QuestionQA
QuestionComment
Why is subcut dose divided by 2?
17500
QuestionComment
Good qn

19770
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Axillary Dominant
QuestionComment
Subcutaneous morphine is twice as strong as oral morphine (so you only need half as much of it)
19983
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DNA Haemophilus
QuestionComment
It's on the BNF under palliative care pain prescribing. There's a whole table to convert doses
39919
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Acute DNA
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Yoghurt Pot
QuestionComment
This question is a bit pointless if you're not giving them the dose of the breakthrough morphine
61770
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Troll9000
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3680
Conversion of morphine from oral formulation to subcutaneous formulation
Topic
74
Elderly Care
4 x 15 = 60mg needed as a baseline

60/6 = 10mg x 2 = 20mg needed as a breakthrough dose

60 + 20 = 80mg needed orally to manage pain.

80/2 = 40mg needed subcutaneously to manage pain.
10151
QuestionQAAnswer
40
mg
 

Case Presentation:

A 86-year-old gentleman is currently on the care of the elderly ward. His regular medicines are listed below. Weight 60kg.

**PH** Metastatic prostate cancer, Osteoarthritis, Hypertension, Hypercholesterolaemia

**DH** Morphine 15mg PO QDS, ramipril 5mg PO OD, Atorvastatin 20mg PO OD

In addition to his regular morphine, this patient requires **TWO** breakthrough doses of morphine throughout the day. This manages his pain.

He has been having difficulty swallowing and the decision has been made to switch the formulation of his medication from oral to another formulation that doesn't require swallowing.

What is the total dose of morphine required daily to manage this patient's pain if it is given subcutaneously?