chemotherapy dose modifications

Question 1

What is the conversion from oral morphine to SC oxycodone

Answer 1

divide morphine dose by 3

Question 2

What is the conversion from oral morphine to transdermal fentanyl

Answer 2

Divide oral daily morphine dose by 3

Question 3

What is the conversion from oral morphine to transdermal buprenorphine

Answer 3

Divide oral daily morphine dose by 2

Question 4

How is doxorubicin & epirubicin dosed in hepatic impairment

Answer 4

Bilirubin 20 – 50 - 50% dose
Bilirubin 50-85 - 25% normal dose
Bilirubin >85 - avoid use

ALT/AST >2-3x ULN - 25% dose reduction
ALT >3x ULN - 50% dose reduction

Question 5

how is capecitabine dose adjusted in renal impairment

Answer 5

25% Dose reduced if GFR 50-30
GFR <30 - contraindicated

Question 6

when is gemcitabine dose adjusted for renal impairment

Answer 6

No adjustment unless GFR <30.

Question 7

how is docetaxel dose adjusted for hepatic impairment

Answer 7

Bili >22 or ALT >3.5x ULN or ALP >6x ULN - omit

Question 8

how is paclitaxel dose adjusted for hepatic impairment

Answer 8

bili 1.25-2x ULN - 20% dose reduction

Question 9

what chemotherapy drug can cause cerebellar dysfunction

Answer 9

5FU

Question 10

what is the dose conversion between sc lorazepam and midazolam

Answer 10

0.5mg lorazepam = 2.5mg midaz = 5mg diazepam