ABIM Palliative Care

Practice session

A hospitalist is called to the medical floor to see a 68-year-old man with metastatic pancreatic cancer admitted for pain crisis. He has been on morphine ER 60 mg PO BID (120 mg/day) with breakthrough morphine IR 20 mg PO Q2H PRN, using roughly 80 mg IR over the past 24 hours. What is the total daily oral morphine equivalent (MME) and an appropriate 24-hour IV morphine infusion rate after a 25% reduction for incomplete cross-tolerance when rotating to IV morphine?

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