QuestionSBA
QuestionChoice
Although Diamorphine is sometimes used in syringe drivers, this is the incorrect dose equivalence. With 120mg Morphine sulfate taken orally in the past 24 hours, this would be equivalent to 40mg s/c Diamorphine.
10028551
e
Switch to subcutaneous infusion of 30mg Diamorphine hydrochloride over 24 hours
QuestionChoice
This patient has taken (40x2) + (10x4) = 120mg Morphine sulfate PO in the last 24 hours. To convert PO morphine to SC morphine you simply have to divide the total 24 hour dose by 2.
10028547
a
Switch to subcutaneous infusion of 60mg Morphine sulfate over 24 hours
QuestionChoice
This would be correct if the total oral intake of Morphine sulfate over the last 24 hours was 180mg.
10028548
b
Switch to subcutaneous infusion of 90mg Morphine sulfate over 24 hours
QuestionChoice
Although this is the correct conversion, syringe drivers typically run over 24 hours, rather than every 12 hours.
10028549
c
Switch to subcutaneous infusion of 30mg Morphine sulfate over 12 hours
QuestionChoice
When converting from oral to subcutaneous you cannot simply use the same dosage as the bioavailability is different. This would result in a overdose of morphine to the patient.
10028550
d
Switch to subcutaneous infusion of 120mg Morphine sulfate over 24 hours
Concept
Chapter
2693
6086
Opioid conversion
Topic
328
Palliative care prescribing
18112
Case Presentation:


A 93-year-old inpatient on the Senior Health ward is commenced on palliative care, and his analgesia regimen needs to be converted from oral to a syringe driver.

**PMH** Small cell lung cancer, Osteoarthritis, COPD.

**DH** Morphine sulfate M/R 40mg PO BD, Morphine sulfate 10 mg/5 mL solution (Oramorph) 5 mL PO PRN. Paracetamol 1g PO QDS, Ibuprofen 400mg PO TDS, Salmeterol 50 micrograms INH BD. He has taken 4 doses of her Oramorph in the last 24 hours.

Question:
Select the most appropriate decision option with regard to his pain management based on these data.
a