Opioids - Introduction to Opioids Codeine - - Typically...

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Introduction to Opioids Codeine - Typically combined with acetaminophen or aspirin - Analgesia dependent on metabolism to morphine CYP2D6 - Doses exceeding 60 mg not recommended o risk of severe hypotension o significant GI side effects (nausea and vomiting) - Treatment of mild to moderate pain - Duration of action 2-4 hr Morphine - MS Contin®; generic ER, CR, SR o Dosed every 12 h, some patients require every 8 h - Kadian® , Avinza® dosed q 24h - MSIR® immediate release - Metabolism not significantly affected by cirrhosis - Active metabolite accumulates if CrCl < 30 ml/min o morphine 6 glucuronide and morphine 3 glucuronide accumulates - True morphine allergy reactions rare o Alternatives : methadone, fentanyl, meperidine Oxycodone - Single or combination product with APAP or ASA - Analgesic potency 25-50% greater than morphine - OxyContin® (sustained release) o Dosed every 12h, may dose every 8 hours - OxyIR ® (immediate release) o Duration of effect is 4 hours - Safe in renal insufficiency Hydromorphone - 5-10 x more potent than morphine - Dilaudid® (immediate release) o Dosed every 3- 4 hours - Considerations o Safe in renal insufficiency o Less histamine release than Morphine Hydrocodone - Combination agent with either APAP or ASA - Oral analgesic potency is half of oral morphine - Metabolized to morphine by cytochrome P-450
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Opioids - Introduction to Opioids Codeine - - Typically...

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