[Verse 1] Patient tolerating poorly, adverse effects got 'em drowning Nausea, sedation, myoclonus — symptoms stacking, compounding Inadequate analgesia, route switch, kidney function slipping Cost and access blocking therapy — that's when rotation's fitting Five indications, memorize the grid: Intolerable side effects, poor control, renal skid Route change, formulary wall — when any one applies Pull out the conversion table, calculate with precise eyes [Chorus] Total daily dose — add every milligram up Convert with the table, then cut it — incomplete cross, so cut Thirty percent reduction minimum for tolerance gap Breakthrough dosing ten to fifteen percent back on the map Reassess in twenty-four, don't set it and forget T-D-C-R-B — five steps, no regrets [Verse 2] Oral morphine to IV, divide by three — that's the ratio Oral to transdermal fentanyl, every sixty morphine milligrams daily flow Converts to twenty-five micrograms per hour patch adhered IV to oral, flip the fraction — multiply, be clear Fentanyl patch takes twelve to eighteen hours to absorb and peak Overlap your coverage when transitioning, plug every leak Fever and heat increase the flux right through the dermis Don't let assumptions burn the patient — check the surface [Chorus] Total daily dose — add every milligram up Convert with the table, then cut it — incomplete cross, so cut Thirty percent reduction minimum for tolerance gap Breakthrough dosing ten to fifteen percent back on the map Reassess in twenty-four, don't set it and forget T-D-C-R-B — five steps, no regrets [Verse 3] Methadone — the outlier, non-linear conversion beast Low morphine equivalents, ratio three to one at least High-dose morphine, ratio climbs to twelve or even more Dose-dependent, unpredictable — don't walk through that door alone QT prolongation lurking, long half-life accumulates slow Call the specialist, involve pharmacy before you go Buprenorphine transitions need a micro-induction mind No full agonist ceiling clash — sequence matters every time [Bridge] Sources of error lurking in the decimal placement Wrong direction of conversion — oral read as IV patient Forgetting incomplete cross-tolerance, skipping the reduction Stacking breakthrough doses wrong, ignoring organ dysfunction Pediatric weight-based slip, elderly with slowed clearance Every error downstream means respiratory impairment Double-check your math, your route, your organ function score Consult when uncertain — that's not weakness, that's the floor [Chorus] Total daily dose — add every milligram up Convert with the table, then cut it — incomplete cross, so cut Thirty percent reduction minimum for tolerance gap Breakthrough dosing ten to fifteen percent back on the map Reassess in twenty-four, don't set it and forget T-D-C-R-B — five steps, no regrets
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