Old woman with Stage 4 breast cancer

HG is a 48 year old woman with Stage 4 breast cancer. She was transferred from the hospital internal medicine floor to the hospital’s inpatient palliative care unit, on an infusion of hydromorphone ($$0.4\mathrm{mg}$$hour with a$$0.2\mathrm{mg}$$demand bolus, using about once per hour).

The patient is ready for discharge home to hospice care. The attending physician has asked that you calculate an equivalent regimen using OxyContin and oxycodone for breakthrough. What do you recommend? This regimen is currently keeping her comfortable. A. OxyContin$$15\mathrm{mg}$$PO Q12H and Oxycodone tablet$$5\mathrm{mg}$$every 4 hours as needed for breakthrough pain. B. OxyContin 20mg PO Q12H and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain. C. OxyContin$$30\mathrm{mg}\mathrm{PO}$$Q12H and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain. D. OxyContin$$60\mathrm{mg}$$PO Q12H and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain.

Calculate$$24\mathrm{hr}$$dose of new drug and reduce dose at least$$25\%$$. (If the problem on the exam does not specify to reduce it, just to find the equivalent dose, then do not reduce it.)

3. HG is a 48 year old woman with Stage 4 breast cancer. She was transferred from the hospital internal medicine floor to the hospital’s inpatient palliative care unit, on an infusion of hydromorphone ($$0.4\mathrm{mg}$$hour with a$$0.2\mathrm{mg}$$demand bolus, using about once per hour). The patient is ready for discharge home to hospice care. The attending physician has asked that you calculate an equivalent regimen using OxyContin and oxycodone for breakthrough. What do you recommend?

This regimen is currently kecping her comfortable. A. OxyContin$$15\mathrm{mg}\mathrm{PO}Q12\mathrm{H}$$and Oxycodone tablet$$5\mathrm{mg}$$every 4 hours as nceded for breakthrough pain: B. OxyContin$$20\mathrm{mg}\mathrm{PO}Q12H$$and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain. C. OxyContin$$30\mathrm{mg}\mathrm{PO}\mathrm{Q}12\mathrm{H}$$and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain. D. OxyContin 60mg$$\mathrm{PO}$$Q12H and Oxycodone tablet$$10\mathrm{mg}$$every 4 hours as needed for breakthrough pain.