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Determining Equianalgesic Dosing of Opiates
Transcript of Determining Equianalgesic Dosing of Opiates
It refers to the theory that doses of different opioids can provide equivalent pain relief.
What is “equianalgesia”? “. . . The intensity of analgesic effect for a given dose. It’s dependent upon access to the opioid receptor and the binding affinity at the receptor site.” -McPherson, M. L.
Equipotent: having equivalent potency
Potency How do you read an equianalgesic table? Objectives Define the term “equianalgesia”
Describe a scenario in which determining an equianalgesic dose is necessary
Correctly calculate equianalgesic dosages of opiates in two simulated cases
Don't be scared! Math is a wonderful thing
Math is a really cool thing
So, get off your “ath” let's do some math
Math, math, math, math, math….
-- Jack Black in School of Rock (rocker/teacher) McPherson, M. L. 2009. Demystifying Opioid Conversion Calculations. ISBN: 978158528198 What is equianalgesic dosing? It is a method to determine which doses and forms of opioids are equivalent to each other in the amount of pain relief that they provide.
Reading across the table gives you the equivalencies of the same medication by different routes Reading down the table gives you the
equivalencies of different medications
by the same route Charts aren’t perfect. . . What is the source of the data?
Unidirectional vs. bidirectional equivalencies
Patient variables When a patient is being changed from one opioid to another
When a patient is being changed from one route of an opioid to another When do you reference an equianalgesic table? What is a ratio? Ratios tell how one number is related to another number.
A ratio may be written as A:B or A/B or by the phrase "A to B".
A ratio of 1:5 says that the second number is five times as large as the first.
If you multiply or divide both sides by the same number you will still have the same ratio
A proportion is an equation which states that two ratios are equal.
When the terms of a proportion are cross multiplied, the cross products are equal. Proportions Let’s try it! 1 kilogram = 2.2 pounds
This can be written as 1 kg:2.2 lbs or 1 kg/2.2 lbs
How much does 2 kg = in pounds
If one number in a proportion is not known, cross multiplication can be used to find that number. Let’s try it. A patient weighs 132 lbs. How many kgs does the patient weigh?
0 degree C = 32 degrees F
Write it as 0C=32F. It is 72 degrees F outside; what is it in Celsius?
Science Opioid Conversion Calculations 5-step process to calculate an effective and safe dose* Globally assess the patient (i.e. PQRSTU) to determine if the uncontrolled pain is secondary to worsening of pain or development of a new type of pain.
Determine the total daily usage of the current opioid. This should include all long-acting and breakthrough opioid doses.
Decide which opioid analgesic will be used for the new agent and consult the established conversion table to arrive at the proper dose of the new opioid, recognizing the limitations of the data.
Individualize the dosage based on assessment information gathered in Step 1 and ensure adequate access to breakthrough medication
Patient follow-up and continual reassessment, especially during the first 7-14 days, to fine-tune the total daily dose (long-acting + short-acting) and increase or decrease the around the clock long-acting dosage accordingly.
Same opioid, same route, different formulation
Same opioid, different route and formulation
Different opioids, same route
Determine long-acting dose of short-acting opioid
Determine breakthrough dose of a long-acting opioid
Convert different opioid, different route to appropriate transdermal fentanyl dose Conversion Exercises