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54 Cards in this Set
- Front
- Back
Levodopa (Dopar) - Indication
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Used for treatment in PD (Parkinson’s disease)
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Levodopa (Dopar) - Action
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is converted to dopamine in the CNS, where it serves as a neurotransmitter. Carbidopa, a decarboxylase inhibitor, prevents peripheral destruction of levodopa.
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Levodopa (Dopar)- Pharmacokinetics
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administered orally and undergoes rapid absorption from the small intestine.
Widely distributed. Levodopa--enters the CNS in small concentrations. Carbidopa--does not cross the blood-brain barrier Levodopa--mostly metabolized by the GI tract and liver. Carbidopa --30% excreted unchanged by the kidneys. Half-life: Levodopa--1 hr; carbidopa--1-2 hr. |
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Levodopa (Dopar)- Adverse effects
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e. CNS: involuntary movements, anxiety, dizziness, hallucinations, memory loss, psychiatric problems.
EENT: blurred vision, mydriasis. GI: nausea, vomiting, anorexia, dry mouth, hepatotoxicity. Derm: melanoma. Hemat: hemolytic anemia, leukopenia. Misc: darkening of urine or sweat. |
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Levodopa (Dopar)- onset, peak, duration
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Levodopa 10-15 min unknown 5-24 hr or more
Carbidopa/levodopa sustained release unknown 2 hr 12 hr |
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Levodopa (Dopar)- route/dosage
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PO (Adults): 250 mg 2-4 times daily; may increase by 100-750 mg q 3-7 days until desired effect is achieved (not to exceed 8 g/day).
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Zolpidem (Ambien) - Indications
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Insomnia
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Zolpidem (Ambien) - Action
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Produces CNS depression by binding to GABA receptors. Has no analgesic properties.
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Zolpidem (Ambien) - Pharmacokinetics
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Rapidly absorbed following oral administration
distribution not known Converted to inactive metabolites, which are excreted by the kidneys. Half-life: 2.5-2.6 hr (increased in geriatric patients and patients with hepatic impairment) |
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Zolpidem (Ambien) - onset, peak, duration
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PO rapid 30 min-2 hr 6-8 hr
PO-ER rapid 2-4 hr 6-8 hr |
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Zolpidem (Ambien) - Adverse effects
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b. CNS: abnormal thinking, amnesia, behavior changes, daytime drowsiness, dizziness, "drugged" feeling, hallucinations, sleep-driving.
GI: diarrhea, nausea, vomiting. Misc: ANAPHYLACTIC REACTIONS, hypersensitivity reactions, physical dependence, psychological dependence, tolerance. |
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Zolpidem (Ambien) - Route/dosage
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PO (Adults): Tablets-10 mg at bedtime; extended-release tablets -- 12.5 mg at bedtime.
Geri - cut in half |
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Morphine Sulfate - Indication
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Severe pain.
Pulmonary edema. Pain associated with MI. |
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Morphine Sulfate - Action
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Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.
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Morphine Sulfate - Pharmacokinetics
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Variably absorbed (about 30%) following oral administration. More reliably absorbed from rectal, subcut, and IM sites.
Widely distributed. Crosses the placenta Protein Binding Mostly metabolized by the liver. Active metabolites excreted renally. Half-life: Adults 2-4 hr |
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Morphine Sulfate - Adverse effects
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d. CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams.
EENT: blurred vision, diplopia, miosis. Resp: RESPIRATORY DEPRESSION. CV: hypotension, bradycardia. GI: constipation, nausea, vomiting. GU: urinary retention. Derm: flushing, itching, sweating. Misc: physical dependence, psychological dependence, tolerance. |
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Morphine Sulfate - peak, onset, duration
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PO unknown 60 min 4-5 hr
PO-ER, SR unknown 3-4 hr 8-24 hr IM 10-30 min 30-60 min 4-5 hr Subcut 20 min 50-90 min 4-5 hr Rect unknown 20-60 min 3-7 hr IV rapid 20 min 4-5 hr Epidural 6-30 min 1 hr up to 24 hr (48 hr for liposomal injection) IT rapid (min) unknown up to 24 hr |
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Morphine Sulfate - Route/dosage
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PO, Rect - 30 mg q 3-4 hr initially or once 24-hr opioid requirement is determined
IM IV, Subcut - for moderate to severe pain in opioid-naive patients--4-10 mg q 3-4 hr. MI--8-15 mg, for very severe pain additional smaller doses may be given every 3-4 hr. Continuous infusion--0.8-10 mg/hr; may be preceded by a bolus of 15 mg Epidural (Adults): Intermittent injection--5 mg/day (initially); if relief is not obtained at 60 min, 1-2 mg increments may be made; (total dose not to exceed 10 mg/day. Continuous infusion--2-4 mg/24 hr |
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Prozac (sarafem) - indication
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Various forms of depression.
OCD. Bulimia nervosa. Panic disorder. Sarafem: Management of premenstrual dysphoric disorder (PMDD). |
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Prozac (sarafem) - Action
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Selectively inhibits the reuptake of serotonin in the CNS.
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Prozac (sarafem) - Pharmacokinetics
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Well absorbed after oral administration
Crosses the blood-brain barrier. Protein Binding: 94.5%. converted by the liver to norfluoxetine, another antidepressant compound 12% excreted by kidneys as unchanged fluoxetine, 7% as unchanged norfluoxetine. Half-life: 1-3 days (norfluoxetine 5-7 days). |
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Prozac (sarafem) - onset, peak, duration
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PO 1-4 wk unknown 2 wk
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Prozac (sarafem) - adverse reactions
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d. CNS: SEIZURES, anxiety, drowsiness, headache, insomnia, nervousness, abnormal dreams, dizziness, fatigue, hypomania, mania, weakness.
EENT: stuffy nose, visual disturbances. Resp: cough. CV: chest pain, palpitations. GI: diarrhea, abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency. Derm: excessive sweating, pruritus, erythema nodusum, flushing, rashes. Endo: dysmenorrhea. MS: arthralgia, back pain, myalgia. Neuro: tremor. Misc: allergic reactions, fever, flu-like syndrome, hot flashes, sensitivity reaction. |
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Prozac (sarafem) - Route/dosage
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20 mg/day in the morning. After several weeks, may increase by 20 mg/day at weekly intervals. Doses greater than 20 mg/day should be given in 2 divided doses, in the morning and at noon (not to exceed 80 mg/day)
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Alprazolam (Xanax) - Indication
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Treatment of Generalized Anxiety Disorder (GAD).
Panic Disorder. Management of anxiety associated with depression. |
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Alprazolam (Xanax) - Action
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Acts at many levels in the CNS to produce anxiolytic effect.
May produce CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. (benzodiazepines) |
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Alprazolam (Xanax) - Pharmacokinetics
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Well absorbed (90%) from the GI tract;
Widely distributed, crosses blood-brain barrier. Metabolized by the liver (CYP3A4 enzyme system) Half-life: 12-15 hr. |
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Alprazolam (Xanax) - onset, peak, duration
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PO 1-2 hr 1-2 hr up to 24 hr
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Alprazolam (Xanax) - Adverse effects
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d. CNS: dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation.
EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting, weight gain. Derm: rashes. Misc: physical dependence, psychological dependence, tolerance. |
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Alprazolam (Xanax) - Route/dosage
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Anxiety
PO (Adults): 0.25-0.5 mg 2-3 times daily (not >4 mg/day Panic Attacks PO (Adults): 0.5 mg 3 times daily; may be increased by 1 mg or less every 3-4 days as needed (not >10 mg/day). |
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Triptan (Imetrex) - Indications
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Acute treatment of migraine attacks.
Subcut: Acute treatment of cluster headache episodes. |
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Triptan (Imetrex) - Action
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Acts as a selective agonist of 5-HT1 at specific vascular serotonin receptor sites, causing vasoconstriction in large intracranial arteries.
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Triptan (Imetrex) - Pharmacokinetics
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Well absorbed (97%) after subcut administration. Absorption after oral administration is incomplete and significant amounts undergo substantial hepatic metabolism, resulting in poor bioavailability (14%). Well absorbed after intranasal administration.
Does not cross the blood-brain barrier Mostly metabolized (80%) by the liver. Half-life: 2 hr. |
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Triptan (Imetrex) - onset, peak, duration
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PO within 30 min 2-4 hr up to 24 hr
Subcut 30 min up to 2 hr up to 24 hr Nasal within 60 min 2 hr unknown |
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Triptan (Imetrex) - adverese effects
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d. CNS: dizziness, vertigo, anxiety, drowsiness, fatigue, feeling of heaviness, feeling of tightness, headache, malaise, strange feeling, tight feeling in head, weakness.
EENT: alterations in vision, nasal sinus discomfort, throat discomfort. CV: MI, angina, chest pressure, chest tightness, coronary vasospasm, ECG changes, transient hypertension. GI: abdominal discomfort, dysphagia. Derm: tingling, warm sensation, burning sensation, cool sensation, flushing. Local: injection site reaction. MS: jaw discomfort, muscle cramps, myalgia, neck pain, neck stiffness. Neuro: numbness. |
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Triptan (Imetrex) - route/dosage
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PO (Adults): 25 mg initially; if response is inadequate at 2 hr, up to 100 mg may be given If headache recurs, doses may be repeated q 2 hr (not to exceed 300 mg/day).
Subcut (Adults): 6 mg; may repeat after 1 hr (not to exceed 12 mg in 24 hr). Intranasal (Adults): Single dose of 5, 10, or 20 mg in one nostril; may be repeated in 2 hr, not to exceed 40 mg/24 hr or treatment of >5 episodes/mo |
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Valproic Acid (Depakote) - Indication
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Monotherapy and adjunctive therapy for simple and complex absence seizures.
Monotherapy and adjunctive therapy for complex partial seizures. Adjunctive therapy for patients with multiple seizure types, including absence seizures. Divalproex sodium only: Manic episodes associated with bipolar disorder, Prevention of migraine headache . |
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Valproic Acid (Depakote) - Action
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Increase levels of GABA, an inhibitory neurotransmitter in the CNS.
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Valproic Acid (Depakote) - Pharmacokinetics
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Well absorbed following oral administration; . IV administration results in complete bioavailability.
Rapidly distributed into plasma and extracellular water. Cross blood-brain barrier Protein Binding: 80-90%, Mostly metabolized by the liver; minimal amounts excreted unchanged in urine. Half-life: Adults: 9-16 hr. |
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Valproic Acid (Depakote) - onset, peak, duration
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PO--liquid 2-4 days 15-120 min 6-24 hr
PO--capsules 2-4 days 1-4 hr 6-24 hr PO--delayed-release products 2-4 days 3-5 hr 12-24 hr PO--extended-release products 2-4 days 7-14 hr 24 hr IV 2-4 days end of infusion 6-24 hr |
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Valproic Acid (Depakote) - adverse effects
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d. CNS: agitation, dizziness, headache, insomnia, sedation, confusion, depression.
CV: peripheral edema. EENT: visual disturbances. GI: HEPATOTOXICITY, PANCREATITIS, abdominal pain, anorexia, anorexia, diarrhea, indigestion, nausea, vomiting, constipation, increased appetite. Derm: alopecia, rashes. Endo: weight gain. Hemat: leukopenia, thrombocytopenia. Metab: HYPERAMMONEMIA. Neuro: tremor, ataxia. |
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Valproic Acid (Depakote) - route/dosage
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po - Initial dose of 10-15 mg/kg/day in 1-4 divided doses; ↑ by 5-10 mg/kg/day weekly until therapeutic response achieved (not to exceed 60 mg/kg/day);
IV (Adults and Children): Give same daily dose and at same frequency as was given orally; switch to oral formulation as soon as possible. Rect (Adults and Children): Dilute syrup 1:1 with water for use as a retention enema. Give 17-20 mg/kg load, maintenance 10-15 mg/kg/dose q 8 hr. Mood Stabilizer Depakote--Initial dose of 750 mg/day in divided doses initially, titrated rapidly to desired clinical effect or trough plasma levels of 50-125 mcg/ml (not to exceed 60 mg/kg/day) |
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Naloxone (Narcan) - Indication
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Reversal of CNS depression and respiratory depression because of suspected opioid overdose
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Naloxone (Narcan) - Action
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Competitively blocks the effects of opioids, including CNS and respiratory depression, without producing any agonist (opioid-like) effects.
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Naloxone (Narcan) - Phramacokinetics
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Well absorbed after IM or subcut administration
Rapidly distributed to tissues. Metabolized by the liver. Half-life: 60-90 min |
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Naloxone (Narcan) - onset, peak, duration
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IV 1-2 min unknown 45 min
IM, Subcut 2-5 min unknown >45 min |
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Naloxone (Narcan) - adverse effects
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d. CV: hypertension, hypotension, ventricular fibrillation, ventricular tachycardia.
GI: nausea, vomiting. |
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Naloxone (Narcan) - route/dosage
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IV (Adults): 0.02-0.2 mg q 2-3 min until response obtained; repeat q 1-2 hr if needed.
IV, IM, Subcut (Adults): Patients not suspected of being opioid dependent--0.4 mg (10 mcg/kg); may repeat q 2-3 min (IV route is preferred). Some patients may require up to 2 mg. Patients suspected to be opioid dependent--Initial dose should be decreased to 0.1-0.2 mg q 2-3 min. |
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Fentanyl - Indication
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Management of breakthrough cancer pain in patients with malignancies who are already receiving and are tolerant to opioid therapy for their underlying cancer pain.
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Fentanyl - Action
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Binds to opiate receptors in the CNS, altering response to and perception of pain.
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Fentanyl - Pharmacokinetics
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Well absorbed (92% of dose) through skin surface under transdermal patch
Mostly metabolized by the liver 10-25% excreted unchanged by the kidneys. Half-life: 17 hr after removal of a single application patch, increases to 21 hr after removal of multiple patches |
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Fentanyl - onset, peak, duration
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Transdermal 6 hr† 12-24 hr 72 hr‡
Oral/transmucosal rapid 15-30 min several hrs |
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Fentanyl - adverse effects
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CNS: confusion, sedation, weakness, dizziness, restlessness.
Resp: APNEA, bronchoconstriction, laryngospasm, respiratory depression. CV: bradycardia. GI: anorexia, constipation, dry mouth, nausea, vomiting. Derm: sweating, erythema. Local: application site reactions. MS: skeletal and thoracic muscle rigidity. Misc: physical dependence, psychological dependence. |
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Fentanyl - route/dosage
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Transdermal (Adults): 25 mcg/hr is the initial dose; patients who have not been receiving opioids should receive not more that 25 mcg/hr.
Morphine 10 mg IM or 60 mg PO q 4 hr (60 mg/24 hr IM or 360 mg/24 hr PO) is considered to be approximately equivalent to transdermal fentanyl 100 mcg/hr. Transdermal patch lasts 72 hr in most patients. |