Oral to iv morphine

Hello Anton,
You bring up an excellent point. The registry only recorded if patients received morphine, but the total dose used, the timing of its administration, and the precise temporal relationships to adverse events could not be determined. But what’s the point of morphine? To decrease preload and decrease the anxiety associated with air hunger….the paper makes reference to a study that showed there was actually no decrease in preload with morphine. Now tack onto that the risks of giving opioids (ie respiratory depression). Even at low doses of morphine with minimal reapiratory depression risk, there would be minimal to no decrease in preload, why would I choose this medication over ntg? Based on this paper, even with all its limitations, I think ntg makes more physiologic sense and more easily titratable IMHO. What about u?

In every case, healthcare providers should always be prepared to manage withdrawal symptomatically with non-opioid medications because there is no completely reliable method for determining whether a patient has had an adequate opioid-free period. A naloxone challenge test may be helpful; however, a few case reports have indicated that patients may experience precipitated withdrawal despite having a negative urine toxicology screen or tolerating a naloxone challenge test (usually in the setting of transitioning from buprenorphine treatment). Patients should be made aware of the risks associated with precipitated withdrawal and encouraged to give an accurate account of last opioid use. Patients treated for alcohol dependence with REVIA should also be assessed for underlying opioid dependence and for any recent use of opioids prior to initiation of treatment with REVIA. Precipitated opioid withdrawal has been observed in alcohol-dependent patients in circumstances where the prescriber had been unaware of the additional use of opioids or co-dependence on opioids.

The objective of this research was to examine the speed of onset and effectiveness of pain relief between oral and intravenous morphine in acutely injured children. An observational study of children aged 3 to 13 years with closed forearm fractures was performed in three accident and emergency departments. The study gathered information on age, gender, body weight, time of arrival, dose, route and time of morphine administration. Pain assessment using a Faces Scale was documented on arrival and repeated at 10, 30 and 60 minutes after morphine was given. Forty-seven children were studied. Of these, 25 were given intravenous morphine, 22 were given oral morphine. There was no statistically significant difference in age, body weight or time until morphine was administered. The change in median pain scores was analysed using the Mann-Whitney U test. This showed that there was a statistically significant reduction in pain score in the intravenous group compared with the oral group between arrival and 10 minutes after giving morphine and between arrival and 60 minutes after giving morphine. Intravenous morphine appears to give more rapid onset and more prolonged pain relief than oral morphine for children with acute injuries. We recommend that in accident and emergency departments where staff are experienced in paediatric cannulation, morphine should be given via the intravenous route in acutely injured children. However we do not advocate inexperienced staff attempting multiple venepunctures in a child resulting in increased anxiety.

In fact, more recent data demonstrates that these conversion ratios may be too simplistic and can vary based on many factors such as chronicity of opioid use, total daily dose, ethnicity, age, and can even differ depending on the direction of conversion (. conversion from morphine to hydromorphone ¹ hydromorphone to morphine). Increasing research in the area of pharmacogenetics examines how genetic polymorphisms of liver metabolic enzymes can explain some of these highly variable effects seen from patient to patient. An expert panel (Fine et al.) suggested the need to revise these tables with different conversion values that take into account this complexity. In addition updated approaches on opioid switching have been discussed in several resources. Of particular note are substantial changes to calculations when converting to PO methadone, which is more potent than originally thought. Due to potential for serious adverse patient outcomes equianalgesic dose calculations are now adjusted based on the total daily dose of morphine equivalents with higher daily doses requiring increasingly less methadone.

Oral to iv morphine

oral to iv morphine

In fact, more recent data demonstrates that these conversion ratios may be too simplistic and can vary based on many factors such as chronicity of opioid use, total daily dose, ethnicity, age, and can even differ depending on the direction of conversion (. conversion from morphine to hydromorphone ¹ hydromorphone to morphine). Increasing research in the area of pharmacogenetics examines how genetic polymorphisms of liver metabolic enzymes can explain some of these highly variable effects seen from patient to patient. An expert panel (Fine et al.) suggested the need to revise these tables with different conversion values that take into account this complexity. In addition updated approaches on opioid switching have been discussed in several resources. Of particular note are substantial changes to calculations when converting to PO methadone, which is more potent than originally thought. Due to potential for serious adverse patient outcomes equianalgesic dose calculations are now adjusted based on the total daily dose of morphine equivalents with higher daily doses requiring increasingly less methadone.

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