Thanks to our palliative care physicians, we had a great palliative care MR on pain control at the end of life:
1) Opioid Equivalence:

• Codeine: 100mg PO
• Morphine: 10mg PO (5mg IV/SC)
• Oxycodone: 5mg PO
• Hydromorphone: 2mg (1mg IV/SC)

2) Opioid Side Effects:

• N/V: may resolve after a period of time
• Constipation: does not resolve over time
• Somnolence/drowsiness
• pruritis
• urinary retention

3) Opioid Toxicity:

• Myoclonus is an early sign of toxicity
• Nausea/vomitting
• myosis
• Somnolence
• Respiratory depression

4) Treatment of opioid toxicity:

• Dose reduction 25-50%
• Change type of opioid

5) Incomplete Cross Tolerance:

• Results in increased response to an equivalent dose of a different type of opioid
• Therefore, when changing to a different opioid dose should be reduced by 25-50%