QuestionSBA
QuestionChoice
200mg oral morphine sulphate is equivalent to 60mg diamorphine SC. 100mg SC diamorphine will be uptitrating her pain control, which is not necessary when it is currently well controlled
34459
e
Diamorphine sulphate 100mg SC and 17mg SC PRN
QuestionChoice
To convert oral morphine sulphate into subcutaneous infusion, the regular dose has to be half the daily amount of PO morphine sulphate (200/2 = 100mg)
34456
b
Morphine sulphate 75mg SC and 13mg SC PRN
QuestionChoice
The patient is currently on a total of 200mg morphine sulphate PO a day (75mg 12 hrly regular Morphine sulphate and 5 doses of 10mg/5mL of Oramorph® = 150mg + 5 x10mg = 200mg). To convert into subcutaneous infusion, the regular dose has to be half the daily amount of PO morphine sulphate (200/2 = 100mg) and the PRN dose one sixth the total amount given regularly (1/6 x 100 = 16.7mg)
34455
a
Morphine sulphate 100mg SC and 17mg SC PRN
QuestionChoice
200mg oral morphine sulphate is equivalent to 60mg diamorphine SC
34458
d
Diamorphine sulphate 50mg SC and 13mg SC PRN
QuestionChoice
200mg morphine sulphate approximates to a buprenorphine '70' patch and a '15' patch
34457
c
Buprenorphine 70 microgram/h transfermal patch applied 72-hrly
QuestionComment
hell yeah
39389
User
subscriber
Serpiginous Metabolism
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2834
Opioid Conversion
Topic
74
Elderly Care
6902
Case Presentation:


A 80-year-old man was admitted into the Care of the Elderly Ward a week ago for chest infection. His condition has worsened over the last few days and he is not for cardiopulmonary resuscitation. PMH Osteoarthritis, GORD, HTN, Heart failure, pancreatic cancer. DH Morphine sulphate M/R (MST Continus ® ) 75mg PO 12-hrly, Morphine sulphate 10mg/5mL (Oramorph ®) 5mL PO as required, Omeprazole 20mg OD PO, Bisoprolol 10mg PO OD, Ramipril 2.5mg PO OD. He has taken 5 doses of immediate release morphine in the last 24 hour.
A decision is made by the palliative care team to stop all inappropriate medication and convert his analgesic regimen to a continuous subcutaneous infusion via a syringe driver.

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