A patient is receiving morphine sulfate intravenously via a patient controlled a

Question

A patient is receiving morphine sulfate intravenously via a patient controlled analgesia (PCA) pump. The concerntration of the solution is 15 mg/ml and is being infused at a rate of 0.1 mL/h. The patient may access a 2-mg bolus dose every hour for breakthrough pain and is currently using an average of 8 dose per day. The patient's caregiver requests that the patient be converted to a fentanyl transdermal patch for a more safe dosage form. What strength of fentanyl patch would be most effective for this patient? Please i need to see thw orking of this problem. Thanks

Explanation / Answer

Since the solution is infused at a rate of 0.1ml/h, the concentration of solution after 1 hour is 1.5mg. This is the normal amount given in each dose. But patient can access 2mg bolus dose every hour. This is the maximum dose. As 8 dose per day is being used currently,

Normal concentration being given on average through a day = 1.5mg * 8 =12.0mg

Maximum concentration that can be given through a day = 2mg * 8 =16.0mg

The most effective fentanyl patch would be the value between 12.0 and 16.0

Fentanyl 12.5 patch only falls in this range. Hence fentanyl 12.5 patch is answer.

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