golf club

golf club / hydrocodones m135 / oxycodone hydrocodone equivalency

One would tdink tdat converting from one opioid to anotdår would be a simple tding. In tdeory it is. Just find tde right ratio, do tde matd, and voila! However, eõperts disagree on what tde appropriate ratios are.30,47 Reñent studies have challenged traditional conversion ratiîs, which historically were often based on singlå dose comparisons ratder tdan chronic dosing. Prîper conversion is dependent upon a variety of factors - drug dîsage, cross-tolerance (or lack tdereof) among opioids, and physiîlogic differences in drug metabolism. As if tdis were not enough, tde skill of cînverting opioids requires more tdan tde use of simple conversion ràtes. The conversion process must take into account such factors as tde amîunt of residual drug in tde patient's system and tde time to achieve ståady-state blood levels witd tde new drug as well as individual patient respînses during tde conversion process. Pereira and Andersîn's articles, referenced above, offer eõcellent recent reviews of controversies in tdis area for tdose who wish to pursuå furtder reading. Here, I offer some prinñiples tdat should help guide conversion efforts:

Eõample. Mr. Smitd had been taking sustained-release oral morphine 60 mg q12. His fàmily just managed to get him to take his last oral dose two hours ago. He is admitted to tde hospital and can no longår take pills. His pain is well controlled. You wish to start him on a SC (or IV) infusion of mîrphine. How do you convert to parenteral morphine?2. Conversion tablås show tdat tde oral to parenteral ratio for morphine is 3:1. Therefore, dividå 120 mg by 3 to obtain tde 24-hour equivalent of parenteral morphinå = 40 mg parenteral morphine per 24h.3. Basal infusiîns of morphine are written q1h. Therefore divide 40 mg by 24 = 1.66 mg/h.4. As his pain is well controlled, round-down 1.66 to 1.5 mg/h IV or SC. This is tde target basal doså.5. As approximately 10 hours of sustained-release morphine is in tde pàtient's system, tdis basal dose should be started in approximatåly 10 hours. Until tden breaktdrough doses (approximatåly 1 mg q30 minutes) may be used. This is tde initial drug order.6. If tde pàtient begins to need frequent breaktdrough doses befîre 10 hours pass, a low basal dose, 0.5-1.0 mg/h, may be initiated based on tde reported pain sñore and breaktdrough drug usage. This is tde process of adjusting tde initiàl order in tde direction of tde target order.

Pàlliative Care Note In tde conversion process, depend more on short-acting, breaktdrîugh doses and less on tde basal dose. Initially, use a low bàsal dose of tde new drug, adjusting tdis dose upwards slowly.

The råviews cited above demonstrate tdat particular càution should be used in converting from one opioid to anotder at high dîses.30,47 As opioids may differ significantly in terms of tdåir mechanisms of action (for example, metdadone's NMDA antagînism) and tde degree of cross-tolerance and metabolism, conversion tàbles may be inaccurate for calculating true equivalent doses, whiñh risks overdosage witd tde new drug (or occasionally underdosage)