Event 2: Second Pain Consult

Meeting with Anesthesia Attending

Equianalgesic Chart

The equianalgesic chart gives an estimate of how one opioid compares to another. When converting from one formulation to another, or from one opioid to another, each dose on the chart is roughly equivalent to the others.

Therefore, you can see that morphine, 10mg IV is equal to morhpine 30mg oral, which is equal to hydrocodone 30mg oral, or oxycodone 20mg, oral, or hydromorphone 8mg, oral, or hydromorophone 2mg, IV.

Equianalgesic Opioid Dosing
Drug Equianalgesic Dose (mg): Parenteral/IV Equianalgesic Dose (mg): Oral
Morphine 10 30
Hydrocodone N/A 30
Hydromorphone 2 8
Oxycodone N/A 20

Test Your Knowledge

Question 1

If Mrs. Wright is taking Oxycontin (long-acting oxycodone) 20mg twice a day, and hydrocodone (Norco) 10mg every four hours, how many total oral morphine equivalents (OME) is she taking?

Incorrect
Incorrect
Correct
Incorrect

Mrs. Wright's OME 

Practice Conversion

First Calculation

Please calculate the OME for Mrs. Wright's Norco (hydrocodone) 10mg every 4 hours.

Incorrect
Correct
Incorrect
Incorrect

Second Calculation

What is the calculated IV morphine dose for 60 OME, which was the calculated Norco (hydrocodone) daily dose?

Incorrect
Correct
Incorrect
Incorrect

Suggested PCA Dose for Mrs. Wright 

Kidney failure, whether acute or chronic, adds to the complexity of Mrs. Wright's care. Morphine is not metabolized well in patients with kidney failure; Dilaudid (hydromorphone) is better metabolized and is a better option for Mrs. Wright.

Practice Conversion

Calculation 1

What is the calculated IV Dilaudid (hydromorphone) dose for 20 mg IV morphine?

Incorrect
Incorrect
Correct
Incorrect

IV PCA Dose of Dilaudid for Mrs. Wright

What is the IV PCA dose of Dilaudid for Mrs. Wright?

According to the medical student, Andrew, Mrs. Wright should be started on a dilaudid IV PCA where she receives around 4mg daily to get what she is used to and a little more for her acute pain.

We may need to use a further reduced dose to account for incomplete cross-tolerance at the receptor level, since we are switching her from one opioid medication to another. Andrew thinks if a 0.2mg IV every 20 mins with a lockout of 0.6mg every hour is ordered, Mrs. Wright should be able to receive up to 14.4mg IV dilaudid every 24 hours. That should be more than enough to control her pain.

Test Your Knowledge

Practice these conversions. No need to decrease for cross tolerance for these examples.

Question 1

Which medication would you most want to avoid in a patient with chronic kidney disease?

Incorrect
Correct
Incorrect
Incorrect

Question 2

Please convert IV hydromorphone 4mg to oral morphine (OME).

Incorrect
Incorrect
Correct
Incorrect

Question 3

Please convert morphine 30mg oral to IV morphine.

Incorrect
Incorrect
Correct
Incorrect

Question 4

Please convert Oral OxyContin 80mg BID to IV Dilaudid.

Incorrect
Incorrect
Correct
Incorrect
SUPPORTING ORGANIZATIONS
University of Alabama at Birmingham logo
University of Alabama at Birmingham