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Drug Calculations Update

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) Take the Fentanyl Patch off? b) Leave it on for 12 hours then remove c) Leave it on?. C – Leave the patch on

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Drug Calculations Update

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  1. Drug Calculations Update

  2. (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) Take the Fentanyl Patch off?b) Leave it on for 12 hours then removec) Leave it on? C –Leave the patch on For uncontrolled pain, please seek specialist advice.

  3. 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. 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

  5. 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

  6. Convert s/c Diamorphine 20 mgs via a CSCI/24hrs to MR release oral Morphine bd • 20mgs x3= 60mgs divide by 2 = 30mgs bd • Diamorphine 20mgs x3=60mgs MR Morphine then divide by 2 for bd dose = 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.

  7. 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

  8. 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

  9. 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

  10. 16 What is the oral breakthrough drug and dose for a patient on s/c Diamorphine 180mgs via a CSCI over 24hrs • 180mgs ÷ 6 = 30mgs Diamorphine = 90mgs oral Morphine • Breakthrough dose is 1/6th 24hr dose 17What 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

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