calculation help

toomuchbaloney · Jun 9, 2014

10% of what?

what is the Roxanol dose?

loriangel14, RN · Jun 9, 2014

What is the 10% rule? How much Roxanol?

jackielgr · Jun 12, 2014

There wasn't a dose on calculation. I would say 20mg/ml. I will have to get back with rule. Thought rule was something hospice knew about. This is new to me.

toomuchbaloney · Jun 12, 2014

There wasn't a dose on calculation. I would say 20mg/ml. I will have to get back with rule. Thought rule was something hospice knew about. This is new to me.

YOu must provide the Roxanol dose if you want to discern how much the long acting med must be increased. Even as a new hospice nurse you must be able to understand that. How much morphine did the patient actually take in the last 24 hours?

Your medical director determines the "rule" for your agency. Not every MD uses a 10% rule.

guest538567 · Jun 14, 2014

What I think you are referring to are recommended practice "rules" for long-acting morphine and establishing enough short acting morphine for breakthrough pain. All opioid conversions are done using 24 hour consumption of oral morphine as the standard conversion. It's easy in this case since you are using short acting morphine. You can just calculate all of the short acting morphine in 24 hours and divide by 2 (MS contin is a 12 hour drug)- this gives you an idea of where you could start your MS Contin. For example, you if you had a patient taking 20mg of oral morphine elixir (roxanol) 6 times in 24 hrs, this would equate to 120mg in 24 hrs, and you could start the MS contin at 60mg every 12 hours. Some then recommend you provide a certain percentage of the total 24 hour dose back as breakthrough - for example 1/6 (every 4 hours) of the 120mg is 20mg that patient can take every 4 hours for breakthrough pain.

Consider though that 20mg/ml is the concentration that you listed not necessarily the dose.

Here are some basic guidelines for conversion and prn dosing. Medscape: Medscape Access

guest538567 · Jun 14, 2014

Here is a chart that explains this (site is in NZ although the concept is the same) ... http://www.saferx.co.nz/Morphine_titration_guide.pdf

Unless you are an NP this really should be done by the provider. If you just want to learn about opioid management there are classes that you can take online (ie. medscape) and books that you can get on Amazon.

guest538567 · Jun 14, 2014

OK... I reread your question. This is for some type of test? Here is my guess. Pt is on 45mg MS Contin BID - total 90mg in 24 hours. 10% of this is 9mg which would be your prn dose for breakthrough pain. I would round this to 10mg. Pt needed 6 prn doses. This means pt needed an extra 60mg in 24 hours. Total 24 hour morphine dose is 150mg. MS Contin comes in 15, 30, 60, 100, 200mg doses. You cannot get exactly get 150mg easily. As a provider, and considering pill burden, I would likely just go to 60mg BID although you could theoretically give a script for 15mg and 60mg to combine for 75mg BID. Then using your "10 percent rule" (150mg x .10) your prn dose would increase to 15mg at whatever frequency. I think this is the answer to your question.

toomuchbaloney · Jun 14, 2014

My apologies for the harshness of my reply.

jackielgr · Jun 14, 2014

Thank you so much.I came up with the same answer to. After thinking about it. Yes you are right this was a test for new hire. I will look at the link provided. The provider does make the dose decision. This was just on the quiz and I needed to understand it.

toomuchbaloney · Jun 14, 2014

I didn't understand the question. dang I feel old