1. Drug Calculations Update

2. (1) Your patient has a Fentanyl patch in situ
(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
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
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. 40x 1½ =60mgs Morphine Sulphate
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
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.

7. 10. Convert s/c Morphine Sulphate. 60mgs via a CSCI/24hrs to MR oral
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
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
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
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