OPIOID AGENTS Opioid analgesics are the cornerstone of pharmacologic management of moderate to severe acute pain (standard doses are shown in Tâble.,.3.2-4). Proper use of opioids involves selecting a particular drug, and considering (1) route of administration, (2) suitable initial dose, (3) frequency of administration titrated against analgesic response, (4) optimal use of nonopioid analgesics and adjunct agents, (5) incidence and severity of side effects, and (6) whether the analgesic will be continued in an inpatient or ambulatory setting. Patients vary greatly in their responses to opioid analgesics; these variations are related to age, body mass, and previous or chronic exposure to opioids. Relative potency estimates provide a rational basis for selecting the appropriate starting dose to initiate analgesic therapy, changing the route of administration (e.g., from parenteral to oral), or switching to another opioid ( T.ib.!§,,3.2.-5.). An oral opioid such as a codeine-acetaminophen combination, or a stronger compound such as oxycodone with acetaminophen is useful for ED pain patients able to take oral medications.
TABLE 32-4 Opioid Analgesics
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