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

So you you're right.

My new chart I think is gonna cause quite a stir because I have that for hydromorphone, two milligrams IV is five milligrams oral, which is much closer to the numerous studies we have showing the bioavailability.

Really is about fifty percent, although there is quite a wide range.

Also, I lowered the equivalent to oral morphine from thirty to twenty five.

Because Dr.

Reddy's data showed that it's b about ten or eleven, twelve times the potency of IV diluted when you're switching to oral morphine.

So the chart still works.

Everybody's got their own chart.

But frankly, my chart is based on the very, very latest best evidence available.

So you're questioning bidirectionality.

Yes.

And in fact with the IV hydromorphone to oromorphine, doctor Reddy did look at that and she did show bidirectionality.

But when you look at data looking at

IV or sub Q morphine to IV or sub Q hydromorphone or oral morphine or hydromorphone, those old studies show that it's not quite as bio bi-directional as you would think.

So in in the charts, what people have done is kind of split the difference.

So, you know, I know my pharmacy students, when they see a chart like this and we talk about drug math, they get very excited because they think there's one right answer.

But that's the whole point.

I actually flirted with doing away with a chart, as you just suggested, or instead of putting a number in there, putting in a range like, well, one two milligrams of IV diluted is somewhere between twenty and thirty milligrams of oromorphine.

But I think that would confuse people even more.

So I chose to stick with the very best number from the data that I could find and come up with a five step process that I strongly advocate.

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