BASIC-06 · Pharmacology Cross-Cutting

Pharmacology Cross-Cutting. Topics: Opioid Equianalgesic Math, Neuropathic Pain Agents, and NSAIDs. Part of the Foundational Sciences series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: That 90 MME threshold mandates a formal pain plan reassessment, a naloxone co-prescription, and a specialist referral. — Correct: Offer naloxone based on overdose risk factors, including prior overdose, substance use disorder, sleep-disordered breathing, concurrent benzodiazepines, lost tolerance or ≥50 MME/day. Dosage guideposts are not rigid limits or a mandatory 90-MME naloxone/referral trigger. (2) In the audio: But because the drug takes 15 to 60 hours to clear — Correct: The US methadone label gives a plasma elimination half-life of 8 to 59 hours, not 15 to 60. (3) In the audio: The pain relief from a dose of methadone lasts only six to eight hours — Correct: The methadone label gives 4–8 hours of analgesia after a single dose and an 8–59-hour elimination half-life. Steady state/full effect takes at least 3–5 days on a dose and sometimes longer; respiratory depression can be delayed. (4) In the audio: Which is precisely why surgical protocols dictate that you hold aspirin for 7 to 10 days prior to elective surgery. — Correct: Seven to ten days is a conventional platelet-lifespan/full-turnover interval, not a universal surgical hold. Continue low-dose aspirin after prior PCI if possible; otherwise individualize by indication and bleeding/thrombotic risk. If interruption is necessary, AHA/ACC lists about four days for platelet-function recovery. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/BASIC-06-a.