Transcript s/c Morphine Sulphate is twice as strong as oral Morphine Sulphate

Drug Calculations
Update
(1) Your patient has a Fentanyl patch in
situ. They now have uncontrolled pain
and you wish to commence a syringe
driver, would you:
a)
b)
c)
Take the Fentanyl Patch off?
Leave it on for 12 hours then remove
Leave it on?
C – Leave the patch on
For uncontrolled pain, please seek specialist
advice.
2
Convert MR oral Morphine 60mgs bd
to Diamorphine
• Add bd doses together then divide by 3
• (60+60=120) divide by 3= 40mgs Diamorphine
3
Convert MR oral Morphine 90mgs bd
to Diamorphine
• Add bd doses together then divide by 3
• (90+90=180) divide by 3=60mgs Diamorphine
4
Convert MR oral Morphine 60mgs bd
to s/c Morphine Sulphate via a
CSCI/24hrs
• Add the bd doses together then divide by 2
• (60+60=120) divide by 2= 60mgs Morphine
Sulphate
5
Convert s/c Morphine 90mgs to MR
oral Morphine 24hrs
• Times by 2
• 90x2=180 mgs Morphine
6
Convert Diamorphine s/c 40mgsvia a
CSCI/24hrs to Morphine Sulphate s/c
via a CSCI/ 24hrs
• Diamorphine is 1½ times stronger than Morphine.
• 40x 1½ =60mgs Morphine Sulphate
7
Convert s/c Morphine Sulphate
120mgsvia a CSCI/24hrs to s/c
Diamorphine via a CSCI/24hrs
• Morphine is 1½ times weaker than
Diamorphine.
• 120 divided by 1½ = 80mgs Diamorphine
8
Convert s/c Diamorphine 20 mgs via a
CSCI/24hrs to MR release oral
Morphine bd
• Diamorphine 20mgs x3=60mgs MR Morphine
then divide by 2 for bd dose = 30mgs bd
• 20mgs x3= 60mgs divide by 2 = 30mgs bd
9
Convert s/c Diamorphine 120 mgs
via a CSCI/24hrs to MR oral
Morphine bd
• Diamorphine 120mgs x3=360mgs MR
Morphine then divide by 2 for bd dose =
180mgs bd.
• 120mgs x3 =360mgs divide by 2 = 180mgs bd.
10
Convert s/c Morphine Sulphate
60mgs via a CSCI/24hrs to MR oral
Morphine over 24hrs
• s/c Morphine Sulphate is twice as strong as
oral Morphine Sulphate
• 60mgs s/c = 120mgs
11
Convert s/c Morphine Sulphate
240mgs via a CSCI/24hrs to MR oral
Morphine bd
• s/c Morphine Sulphate is twice as strong as
oral Morphine Sulphate
• 240mgs s/c = 480mgs oral over 24hrs
240mgs oral bd
12
Convert MR oral Oxycodone
20mgs/24hrs to MR oral
Morphine over 24hrs
• Oxycodone is twice as strong as oral
Morphine Sulphate
• 20mgs Oxycodone = 40mgs Morphine
Sulphate
13
Convert MR oral Morphine 200mgs
over 24hrs to MRoral Oxycodone
over 24hrs
• Oxycodone is twice as strong as oral
Morphine Sulphate
• 200mgs oral Morphine = 100mgs Oxycodone
14
What is the oral breakthrough dose
for a patient on MR oral Morphine
60mgs bd?
• Breakthrough dose is 1/6th 24hr dose
• 60mgs bd = 120mgs daily
Breakthrough 20 mgs
15
What is the s/c breakthrough dose
for a patient on s/c Diamorphine
180mgs via a CSCI over 24hrs?
• Breakthrough dose is 1/6th 24hr dose
• 180mgs ÷ 6 = 30mgs Diamorphine
16
What is the oral breakthrough drug
and dose for a patient on s/c
Diamorphine 180mgs via a CSCI
over 24hrs
• Breakthrough dose is 1/6th 24hr dose
• 180mgs ÷ 6 = 30mgs Diamorphine = 90mgs
oral Morphine
17
What is the oral breakthrough drug
and dose for a patient on MR oral
Oxycodone 60mgs bd
• Breakthrough dose is 1/6th 24hr dose
• 60mgs bd = 120mgs daily oral Oxycodone =
20mgs oral Oxycodone breakthrough