Mary Lynn McPherson

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498 appearances 2 recordings 1 series first heard Oct 2018 last heard Dec 2021

Mary Lynn McPherson’s voice in public audio — every appearance, attributed to the second.

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GeriPal - A Geriatrics and Palliative Medicine Podcast · All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson · 5 Oct 2018 podcast

And an oldie but a goody is nalbufene.

And we are seeing people use nalbufene now for acute pain in the face of the IV morphine, hydromorphine fentanyl shortage.

So something to learn.

I I think there's some hope for using it more routinely in clinical practice.

I'm disappointed that lavorphanol is so expensive because lavorphenol is very similar to methadone in terms of the properties that make methadone a favorable drug, NMD receptor antagonism, twice a day dosing.

Uh but it is a branded product right now and it's obscenely expensive.

It would be nice if we had a generic formulation of that.

Sure.

The the methods that I had in that table are evidence based methods, uh some better than others.

But uh I just worked with a group where we came up with a position paper looking at the American Pain Society guidelines for the safe and effective use of methadone and we applied that to hospice and palliative care.

And we came up with a very simple strategy that frankly was based more on safety than anything.

Anybody on up to sixty milligrams of oral morphine a day we consider along with opioid naive patients and we would start anywhere from two to five or maybe seven and a half milligrams a day if it's a pretty robust patient.

If they're on greater than 60 milligrams a day of oral morphine equivalent and they're under sixty-five years old, we do a ten to one conversion.

So every ten milligrams of oral morphine is one milligram of oral methadone.

If they're on greater than two hundred milligrams of oral morphine equivalent, or they're over sixty five years old, we do a twenty to one conversion.

But we do recognize the discontinuous nature of this approach.

If you go to bed sixty-four years old,

And you wake up sixty-five, I mean, y your organs didn't shut down automatically.

So I'm always asking nurses: is the patient a young or an old sixty-three, or a young or an old

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