ABFM Palliative Care

Practice session

A family physician sees a 71-year-old woman with metastatic colon cancer in clinic. She is taking morphine sustained-release 30 mg PO every 12 hours (60 mg/day) with good pain control but persistent, refractory nausea attributed to morphine. You rotate to oral hydromorphone. Using standard equianalgesic dosing and accounting for incomplete cross-tolerance, what is the most appropriate starting daily dose of oral hydromorphone?

Loading your practice session…