Effective Management of Acute and Chronic Pain with Opioid Analgesics, 2nd Edition _ ________________
‒ Definition of ADF based on the FDA guidance for industry, Abuse-Deterrent Opioids – Evaluation and Labeling [15]. ‒ Recognition that all ADFs have the same potential for addiction and overdose death as non-abuse-deterrent opioids ‒ How to understand FDA-approved ADF product labeling 6. Initial dosing, dose titration, dose tapering (when appropriate) for analgesia a. Concepts and limitations of the conversion charts in labeling and the limitations of relative potency or equianalgesic dosing tables in literature b. Interindividual variability of response c. Special populations ‒ Pregnant, postpartum, breastfeeding, and neonatal opioid withdrawal syndrome ‒ Renal and hepatic impairment ‒ Children and adolescents ‒ Genetic and phenotypic variations ‒ Older adults ‒ Sleep disorders ‒ Common and uncommon psychiatric disorders 7. Contraindications 8. Adverse Events a. Medication errors b. Periods of greater risk for significant respiratory depression, including at treatment initiation and with dose increases c. Serious adverse drug reactions (including overdose and death) d. Labeled warnings e. Common adverse drug reactions 9. Drug interactions a. Pharmacokinetic interactions based on metabolic pathway b. Pharmacokinetic and pharmacodynamic interactions with alcohol c. Concerns with particular drug–drug interactions, including, but not limited to: ‒ Benzodiazepines and other central nervous system depressants, including alcohol
10. Key safety strategies for use with opioid medications a. Dosing instructions including daily maximum b. Safe storage to reduce risk of accidental
exposure/ingestion by household contacts, especially children/teens and to reduce risk of theft
c. Naloxone products for use in the home to reduce risk of overdose deaths in patients and household contacts d. Proper disposal of used (e.g., transdermal systems) and unused opioids e. Pain management after an opioid overdose f. Driving and work safety IV. MANAGING PATIENTS ON OPIOID ANALGESICS HCPs should be knowledgeable about the appropriate use of opioids in patients with acute and chronic pain, including the importance of balancing potential benefits with the risks of serious adverse outcomes such as overdose and death. A. Initiating treatment with opioids — acute pain 1. Patient selection ― consider when an opioid is an appropriate option and consult the PDMP 2. Dosing — as needed vs. around-the-clock dosing, prescribing an appropriate quantity based on the expected duration of pain, i.e., the least amount of medication necessary to treat pain and for the shortest amount of time 3. Naloxone for home use ― prescribe and discuss the use of naloxone products and the various means of administration 4. Screening tools for risk of abuse B. Initiating treatment with opioids — chronic pain 1. Patient selection a. Differences in benefit and risk and expected outcomes for patients with chronic pain, palliative care, or end-of-life care b. Differences in initiating treatment in opioid nontolerant vs. opioid-tolerant patients 2. Dosing a. As needed vs. around-the-clock
b. How to determine a safe initial dose c. Safe conversion from other opioids
3. Considerations in opioid selection a. IR or ER/LA
‒ Monoamine oxidase inhibitors ‒ Antidiuretic hormone drugs
b. Special precautions with methadone c. Products restricted to opioid-tolerant patients 4. When and how to use an opioid or non-opioid analgesic to supplement pain management
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MDUT1125
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