Additions and Corrections
Additions
- The Hopkins Opioid Program has a free and easy to use online opioid conversion tool. Sign-in is required. www.hopweb.org
Corrections 2011 edition
- Pearl 10 is incorrect. "Hydromorphone (Dilaudid): a better drug choice for patients with renal insufficiency, due to it's short half-life (2-3 hrs) and no active metabolites. 3-McCaffery, p. 226"
H3G is an active metabolite of hydromorphone. It has no analgesic properties and upon accumulation (as can occur with renal insufficiency), can cause neuroexcitatory symptoms: tremor, agitation, myoclonus, allodynia, seizures, cognitive dysfunction. Rotation to a structurally dissimilar opioid (ie: methadone or fentanyl) usually results in a resolution of these neuro symptoms over a period of hours to days.
References:
Journal of Palliative Medicine. 2011 Sept; 14(9): 1029-1033.
Life Science. 2001 Jun 15; 69(4): 409-420.
Clinical and Experimental Pharmacology & Physiology. 2000 July; 27(7): 524.
Corrections 2008 edition
- IV Page 2
Under Naloxone Guidelines, #3 Naloxone Administration: There are several typos involving mg and mL. However, the overall guidelines have changed. New guidelines are as follows: naloxone (0.4 mg/mL, 1 mg/mL) - give 0.4-2 mg IV q2-3 min prn up to 10 mg; give IM/SC if IV route not available; supplemental IM doses last longer; may dilute 0.4 mg in 10 mL and give 0.5 mL in q1 minute increments to avoid abrupt cessation of pain control.
- Pearl 9 is incorrect. "Hydromorphone (Dilaudid): a better drug choice for patients with renal insufficiency, due to it's short half-life (2-3 hrs) and no active metabolites. 3-McCaffery, p. 226"
H3G is an active metabolite of hydromorphone. It has no analgesic properties and upon accumulation (as can occur with renal insufficiency), can cause neuroexcitatory symptoms: tremor, agitation, myoclonus, allodynia, seizures, cognitive dysfunction. Rotation to a structurally dissimilar opioid (ie: methadone or fentanyl) usually results in a resolution of these neuro symptoms over a period of hours to days.
References:
Journal of Palliative Medicine. 2011 Sept; 14(9): 1029-1033.
Life Science. 2001 Jun 15; 69(4): 409-420.
Clinical and Experimental Pharmacology & Physiology. 2000 July; 27(7): 524.
Corrections 2004 edition
- Page 2 and 4/5
Fentanyl transdermal (Duragesic) Conversion Chart: Janssen has revised the low conversion dose for the 25 mcg patch. The currently advised doses are PO morphine 60-134 mg and IM morphine 10-22 mg. On pages 4/5, this will change all the values in the second column of all three charts (#tabs or mLs QD to convert to fentanyl 25 mcg patch). Since the conversion chart was already conservative, it is unlikely that using the old values would pose any serious risk of overdose.
- Page 4/5
Note "c" at the bottom of page 5 reads (See also Pearl 22). It should read Pearl 21.
Corrections 2002, 1999 and 1998 editions
- Fentanyl transdermal (Duragesic) Conversion Chart: Janssen has revised the low conversion dose for the 25 mcg patch. The currently advised doses are PO morphine 60-134 mg and IM morphine 10-22 mg. On pages 4/5, this will change the values in the analgesic conversion chart for converting to fentanyl patch (#tabs or mLs QD to convert to fentanyl 25 mcg patch). Since the conversion chart was already conservative, it is unlikely that using the old values would pose any serious risk of overdose.
- Pearl 10 in the 2002 version (which is Pearl 13 in the 1999 edition, and the 12th pearl in the 1998 version) has been deleted. Roxanol droppers are not uniform in size, hence the dosage varies.
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