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End of Life Online Curriculum - Modules

Overview of Palliative Care

Dyspnea

Home Hospice

Opioid Conversion

Prognostication

Transition to Death

Palliative Sedation

Communication

Bereavement

 

Pain Control: Opioid Conversion

Introduction & Learning Objectives
Pre-Test
General Guidelines
Opioids
Equivalency Table
Equianalgesic Doses
Land Mines

Teaching Exercise 1:

Converting from oral to parenteral morphine
The case continues

Teaching Exercise 2:

Converting from oral morphine to fentanyl transdermal patch
Opioid Conversion Tutorial
Levy's Rule
Example 1
Example 2
Pearls
Resources
Post Test

Appendices
How to institute opioid therapy
Communication with patients & family on pain treatment
Parenteral to oral conversion ratios of common opioids
Facts about the fentanyl transdermal patch
Using opioid infusions to palliate pain

Author

Levy's Rule

Levy's Rule to convert from oral morphine to transdermal fentanyl
The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours.
Source: Levy M. Pharmacologic treatment of cancer pain. N Engl J Med 1996;335:1124-32.
  1. Levy's Rule: Example 1 - Mr. John Smith, a terminally ill, lung cancer patient.
  2. Levy's Rule: Example 2 - Mr. Tom Hack, a terminally ill, colon cancer patient.

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©End of Life Curriculum Project, a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School.
Funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine. VJ Periyakoil, MD, Director.