needed in the immediate postoperative period, and these are given as intermittent intravenous (IV) doses or through epidural or patient-controlled analgesia. One route of administration that is no longer recommended is the intramuscular (IM) route. Because the administration of medication via the IM route allows for irregular absorption and tissue sclerosis, most national guidelines and pain specialists have eliminated the IM route from their recommendations (APS, 2008).

For patients with chronic pain, the pain will continue with no end point, and so medication use will continue. For these patients, a careful assessment of pain patterns and intensities throughout the day will help determine when and how the opioid medication will be prescribed. For some patients with chronic pain, sitting can be very painful, whereas others cannot tolerate standing or lying in bed. For these patients, pain medication should be chosen to have the biggest effect on these particularly painful times. If the pain is only episodic or present at certain times of day, a short-acting medication may provide all the pain relief that is needed. However, most patients with chronic pain have pain that is continuous, so adding an ER medication is common.

Most short-acting opioid medications are designed for moderate to severe pain intensities. Onset of action is usually 10 to 60 minutes, with a short duration of action of 2 to 4 hours (Katz, McCarberg, & Reisner, 2007). Overall advantages to short-acting medications include a synergistic effect with the combination medications such as acetaminophen and an opioid, that can improve pain relief and provide a better outcome.

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