Can someone please correct my questions

[brathernotsay]

1. i am working on a med math problem could you take a look at it for me please, I know that hydromorphone is 5 times more potent than morphine. and that parentarel narcotics are two times more potent than oral meds,

if a client requires a conversion from IV hydromorphone to oral morphine, they are currently receiving hydromorphone IV/SC 1 mg q3-4h prn. what would and appropriate dose of oral morphine be? would it be oral morphine 10 mg, q 3-4h? My rationale for that is since IV medications is 2 times more potent than oral meds, and hydromorphone is 5 times more potent than morphine according to the chart my equation would be as follows, IV hydromorphone 1 mg X 2 = 2mg oral morphine........so 2 mg X 5 mg morphine (since hydromorphone is 5 times more potent than morphine) which would give me 10 mg oral morphine to give....is this correct? if not please someone correct me, so that i understand why and what i did wrong?

[brathernotsay]

i also know you must further reduce it down to 25% just not sure if i am on the right track, someone that is knowledgeable please help me

[RescueNinjaKy]

My question is why would this ever be asked? Your role as a nurse shouldn't be making an order for medication.

I mean if the provider wants to change the order they Will specify the dosage instead of telling the nurse to figure it out. Also many computer systems now have the option to look up the therapeutic dosages

[RescueNinjaKy]

I mean if your information in regards to the strength conversion is correct then judging from your math it should be correct

[NICUmiiki, DNP, NP]

Your logic leading to 10mg q3-4h seems correct based on the information you've given, although that question seems WAY out of line. My drug guide says that 10-30mg morphine PO q4h is appropriate for an adult.

[mrsboots87]

Figuring out a dose based on weight and such is in scope when given an order. But figuring out a dose conversion between IV and PO is not a nurses job. I haven't checked my practice acts for my state, but I believe that would fall under practicing medicine and not in a nurses scope. When a doctor wants to change between IV and PO they will write out the order already figured out because that is their job. They wouldn't give an order to "convert from IV to PO and change to hydromorphone from morphine." Why would this be a question in your class? Weird. But your math seems correct based on the info you gave. My nursing instructors have never told us what the actual strength difference is, but just explained that due to digestion and first pass effect, IV will always need a smaller dose than PO to be therapeutic and the physician will give us an order, and we just verify it is within correct dosing range for the patient.