GSF Traffic Light Coding System — SCE Palliative Medicine MCQ

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HardEnd of Life CareGSF Traffic Light Coding SystemSCE Palliative Medicine

A patient receives modified-release oral morphine 45 mg twice daily and six effective 15 mg oral rescue doses in 24 hours, without toxicity. If all rescue use is incorporated, what new twice-daily modified-release dose is calculated?

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Correct answer: C — Modified-release oral morphine 90 mg twice daily

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

B is correct. Baseline morphine is 90 mg/24 hours and rescue use contributes another 90 mg, producing 180 mg/24 hours. Dividing into two modified-release doses gives 90 mg twice daily. Sixty and 75 mg undercount rescue exposure, 105 mg adds an extra 30 mg daily, and 180 mg twice daily fails to divide the daily total. Before prescribing such a large increase, the team must reassess pain mechanism, toxicity, adherence and whether repeated rescue use reflects incident pain.

Reference: Scottish Palliative Care Guidelines: opioid conversion tables: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/medicines-information/choosing-and-changing-opioids-opiates-convertingswitching/opioidopiate-conversion-tables-switching-between-opioid-medicines