Hey Med_made-easy, Thank you for your query The answer is 4 ampoules per day, not 2 :) The dose is 60mg Twice daily (BD). each 5ml ampoule contains 50mg, therefore you will need a second ampoule to get the additional 10mg to make the total 60mg dose. The ampoules should be discarded immediately after use and so you would need 2 ampoules for the first 60mg dose, and another two ampoules for the second 60mg dose of the day. I Hope this helps. KR, MTB
Q1&2 have been removed due to discrepancies You may find the following helpful in regards to palliative care prescribing, breakthrough doses and dose increments of morphine: 1. Please refer to the Prescribing in Palliative care guidance section in the BNF. There is a table in there that has Equivalent doses of opioid analgesics [for example codeine, tramadol, morphine, oxycodone etc] if you are asked to convert from one formulation to another. There are also tables in this guidance to help convert from a total daily dose of morphine to a fentanyl or buprenorphine patch. 2. In terms of breakthrough doses, the Prescribing in Palliative Care guidance in the BNF recommends the following: If pain occurs between regular doses of morphine [‘breakthrough pain’], an additional dose [‘rescue dose’] of immediate-release morphine should be given. An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. The standard dose of a strong opioid for breakthrough pain is usually one-tenth to one-sixth of the regular 24-hour dose, repeated every 2-4 hours as required [up to hourly may be needed if pain is severe or in the last days of life]. - As an example, If someone was on 30mg BD MR morphine, their total dose would be 60mg. - Breakthrough dose would be 6mg -10 mg [1/10th to 1/6th of total daily dose] 3. In terms of dose increments of the background MR morphine, the guidance suggests: the number of rescue doses required and the response to them should be taken into account; increments of morphine should not exceed one-third to one-half of the total daily dose every 24 hours. Some approaches to this include: 1. Calculate the total daily morphine dose by adding the regular dose to the number of breakthrough doses and giving this in 2 instalments of MR morphine - for example, total MR dose = 60mg, pt received another 20mg in breakthrough doses - increase to 40mg BD MR 2. Increasing the regular MR morphine by 30-50% - for example, regular MR morphine is 60mg, pain still not controlled - new dose can be between 80mg and 90mg daily. If you do some research on the internet, there seems to be varied approaches to the above. It would be sensible in practice to go with whatever option gives the lower dose increase and monitor the patient closely. As an FY1 or even senior, I would recommend contacting the palliative care and pain nurses to review your patient and provide guidance on what to prescribe - they are a valuable member of the team and experienced in this field and will be able to assess the patient in an individual basis and advise accordingly.
hi - im a little confused about Q8 - if warfarin comes as 1mg, 3mg and 5mg doses, could the number of 1mg required be 7? (If for the 7mg days - you use 2x3mg pills and 1x1mg pills)
Hi Kate, thank you for your question, Absolutely, you can make the dose using 2 x 3mg tablets and 1 x 1mg. The reason I went for 1x5mg and 2x1mg is because the patient is on 5mg and 7mg on alternate days - so we would only be using 5mg and 1mg tablets to reduce the number of different strengths provided to patient. For the 5mg dose, it would make sense in terms of tablet burden, to use 1x5mg tablet rather than 1x3mg + 2x1mg or combinations thereof. Therefore, if we were to use 2x3mg and 1 x 1mg as per your suggestion (which is not wrong at all), then the patient would have to be supplied with 1mg, 3mg and 5mg tablets. I guess each patient is different but it is perhaps less complicated to supply 2 different strengths rather than 3 different strengths to make up the doses, if that makes sense? Your answer is not incorrect, I imagine in the exam they would be very clear in their question to avoid multiple answers for the calculation. I hope this helps. Please get back in touch if you have any more questions.
@@MindtheBleep I believe the question might be confusing for it asks for "how many 1mg tablets", and one would think that he/she must use the 1mg tablets only.
Dear Desperados, Thank you for taking the time to watch the video and your comment. Apologies for the confusion! We have tried to formulate new questions so as not to repeat the Mock PSA ones so the questions will not be 100% perfect - they are just there for examples/ to get you thinking. Rest assured the questions in the exam will have been looked at closely to ensure there is no ambiguity. Hopefully you still found the video of help :) KR, MTB
Bit confused on the last question, why is it 2 ampoules per day?
Hey Med_made-easy, Thank you for your query
The answer is 4 ampoules per day, not 2 :)
The dose is 60mg Twice daily (BD). each 5ml ampoule contains 50mg, therefore you will need a second ampoule to get the additional 10mg to make the total 60mg dose.
The ampoules should be discarded immediately after use and so you would need 2 ampoules for the first 60mg dose, and another two ampoules for the second 60mg dose of the day.
I Hope this helps.
KR, MTB
Q1&2 have been removed due to discrepancies
You may find the following helpful in regards to palliative care prescribing, breakthrough doses and dose increments of morphine:
1. Please refer to the Prescribing in Palliative care guidance section in the BNF. There is a table in there that has Equivalent doses of opioid analgesics [for example codeine, tramadol, morphine, oxycodone etc] if you are asked to convert from one formulation to another. There are also tables in this guidance to help convert from a total daily dose of morphine to a fentanyl or buprenorphine patch.
2. In terms of breakthrough doses, the Prescribing in Palliative Care guidance in the BNF recommends the following: If pain occurs between regular doses of morphine [‘breakthrough pain’], an additional dose [‘rescue dose’] of immediate-release morphine should be given. An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. The standard dose of a strong opioid for breakthrough pain is usually one-tenth to one-sixth of the regular 24-hour dose, repeated every 2-4 hours as required [up to hourly may be needed if pain is severe or in the last days of life].
- As an example, If someone was on 30mg BD MR morphine, their total dose would be 60mg.
- Breakthrough dose would be 6mg -10 mg [1/10th to 1/6th of total daily dose]
3. In terms of dose increments of the background MR morphine, the guidance suggests: the number of rescue doses required and the response to them should be taken into account; increments of morphine should not exceed one-third to one-half of the total daily dose every 24 hours.
Some approaches to this include:
1. Calculate the total daily morphine dose by adding the regular dose to the number of breakthrough doses and giving this in 2 instalments of MR morphine
- for example, total MR dose = 60mg, pt received another 20mg in breakthrough doses - increase to 40mg BD MR
2. Increasing the regular MR morphine by 30-50%
- for example, regular MR morphine is 60mg, pain still not controlled - new dose can be between 80mg and 90mg daily.
If you do some research on the internet, there seems to be varied approaches to the above.
It would be sensible in practice to go with whatever option gives the lower dose increase and monitor the patient closely.
As an FY1 or even senior, I would recommend contacting the palliative care and pain nurses to review your patient and provide guidance on what to prescribe - they are a valuable member of the team and experienced in this field and will be able to assess the patient in an individual basis and advise accordingly.
hi - im a little confused about Q8 - if warfarin comes as 1mg, 3mg and 5mg doses, could the number of 1mg required be 7? (If for the 7mg days - you use 2x3mg pills and 1x1mg pills)
Hi Kate, thank you for your question,
Absolutely, you can make the dose using 2 x 3mg tablets and 1 x 1mg.
The reason I went for 1x5mg and 2x1mg is because the patient is on 5mg and 7mg on alternate days - so we would only be using 5mg and 1mg tablets to reduce the number of different strengths provided to patient.
For the 5mg dose, it would make sense in terms of tablet burden, to use 1x5mg tablet rather than 1x3mg + 2x1mg or combinations thereof.
Therefore, if we were to use 2x3mg and 1 x 1mg as per your suggestion (which is not wrong at all), then the patient would have to be supplied with 1mg, 3mg and 5mg tablets. I guess each patient is different but it is perhaps less complicated to supply 2 different strengths rather than 3 different strengths to make up the doses, if that makes sense?
Your answer is not incorrect, I imagine in the exam they would be very clear in their question to avoid multiple answers for the calculation.
I hope this helps. Please get back in touch if you have any more questions.
@@MindtheBleep I believe the question might be confusing for it asks for "how many 1mg tablets", and one would think that he/she must use the 1mg tablets only.
Dear Desperados,
Thank you for taking the time to watch the video and your comment. Apologies for the confusion! We have tried to formulate new questions so as not to repeat the Mock PSA ones so the questions will not be 100% perfect - they are just there for examples/ to get you thinking.
Rest assured the questions in the exam will have been looked at closely to ensure there is no ambiguity. Hopefully you still found the video of help :)
KR,
MTB