Follow these guidelines when completing each component of the Collaboration Café. Contact your course faculty if you have questions.
General Instructions
Step 1: Review your assigned client scenario below. Your assigned client is based on the first letter of your last name in the chart below. The scenarios below depict inappropriate or excessive opioid use.
Geraldine Marzec, a 60-year-old female, is currently taking oxycodone ER (OxyContin) 20mg PO BID for chronic low back pain from an old injury.
Step 2: Review the client's case and CDC's (2022) CPG related to opioid prescribing. You can use the Ctrl F function on your keyboard to assist in your review of the CPG to help find keywords. For the purpose of this assignment, all students will be using this CPG, and there is no need to provide a citation or reference.
Step 3: Analyze and critique your assigned case and answer the prompts below with explanation and detail, providing complete references for all citations.
Step 4: Reply to peers with different assigned clients.
Step 5: Look back at your initial post and respond to peers and faculty that have commented.
Include the following sections:
- Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
- Introduce your client, their situation, and their medication regimen. Calculate and describe your client’s daily morphine milligram equivalents (MME). Provide your calculations and a rationale for your answer. Refer to this "CDC MME Calculation Table" Download "CDC MME Calculation Table"Open this document with ReadSpeaker docReaderfor reference.
- Discuss how your client’s daily MME falls above or below the threshold for additional consideration. How do you know?
- Consider the need for additional considerations given the total MME, the limited information available in the case, and the risks for overdose. What other consultations, prescriptions, and education may be required given their current individual circumstances and medications?
- Consider the appropriateness of your client’s medication regimen. According to the CPG, what other prescriptions may be more appropriate for their individual circumstances? If no change is needed or warranted according to the CPG, state that with support from the CPG.
please provide AI and similarity report.
CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022: Recommendation 4
©2021 Chamberlain University LLC. All rights reserved.
Chamberlain University | National Management Offices | 500 W. Monroe St., Suite 28 | Chicago, IL 60661
RECOMMENDATION 4
When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the
lowest effective dosage. If opioids are continued for subacute or chronic pain, clinicians should use caution when
prescribing opioids at any dosage, should carefully evaluate individual benefits and risks when considering increasing
dosage, and should avoid increasing dosage above levels likely to yield diminishing returns in benefits relative to risks to
patients (recommendation category: a; evidence type: 3).
SUPPORTING RATIONALE
“When opioids are used for acute, subacute, or chronic pain, clinicians should start opioids at the lowest possible
effective dosage. For patients not already taking opioids, the lowest effective dose can be determined using product
labeling as a starting point with calibration as needed on the basis of the severity of pain and other clinical factors, such
as renal or hepatic insufficiency (see Recommendation 8). The lowest starting dose for opioid-naïve patients is often
equivalent to a single dose of approximately 5–10 MME or a daily dosage of 20–30 MME/day. A listing of common opioid
medications and their doses in MME equivalents is provided (Table). For example, a label for hydrocodone bitartrate (5
mg) and acetaminophen (300 mg) (207) states that the usual adult dosage is one or two tablets every 4–6 hours as
needed for pain, and the total daily dosage should not exceed eight tablets. Clinicians should use additional caution
when initiating opioids for patients aged ≥65 years and patients with renal or hepatic insufficiency because of a
potentially smaller therapeutic window between safe dosages and dosages associated with respiratory depression and
overdose (see Recommendation 8). Formulations with lower opioid doses (e.g., hydrocodone bitartrate 2.5
mg/acetaminophen 325 mg) are available and can facilitate dosing when additional caution is needed. Product labeling
regarding tolerance includes guidance for patients already taking opioids. In addition to opioids, clinicians should
consider cumulative dosages of other medications, such as acetaminophen, that are combined with opioids in many
formulations and for which decreased clearance of medications might result in accumulation of medications to toxic
levels.”
TABLE. Morphine milligram equivalent doses for commonly prescribed opioids for pain management
Opioid Conversion factor*
Codeine 0.15
Fentanyl transdermal (in mcg/hr) 2.4
Hydrocodone 1.0
Hydromorphone 5.0
Methadone 4.7
Morphine 1.0
Oxycodone 1.5
Oxymorphone 3.0
Tapentadol† 0.4
Tramadol§ 0.2
CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022: Recommendation 4
©2021 Chamberlain University LLC. All rights reserved.
Chamberlain University | National Management Offices | 500 W. Monroe St., Suite 28 | Chicago, IL 60661
Reference
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1
