How To Install Replace Distributor Cap and Rotor Ford F1. F2. 50 F3. 50 9. 2- 9. AAuto. com. Removing the Air Intake Hose (0: 3. Loosen the three air intake hose clamps with a flat blade screwdriver. Unclip the intake hose from the throttle body, oil breather, and max air flow sensor. Pull the intake hose up and out. Removing the Distributor Cap (1: 5. Flip the two clasps off the distributor cap. Pull the cap up. Remove the wires and align them correctly onto the new posts on the cap. Removing and Installing the New Rotor (5: 3. Remember the rotor's position. High performance auto parts and accessories for Ford Thunderbirds, Mustangs, Cougars and many other vehicles, makes and models. Actual Auto Parts is a Major Supply Catalog of Automotive Modules and Sensors. Ensure oil in crankcase is of the correct viscosity and at proper level and battery is properly charged. Operate vehicle until engine is at normal operating temperature. Turn ignition switch to the OFF. Pull it up and off. Insert the new rotor. Installing the New Distributor Cap (6: 1. Insert the distributor cap onto the distributor. Clip the two clasps on the distributor cap. Connect the coil wire. Start the vehicle to test the distributor. Ford Fuel Pumps from JC Whitney. We offer a wide variety of Ford Fuel Pumps to choose from and only include the best brands in the business. Buy Auto Parts including AC Compressor, Evaporator Core, Fuel Pump, Wheel Hub Bearing Assembly, Condenser, Water Pump, Clutch for affordable prices. Take care of your 1966 Ford Thunderbird and you’ll be rewarded with years of great looks and performance. Our accessories and parts are all you need to make it happen. PiMP/PiMPxs V8 Wiring Harness Designed exclusively for our PiMP & PiMPxs ECU when running a small block Ford based engine. Engine harness is complete with circuits for electric fan, fuel pump, water temp, oil pressure, and. On light trucks and compact trucks with a fuel delivery module, cut the fuel pump wires to the fuel delivery module 50mm (2. 1995 camry fuel tank filler neck by 2000 buick lesabre canister. 1992 ford ranger wiper motor fuse location the 1996 bonneville brake line. From luxury accessories to driving necessities, if it’s powered by electricity we have it in the replacement electrical parts for your 1990 Ford Thunderbird. Reinstalling the Air Intake Hose (6: 4. Push the intake hose into place. Insert the hose into the throttle body, oil breather, and max air flow sensor. Tighten the intake hose clamps with a flat blade screwdriver. Double check all the harnesses and hoses. Brought to you by 1. AAuto. com, your source for quality replacement parts and the best service on the Internet. I hope this how- to video helps you out, and next time you need parts for your vehicle, think of 1. AAuto. com. This truck has the 5. V8. This process is the same for both the 5. V8 and the 5. 8 liter V8. The only tool you'll need is a flat blade screwdriver. You can see the distributor cap right here. It's the blue plastic. You'll first want to remove this intake tube. It makes it easier if you get it out of the way. Start by loosening a hose clamp right down here. Loosen two more hose clamps here, one down here, then one up under here, then this clamp here. Pull that off and pull this up and off. Now you can see the cap right here. It just has a couple little clasps. Just take your finger and flip them off. One's in the backside, and you can't really see it. Then you can pull your cap up. Those contacts are blackened, pretty ugly. The rotor should be replaced as well. What I like to do is, there's a little vent right here. Here's my vent on my new cap. I just pull this wire off here, and then I make sure that wire should go on to this post right here. I just pull it right over. Put that wire on that post. Then I just go right in order. Take the wires off, and put them on the new cap. I'm going to do all the ones that come from this side first. I'm going to skip one. I'm skipping taking this one off. Take that one off and put it on there. This one's all the way over here. I'm actually going to take the coil wire off as well. We know that one goes right in the middle, so I'll just take that off, and put it back here. Then I'll take this one off. I know it goes through right to here. Really, all I'm doing is I'm just carefully replacing the wires. Now, once you take these next four off, you're going to have to put the new cap in place. What I'll do is just take this one off first, keep it right there. This one off next, keep it right there. Then pull these two off right where they are. Put these two kind of on, in place, there. I know that this one goes here and this one here. All the wires are on in the same place. I end up back together. Now, I'm actually going to replace the rotor. The rotor, just kind of note its position. It's pointing basically at the engine oil filler. Just pull the rotor right up and off. Okay, here's our old rotor; here. The old one's all burnt and scored there, never a good thing for getting the charge through. You can see our old cap; all these contacts have significant scoring on them which makes it more difficult to get spark through there. Put the new cap in place. Then just pull the clip right up. You may have to reach around the back here a little bit. Bring our coil wire right down and on. Okay, we just did a quick startup there to make sure everything was working right. As long as you plug the wires into the same location on the new cap as they were on the old cap, you will be fine. I'm just kind of fast- forwarding through as we put that intake tube back on. Putting the two tubes to the throttle body in correctly, the one tube that goes down to the oil breather, and then the two max airflow sensors. Make sure they're all on there well. Tighten up the clamps and we should be all set. Tighten up this clamp over here. Reach right over I know you can't see it, but tighten up the one that goes to the oil breather here. Brought to you by www. AAuto. com, your source for quality replacement parts and the best service on the Internet. Please feel free to call us toll- free, 8. We're the company that's here for you on the Internet and in person.
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Overview, Specific Ig. E Testing, Patch Testing. Specific Ig. E testing can be done through skin testing or blood testing. Testing should be based on the clinical scenario. If aeroallergen sensitivity is suspected, a panel of indoor and outdoor allergens is indicated. Trees, grass, and weed pollen should reflect the local botanical flora. Indoors allergens should include dust mite species (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cockroach, select molds, and animal dander (typically cat pelt and dog epithelium). Reactivity persists throughout the year, even if the patient is not in his or her allergy season. Food, venom, and medication allergy evaluations should be based on a history suggestive of an Ig. E- mediated reaction. An example of a supportive history would be symptoms of rhinitis, conjunctivitis, urticaria, wheezing, or anaphylaxis within minutes to hours after exposure. In Vivo (Skin) Testing. Skin testing is generally performed by allergy specialists. Prick/puncture testing remains one of the most common and popular methods for allergy testing. It is relatively easy to perform, is more sensitive than in vitro tests, and is cost effective in the clinical setting. It is an indirect measure of cutaneous mast cell reactivity due to the presence of specific Ig. E. Mast cells reside in the subepithelial layer of the skin and the respiratory, nasolacrimal, and gastrointestinal tracts. Of all these areas, the skin is the most accessible organ to test. Skin testing detects allergen- specific Ig. E bound to mast cells. The allergen cross- links specific Ig. E bound on the mast cell. This causes degranulation of preformed mediators, including histamine and tryptase. Histamine release is the major mediator that results in a hive at the prick site and surrounding erythema, called a wheal and flare. Skin testing is usually done on the forearm or back (see the image below). The prick/puncture method involves a skin testing device pricked through a droplet of allergenic extract. Various skin test devices and extracts are commercially available. The wheal and flare is read in 1. It is measured in millimeters and compared with a positive control (histamine) wheal and flare and a negative control (usually glycerinated saline). A positive test is considered as a wheal equal to or larger to the histamine control (or greater than 3 mm). Infants may have smaller positive tests, but the histamine is correlatively smaller. The sensitivity and specificity of skin testing is dependent on the allergens used. The accuracy of skin testing with commercial, standardized aeroallergen extracts exceeds 8. Food allergy testing has a very high false- positive rate of 5. This includes pregnancy and unstable medical conditions, such as unstable asthma or reduced lung function, recent stroke, or recent cardiac event. Oral and nasal antihistamines should be stopped 3- 7 days before skin testing. Other medications with an antihistaminic effect may alter skin tests as well, including H2 receptor antagonists (cimetidine, ranitidine), tricyclic antidepressants, and antiemetics. Hives, also known as urticaria, are red and sometimes itchy bumps on your skin. Learn about the hives symptoms, diagnosis and treatment here. Some medications may make the treatment of anaphylaxis less effective, such as angiotensin- converting enzyme inhibitors and beta- blockers. These medications should be discontinued prior to skin testing. False- positive results can occur with dermatographism or chronic urticaria. Patients with atopic dermatitis should be tested on unaffected skin. Intradermal testing is useful for Hymenoptera (yellow jacket, wasp, and honey bee) venom anaphylaxis and penicillin allergy. For some aeroallergens, intradermals add little to diagnostic information. Note that there is a higher risk of anaphylaxis. Intradermal testing is more sensitive than prick skin testing, but false- positive results are common due to irritant reactions or intracutaneous bleeding. Intradermal testing typically involves injecting 0. L of antigen into the dermis via a 2. The extracts are diluted to 1. The wheal is measured after 1. A response is considered positive if the wheal is 7 mm or greater (see the image below).
In Vitro Testing. In vitro tests assess antigen- specific Ig. E by testing the patient. Advantages to this method include the use of a single venupuncture that is not affected by medications. In vitro testing can be performed on patients with affected skin, such as dermatographism or atopic dermatitis. It is also a safer option if the patient is at risk for anaphylaxis. However, these tests are expensive compared with skin testing. In this method, immunoassays measure interactions between antigens and antigen- specific antibodies. Immunoassays are often referred to as radioallergosorbent (RAST) testing, but that term is outdated because radiation is rarely used today. Current methods include enzyme- linked immunosorbent assay (ELISA), which uses antibodies linked to enzymes, as well as fluorescent enzyme immunoassays (FEIA) and chemiluminescent immunoassays, which use fluorescent generation with an enzyme. A solid- phase immunoassay has an allergen bound to a matrix. All serotypes (Ig. G, Ig. M, Ig. A, and Ig. E) will bind if they recognize the allergen. A secondary anti- Ig. E antibody is used to identify if Ig. E is bound. The report is a quantitative value in k. IUA/L or in arbitrary divisions into classes I- VI. Asymptomatic sensitization is common below class III (< 3. IUA/L). The accuracy of immunoassays varies with the system being used and the quality of the allergen. There is good predictive value (> 9. Patch testing may help to find the cause of allergic contact dermatitis. This is a condition where you develop patches of dermatitis (eczema) when your.Buy Understanding the Bible by John Stott Online. In this work, first published in 1. John Stott looks at why the Bible was written, why we can trust it, why we should read it and it is about. The author* spells out the Bible's purpose; examines its social, geographical and historical background; and outlines the story and explains the message. Why was it written and can it be trusted? 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Understanding the Bible John R. Title: Understanding The Bible John Rw Stott Author: Phillipp Bergmann Subject: understanding the bible john rw stott Keywords: Read Online understanding the bible. Understanding the Bible John Stott Understanding the Bible . Understanding The Bible John Rw Stott. 12-08-2016 3/4 Understanding The Bible John Rw Stott. If you are looking for Real Simplicity Making Room for Life, our library. Title: Understanding The Bible John Rw Stott Author: Anna Gerber Subject: understanding the bible john rw stott Keywords: Read Online understanding the bible john rw. Title: Understanding The Bible John Rw Stott Author: Melanie Keller Subject: understanding the bible john rw stott Keywords. Tops of 2. 01. 3: TV and Social Media. Over the last few years, premiere sports and special events have dominated Nielsen. Pakistan; Peru; Philippines; Polska (Poland). Primetime Broadcast Programs. Ratings are the percentage of TV homes in the U.S. Take a look at the top rated Pakistani channels for the month of October 2014. The infographics highlight the following trends of Pakistan’s TV media: 1. With an average of about 4. The Oscars was the only non- sports event to make the list. Last year, the Grammy Awards did so, netting a similar 4. In terms of regularly- scheduled programming, football and NBC Sunday Night Football topped the charts. Competition reality programming continued to woo audiences as well, with Dancing With the Stars and American Idol again making the list. A sitcom, The Big Bang Theory, cracked the list for the first time in recent years as well. Time- shifting continued to grow increasingly stocked as a big part of viewers. For the second year in a row, the top time- shifted show in terms of lift percentage severely outpaced the top spot from the year prior. The top TV list of 2. When ranking the top time- shifted show on percent lift, cable. When ranking on absolute difference, broadcast shows rule the time- shifted ranks. Another first in this year. As television content often transcends the viewer experience to become conversation on Twitter, this year. The Top Series list, which looks at airings of regularly scheduled programs since the measurement of Nielsen Twitter TV Ratings began in September, is populated by both cable and broadcast series. English and Spanish- language telecasts on Broadcast and Cable. Persons 2+ estimates include live and same- day timeshifted viewing. Excludes breakouts, and programs less than 5 minutes in duration. Read as: Super Bowl XLVII on CBS averaged 2. Source: Nielsen. Top 1. Primetime TV Programs of 2. Regularly Scheduled. How do television ratings work? Advertisers pay to air their commercials on TV programs using rates that are based on Nielsen's data. What's the best TV show of all time? This poll is strictly about favorite shows, the programs people in Hollywood hold nearest to their hearts — that. Read reviews, compare customer ratings, see screenshots, and learn more about Online Pakistan TV. Download Online Pakistan TV and enjoy it on your iPhone. Read latest news and watch latest tv talk shows from all over Pakistan. Comment on over 6000 public figure profiles and people in the news. Have your say and make. Television content rating systems are systems for evaluating the content and reporting the suitability of television programs for children, teenagers or adults. Have you ever wondered what ratings really are? Pakistan's only media. Dunya News TV – Everyone wants to get hold of news as it happens! One channel that performs this functions perfectly, none other than Dunya News TV! Watch Online Latest Pakistani TV Talk Shows, Breaking News, Recorded Talk Shows,Latest Breaking Pakistan News, Urdu News. Rank. Program. Originator. Persons 2+ Rating. Average # of Viewers. NBC SUNDAY NIGHT FOOTBALLNBC7. SUNDAY NIGHT NFL PRE- KICKNBC5. THE OTFOX5. 0. 14,7. NCISCBS5. 0. 14,6. DANCING WITH THE STARSABC4. NFL REGULAR SEASON LESPN4. AMERICAN IDOL- WEDNESDAYFOX4. BIG BANG THEORY, THECBS4. AMERICAN IDOL- THURSDAYFOX4. DANCING W/STARS RESULTSABC4. Data from 1. 2/3. Regularly scheduled English and Spanish- language programs on Broadcast and Cable. Persons 2+ estimates include live and same- day timeshifted viewing. Excludes breakouts, specials, programs less than 5 minutes in duration and programs with less than 4 telecasts. Read as: NBC Sunday Night Football averaged 2. Source: Nielsen. TOP 1. TIME- SHIFTED TV PROGRAMS OF 2. RANKED BY % CHANGE IN VIEWERSHIP)Rank. Program. Originator% Increase in Viewers from Timeshifted Viewing. THE BRIDGEFX1. 64. COVERT AFFAIRSUSA NETWORK1. JUSTIFIEDFX1. 44. MAD MENAMC1. 43. 3%5. AMERICANSFX1. 43. SUITSUSA NETWORK1. AMERICAN HORROR STORYFX1. SONS OF ANARCHYFX1. GRACELANDUSA NETWORK1. BREAKING BADAMC1. Data from 1. 2/3. Excludes breakouts, specials and programs less than 5 minutes in duration. Read as: The TV viewing audience to The Bridge on FX increased 1. Source: Nielsen. Top 1. Timeshifting TV Programs of 2. Ranked by Absolute Difference in Viewership)Rank. Program. Originator. Absolute Difference. BLACKLISTNBC7,7. 99,0. THE FOLLOWINGFOX5,6. UNDER THE DOMECBS5,4. MARVEL AGENTS S. H. I. E. L. DABC5,3. SLEEPY HOLLOWFOX5,3. THE BIG BANG THEORYCBS4,9. GREY'S ANATOMYABC4,8. SURVIVORCBS4,2. 35,0. VOICENBC4,2. 02,0. REVOLUTIONNBC4,1. Data from 1. 2/3. Broadcast Prime; Absolute difference between Live Person 2+ and Live+7 Projections. A program must reach at least a 1. P2+ rating and have at least 4 telecasts. Excludes breakouts, specials and programs less than 5 minutes in duration. Read as: The TV viewing audience of The Blacklist on NBC increased by nearly 7. Source: Nielsen. Nielsen Twitter TV Ratings: Top 1. Series of Fall 2. Regularly Scheduled. Rank. Network. Program. Average Unique Audience. Average Impressions. Average Unique Authors. Average Tweets. 1AMCBreaking Bad. AMCThe Walking Dead. FXAmerican Horror Story: Coven. ABCScandal. 2,3. 11,0. ABCDancing With the Stars. NBCThe Voice. 2,1. FOXGlee. 2,0. 45,0. FOXThe X Factor. 1,7. MTVCatfish: The TV Show. MTVAwkward. 1,4. 69,0. Data from 9/1/2. 01. Average Unique Audience. Activity metrics (Unique Authors and Tweets) are a measure of relevant Twitter activity from three hours before, during and three hours after an episode. Reach metrics (Unique Audience and Impressions) measure the audience of relevant Tweets ascribed to an episode from when the Tweets are sent until the end of the broadcast day at 5 am. The data includes new/live episodes of regularly scheduled series programs only and excludes programs with less than 4 telecasts. Nielsen Twitter TV Ratings are only available for English- language U. S. Broadcast and Cable Networks. Read as: Breaking Bad on AMC averaged 6. Twitter accounts viewing at least one or more different Tweets about the program per new/live episode from September through November. Source: Nielsen Social. Daily. Med - FENTANYL - fentanyl patch. Special Precautions. Fentanyl transdermal system contains a high concentration of a potent Schedule II opioid agonist, fentanyl. Schedule II opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Fentanyl can be abused and is subject to criminal diversion. The high content of fentanyl in the patches (fentanyl transdermal system) may be a particular target for abuse and diversion.
Back Pain Home > Fentanyl Patch 12.5 Mcg/hr. It is best to underestimate the dose initially, in order to avoid dangerous side effects. Fentanyl (Absorbed through the skin). The fentanyl skin patch. Physical dependence may lead to withdrawal side effects if treatment is stopped. Fentanyl transdermal system patches are intended for transdermal use (on intact skin) only. The fentanyl transdermal system patch should not be used if the pouch seal is broken, or the patch is cut, damaged, or changed in any way. Each fentanyl transdermal system patch may be worn continuously for 7. The next patch should be applied to a different skin site after removal of the previous transdermal system. If problems with adhesion of the fentanyl transdermal system patch occur, the edges of the patch may be taped with first aid tape. If problems with adhesion persist, the patch may be overlayed with a transparent adhesive film dressing (e. Bioclusive. A new patch may be applied to a different skin site. Fentanyl transdermal system is ONLY for use in patients who are already tolerant to opioid therapy of comparable potency. Use in non- opioid tolerant patients may lead to fatal respiratory depression. Overestimating the fentanyl transdermal system dose when converting patients from another opioid medication can result in fatal overdose with the first dose. Rosenfeld on 12 mcg fentanyl patch. Follow @HealthTap </> Embed.Due to the mean half- life of approximately 2. Patients receiving fentanyl transdermal system and any CYP3. A4 inhibitor should be carefully monitored for an extended period of time and dosage adjustments should be made if warranted (see BOX WARNING, CLINICAL PHARMACOLOGY . The dose conversion schedule described in Table C, and method of titration described below are recommended in opioid- tolerant pediatric patients over 2 years of age with chronic pain (see PRECAUTIONS . Patients who are considered opioid- tolerant are those who have been taking, for a week or longer, at least 6. Because serious or life- threatening hypoventilation could occur, fentanyl transdermal system is contraindicated: in patients who are not opioid- tolerantin the management of acute pain or in patients who require opioid analgesia for a short period of time. The most important factor to be considered in determining the appropriate dose is the extent of pre- existing opioid- tolerance (see BOX WARNING and CONTRAINDICATIONS). Initial doses should be reduced in elderly or debilitated patients (see PRECAUTIONS). Fentanyl transdermal system should be applied to intact, non- irritated, and non- irradiated skin on a flat surface such as the chest, back, flank, or upper arm. In young children and persons with cognitive impairment, adhesion should be monitored and the upper back is the preferred location to minimize the potential of inappropriate patch removal. Hair at the application site should be clipped (not shaved) prior to system application. If the site of fentanyl transdermal system application must be cleansed prior to application of the patch, do so with clear water. Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics. Allow the skin to dry completely prior to patch application. Fentanyl transdermal system should be applied immediately upon removal from the sealed package. Do not use if the pouch seal is broken. Do not alter the patch (e. The transdermal system should be pressed firmly in place with the palm of the hand for 3. Fentanyl transdermal system should be kept out of the reach of children. Used patches should be folded so that the adhesive side of the patch adheres to itself, then the patch should be flushed down the toilet immediately upon removal. Patients should dispose of any patches remaining from a prescription as soon as they are no longer needed. Unused patches should be removed from their pouches, folded so that the adhesive side of the patch adheres to itself, and flushed down the toilet. Dose Selection. Doses must be individualized based upon the status of each patient and should be assessed at regular intervals after fentanyl transdermal system application. Reduced doses of fentanyl transdermal system are suggested for the elderly and other groups discussed in PRECAUTIONS. Fentanyl transdermal system is ONLY for use in patients who are already tolerant to opioid therapy of comparable potency. Use in non- opioid tolerant patients may lead to fatal respiratory depression. In selecting an initial fentanyl transdermal system dose, attention should be given to 1) the daily dose, potency, and characteristics of the opioid the patient has been taking previously (e. Each patient should be maintained at the lowest dose providing acceptable pain control. Initial Fentanyl Transdermal System Dose Selection. Overestimating the fentanyl transdermal system dose when converting patients from another opioid medication can result in fatal overdose with the first dose. Due to the mean half- life of approximately 2. The efficacy of fentanyl transdermal system 1. In addition, patients who are not opioid- tolerant have experienced hypoventilation and death during use of fentanyl transdermal system. Therefore, fentanyl transdermal system should be used only in patients who are opioid- tolerant. To convert adult and pediatric patients from oral or parenteral opioids to fentanyl transdermal system, use Table C: Alternatively, for adult and pediatric patients taking opioids or doses not listed in Table C, use the following methodology: Calculate the previous 2. Convert this amount to the equianalgesic oral morphine dose using Table D. Table E displays the range of 2. Use this table to find the calculated 2. Initiate fentanyl transdermal system treatment using the recommended dose and titrate patients upwards (no more frequently than every 3 days after the initial dose or than every 6 days thereafter) until analgesic efficacy is attained. The recommended starting dose when converting from other opioids to fentanyl transdermal system is likely too low for 5. This starting dose is recommended to minimize the potential for overdosing patients with the first dose. For delivery rates in excess of 1. The majority of patients are adequately maintained with fentanyl transdermal system administered every 7. Some patients may not achieve adequate analgesia using this dosing interval and may require systems to be applied every 4. An increase in the fentanyl transdermal system dose should be evaluated before changing dosing intervals in order to maintain patients on a 7. Dosing intervals less than every 7. Because of the increase in serum fentanyl concentration over the first 2. The initial fentanyl transdermal system dose may be increased after 3 days (see DOSAGE AND ADMINISTRATION - Dose Titration). During the initial application of fentanyl transdermal system, patients should use short- acting analgesics as needed until analgesic efficacy with fentanyl transdermal system is attained. Thereafter, some patients still may require periodic supplemental doses of other short- acting analgesics for . The initial fentanyl transdermal system dose may be increased after 3 days based on the daily dose of supplemental opioid analgesics required by the patient in the second or third day of the initial application. Physicians are advised that it may take up to 6 days after increasing the dose of fentanyl transdermal system for the patient to reach equilibrium on the new dose (see graph in CLINICAL PHARMACOLOGY). Therefore, patients should wear a higher dose through two applications before any further increase in dosage is made on the basis of the average daily use of a supplemental analgesic. Appropriate dosage increments should be based on the daily dose of supplementary opioids, using the ratio of 4. Fentanyl transdermal system - 1. Discontinuation of FENTANYL TRANSDERMAL SYSTEMTo convert patients to another opioid, remove fentanyl transdermal system and titrate the dose of the new analgesic based upon the patient's report of pain until adequate analgesia has been attained. Upon system removal, 1. Opioid withdrawal symptoms (such as nausea, vomiting, diarrhea, anxiety, and shivering) are possible in some patients after conversion or dose adjustment. For patients requiring discontinuation of opioids, a gradual downward titration is recommended since it is not known at what dose level the opioid may be discontinued without producing the signs and symptoms of abrupt withdrawal. Tables C, D, and E should not be used to convert from fentanyl transdermal system to other therapies. Because the conversion to fentanyl transdermal system is conservative, use of Tables C, D, and E for conversion to other analgesic therapies can overestimate the dose of the new agent. Overdosage of the new analgesic agent is possible. Matrifen - Summary of Product Characteristics (SPC)Matrifen, 1. Transdermal patch Matrifen, 2. Transdermal patch Matrifen, 5. Transdermal patch Matrifen, 7. Transdermal patch Matrifen, 1. Transdermal patch Matrifen 1. Each transdermal patch contains 1. Matrifen 2. 5 micrograms/hour: Each transdermal patch contains 2. Matrifen 5. 0 micrograms/hour: Each transdermal patch contains 5. Matrifen 7. 5 micrograms/hour: Each transdermal patch contains 8. Matrifen 1. 00 micrograms/hour: Each transdermal patch contains 1. For the full list of excipients, see section 6. Transdermal patch. Rectangular, translucent patch on a removable protective film. The protective film is larger than the patch. Patches are marked with a coloured imprint stating the trade name and strength: Matrifen 1. Matrifen 2. 5 micrograms/hour patch: red imprint. Matrifen 5. 0 micrograms/hour patch: green imprint. Matrifen 7. 5 micrograms/hour patch: light blue imprint Matrifen 1. Adults: Severe chronic pain, which can be adequately managed only with opioid analgesics. Children: Long term management of severe chronic pain in children receiving opioid therapy from 2 years of age. Posology. Fentanyl transdermal patches release the active substance over 7. The fentanyl release rate is 1. The required fentanyl dosage is adjusted individually and should be assessed regularly after each administration. Choice of initial dosage. The dosage level of fentanyl is based upon the previous use of opioids and takes into account the possible development of tolerance, concomitant medicinal treatment, the patient's general state of health and the degree of severity of the disorder. Adults: Opioid- tolerant patients. To convert opioid- tolerant patients from oral or parenteral opioids to Matrifen refer to Equianalgesic potency conversion below. The dosage may subsequently be titrated upwards or downwards, if required, in increments of either 1. Matrifen depending on response and supplementary analgesic requirements. Opioid- naive patients. The initial dosage should not exceed 1. Clinical experience with fentanyl transdermal patch is limited in opioid- na. In the circumstances in which therapy with fentanyl transdermal patch is considered appropriate in opioid- na. Patients can then be converted to fentanyl transdermal patch. The dose may subsequently be titrated upwards or downwards, if required, in increments of 1. Special warnings and precautions for use: Opioid na. Calculate the previous 2. Convert this amount to the equianalgesic oral morphine dose using Table 1. All IM and oral doses in this chart are considered equivalent to 1. IM morphine in analgesic effect. To derive the dosage of Matrifen corresponding to the calculated 2. Table 2 or Table 3 as follows: Table 2 is for adult patients who have been stabilised on oral morphine or another immediate- release opioid over several weeks and who need opioid rotation (conversion ratio of oral morphine to transdermal fentanyl approximately equal to 1. Table 3 is for highly opioid- tolerant adult patients who have been on a stable and well- tolerated opioid regimen for a long period, and who need opioid rotation (conversion ratio of oral morphine to transdermal fentanyl approximately equal to 1. Tables 2 and 3 should not be used to switch from transdermal fentanyl to another opioid treatment. Table 1: Equianalgesic potency conversion. Name of medicinal product. Equianalgesic dosage (mg) i. Oral. Morphine. 10. Hydromorphone. 1. Methadone. 10. 20. Oxycodone. 10- 1. Levorphanol. 24. Oxymorphine. Diamorphine. 56. 0Pethidine. Codeine 2. 00. Buprenorphine. Ketobemidone. 10. Based on studies conducted with single doses, in which the i. Oral dosages are the recommended dosages when changing from parenteral to oral administration.** The efficacy ratio of 3: 1 for morphine i. Table 2: Recommended initial dose of Matrifen based upon daily oral morphine dose (for patients stabilised on oral morphine or immediate release opioid for several weeks and who need opioid rotation)Oral morphine dose per 2. Dose of Matrifen transdermal patch micrograms/hour< 4. Conversion schemes are based on clinical trials. Schemes based on other trials have been found useful in clinical practice and may be used. Table 3: Recommended starting dosage of Matrifen based upon daily oral morphine dosage (for patients on stable and well tolerated opioid therapy for long periods and who need opioid rotation) Oral morphine dose per 2. Dose of Matrifen transdermal patch micrograms/hour< 4. Previous analgesic therapy should be phased out gradually from the time of the first patch application until analgesic efficacy with Matrifen is attained. For both strong opioid- na. The dose should be titrated individually until a balance between analgesic efficacy and tolerability is attained. In patients who experience a marked decrease in the period 4. The dose 1. 2 micrograms/hour is appropriate for dose titration in the lower dosage area. If analgesia is insufficient at the end of the initial application period, the dose may be increased after 3 days, until the desired effect is obtained for each patient. Additional dose adjustment should normally be performed in 1. More than one patch may be used for dose adjustments and for doses greater than 1. Patients may require periodic supplemental doses of a short- acting analgesic for breakthrough pain. Additional or alternative methods of analgesia or alternative administration of opioids should be considered when the Matrifen dose exceeds 3. Opioid withdrawal symptoms (see section 4. Undesirable effects) have been reported when changing from long- term treatment with Morphine to transdermal fentanyl despite adequate analgesic efficacy. In case of withdrawal symptoms it is recommended to treat those with short- acting Morphine in low doses. Discontinuation of Matrifen. If discontinuation of the patch is necessary, any replacement with other opioids should be gradual, starting at a low dose and increasing slowly. This is because fentanyl levels fall gradually after the patch is removed; it takes at least 1. As a general rule, the discontinuation of opioid analgesia should be gradual, in order to prevent withdrawal symptoms (nausea, vomiting, diarrhea, anxiety and muscular tremor). Table 2 and Table 3 should not be used to convert from Matrifen to other therapies to avoid overestimating the new analgesic dose and potentially causing overdose. Use in older people. Elderly or cachectic patients should be observed carefully and the dose reduced if necessary (see section 4. Use in patients with hepatic or renal impairment. Patients with impaired hepatic or renal function should carefully be observed for symptoms of an overdosage and the dose should possibly be reduced (see section 4. Use in febrile patients. Dose adjustment may be necessary in patients during episodes of fever (see section 4. Use in paediatric population. Children aged 1. 6 years and above: follow adult dosage. Children aged 2 to 1. Matrifen should be administered only to opioid- tolerant paediatric patients (ages 2 to 1. To convert paediatric patients from oral or parenteral opioids to Matrifen, refer to “Equianalgesic potency conversion” (Table 1), and “Recommended initial Matrifen dose based upon daily oral morphine dose” (Table 4). In the paediatric studies, the required fentanyl transdermal patch dose was calculated conservatively: 3. It should be noted that this conversion schedule for children only applies to the switch from oral morphine (or its equivalent) to fentanyl patches. The conversion schedule could not be used to convert from fentanyl into other opioids, as overdose could then occur. The analgesic effect of the first dose of Matrifen patches will not be optimal within the first 2. Therefore, during the first 1. Matrifen, the patients should be given the previous regular dose of analgesics. In the next 1. 2 hours, these analgesics should be provided based on clinical need. Since peak fentanyl levels occur after 1. Matrifen therapy or up- titration of the dose (see also section 4. Special warnings and precautions for use). Dose titration and maintenance. If the analgesic effect of Matrifen is insufficient, supplementary morphine or another short- duration opioid should be administered. Depending on the additional analgesic needs and the pain status of the child, it may be decided to increase the dose. Dose adjustments should be done in 1. Method of administration. For transdermal use. Fentanyl transdermal patch should be applied to non- irritated and non- irradiated skin on a flat surface of the torso or upper arm. In young children the upper back is the preferred location to apply the patch, to minimize the potential of the child removing the patch. Hair at the application site (hairless area is preferred) should be clipped (not shaved) prior to system application. If the site requires to be cleansed prior to application of the patch, this should be done with water. Soaps, oils, lotions, alcohol or any other agent that might irritate the skin or alter its characteristics should not be used. The skin should be completely dry before application of the patch. Patches should be inspected prior to use. The transdermal patch should not be divided or cut (see section 4. Patches that are cut, divided, or damaged in any way should not be used. Since the transdermal patch is protected outwardly by a waterproof covering foil, it may also be worn when taking a short shower. The Matrifen patch should be removed from the protective pouch by first folding the notch (located close to the tip of the arrow on the pouch label) and then carefully tearing the pouch material. If scissors are used to open the pouch, this should be done close to the sealed edge so as not to damage the patch inside. Fentanyl transdermal patch is to be attached as soon as the pack has been opened and avoid touching the adhesive side of the patch. 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