Opioid conversions on Naplex and in a real clinical setting

[asian pharm]

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For Equianalgesic conversions on the naplex exam, is the chart provided? I found the chart in rxprpep (pg 199). If not should we memorize those numbers in the chart?

How is it in real life setting? Will every hospital/Physician have its own different chart, or is it a standard chart by DEA that everyone is suppose to follow for opioid dose conversions?

 

[WVUPharm2007]

On Naplex, I'd be shocked if something that hard is on there. Its P-2 level stuff.

In reality, you should use a chart, naturally. Some P&T committees have them already made up for hospital use, some don't. Sometimes physicians just seem to do whatever the hell they want. Your job is to make sure what is given is reasonable. If they are on a respirator, I'd barely even care what the dose is as long as it isn't ridiculous. If they are more opioid naive, you have to be more judicious.

The DEA doesn't meddle in therapeutics. "Patients in critical care need analgesia and that's okay" is about as into it as they get.

 

[KidPharmD]

The conversion chart is pretty standard, but is the result of clinical evidence - not the DEA.

I know most of the conversions I use on a regular basis, but just pull the chart up in lexi-comp for anytime I am unsure.

I do remember having a conversion on my naplex, but don't remember being provided the Chart.

 

[PharmD_Rx2014]

I took the NAPLEX today and the conversion chart was given for both of my questions

 

[sakigt]

IRL they ballpark these things, rarely we'll get an official consult, sometimes they will call and ask. I use the chart and account for decreased cross reactivity and give my suggestion.

I got a new order for a fentanyl patch inpatient, I did the math quickly and suggested to go lower. Even the lower dose knocked the patient out, per RN report. I highly suggest doing the math quickly, or even just checking the package insert when verifying new fentanyl starts. With long acting stuff start low and keep the short acting stuff on board then titrate with that data.