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 I think if we are seeing a lot of idiopathic breakthrough pain, it's not incident pain, it's not end of dose deterioration, much of that is neuropathic.

So if you're seeing that a lot, maybe that's the time also to add one of those adjuvant drugs.

No.

Oh my gosh, that's looking for trouble there.

I mean, I have a whole presentation on how to adjust drips.

So if you think about it, you know, the three of us

It's an important point and people mess this up a lot is, you know, hopefully the three of us have a normal half life of morphine, which is about two to three hours.

So if one of us was on a morphine infusion, it's gonna take eight to twelve hours to get eighty seven to ninety percent of the way to steady state.

So you never wanna write an order, nurse to titrate to comfort, because if you keep increasing and increasing it, you're doing some serious dose stacking and it's all gonna hit steady state.

at three in the morning when the patient is asleep and nobody's really got eyes on the patient.

You can give the nurse the latitude to increase the bolus dose, the clinician dose that the nurse is in charge of because the nurse has to do a clinical assessment prior to giving that.

But if you do have someone with advanced illness and they're on a continuous infusion of an opioid, the bolus dose that is the PCA that the patient can give

there is a pretty wide range there, anywhere from fifty to even a hundred and fifty percent of the hourly infusion.

So if somebody's on

five milligrams an hour of Iv morphine, let's just say, the bulls could be anywhere from two and a half to seven and a half milligrams.

Now I know that sounds a little crazy, but you would only use that crazy dose if you had cut way, way, way back on the continuous infusion because you really felt you're like you were kind of shooting in the dark.

We often have that in a hospice patient.

They're admitted to us, they're on some crazy regimen of maybe transvermophentanyl and they're cacectic and they're on MS continent and they're using Vicodin out the kazoo.

We'll put 'em in patient.

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