What is the difference between ms contin and hydrocodone

Seminars in Anesthesia, Perioperative Medicine and Pain. Development of the Leapfrog methodology for evaluating hospital implemented inpatient computerized physician order entry systems. Qual Saf Health Care. To sign up for updates or to access your subscriber preferences, please enter your email address below.

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Improvement Resources. About PSNet. All Content. Current Weekly Issue. Past Weekly Issues. Curated Libraries. The Fundamentals. Continuing Education. Training Catalog. Editorial Team. Technical Expert Panel. Miscalculated Risk Save. Copy URL. The Case A healthy year-old man was admitted to a teaching hospital for acute low back strain after lifting his 2-week-old infant.

The Commentary High alert medications, opioids, and respiratory depression. To calculate an equianalgesic dose, the following steps should be followed: First, add up the patient's total hour analgesic requirement, including all doses for breakthrough pain. Third, divide the total hour dose of the new drug by the number of daily doses to be administered. The duration of action values in the Table are helpful in this regard.

The specific reduction often depends on how well the patient's pain is controlled. Finally, calculate a rescue dose for breakthrough pain. Take-Home Points Respiratory depression is a potentially serious, but uncommon, adverse effect of opioid analgesics. Fear of respiratory depression should not interfere with provision of appropriate analgesia. Sedation typically precedes respiratory depression; thus, monitoring for sedation should be a routine part of caring for persons who receive opioid analgesics, particularly when starting treatment or changing doses.

In general, use of long-acting opioid analgesics should be reserved for persons who are opioid-tolerant, who are expected to require opioid-level analgesia for an extended period, and whose analgesic requirements are relatively stable. Equianalgesic conversion methods are easily used, but the results are estimates. Importantly, patients whose pain is not well-controlled at the time of drug conversion may not need to have their dose decreased, or may even require an increased dose.

Nurses and pharmacists should actively evaluate changes in prescribed opioid regimens and question orders that appear to represent a significant increase or decrease in dosage compared with a patient's prior stable analgesic requirement. Department of Health and Human Services. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.

None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. The Case. ISMP medication error report analysis.

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Connect With Us. Sign up for Email Updates To sign up for updates or to access your subscriber preferences, please enter your email address below. PSNet Log in. Username or e-mail address. Remember me. It is puzzling that the authors put hydrocodone, morphine, and tapentadol in the "morphine-equivalent" category. Hydrocodone may indeed be a "morphine equivalent" analgesic, but only in the last year has it been marketed without a non-opioid such as acetaminophen. Such a non-opioid limits the dose that can be administered.

Furthermore, hydrocodone is not available for intravenous administration. Tapentadol does not have the same mechanism of action as morphine; it has a dose ceiling whereas morphine does not. Therefore, it does not make sense to classify it as a morphine-equivalent analgesic. The authors assert that fentanyl, hydromorphone, methadone, oxycodone, and oxymorphone are "stronger" than morphine.

While it is true that a smaller dose of these drugs may be required to obtain the same analgesic response as can be obtained with morphine, that fact does not mean that they have greater effectiveness. Morphine is a very effective analgesic and can be given in very large doses to control very severe pain in persons at the end of life.

About 20 mg of oral oxycodone and 7. Are those the data the authors used to classify these drugs as stronger than morphine? There is a great deal of controversy and confusion about opioid analgesics and the role they should play in the control of persistent pain.

Clarity about the meaning of terms and about opioid pharmacology is essential if there is to be a constructive dialog about the role of these drugs in pain control. It is unfortunate that this report adds to the confusion by providing inappropriate classifications of analgesics. One might conclude from the data that there has been an increase in the use of appropriate analgesics the pure opioid agonists and a decrease in the use of inappropriate analgesics drugs with limited efficacy and limiting side effects , but is that the message the authors meant to convey?