#### II. Step 1: Calculate hourly dose for Morphine

1. Typical Hourly Morphine Dose (mg/hour): (100 - age)/24
1. Age 30: 3 mg hourly Morphine dose
2. Age 50: 2 mg hourly Morphine dose
3. Age 70: 1.25 mg hourly Morphine dose
2. Typical hourly higher Morphine dose (double dose)
1. Age 30: 6 mg hourly Morphine dose
2. Age 50: 4 mg hourly Morphine dose
3. Age 70: 2.5 mg hourly Morphine dose

#### III. Step 2: Set Lockout periods and Maximums

1. Maximum Lockout: 20 minutes
2. Typical lockout period range: 6 to 12 minutes
3. Set one hour or four hour maximums
1. Example for one hour Morphine maximum: 10 mg
2. Example for four hour Morphine maximum: 40 mg

#### IV. Step 3: Consider background infusion

1. Indications
1. Opioid Dependence
2. Severe pain on awakening
2. Calculation
1. Set background rate <50% of anticipated requirements
2. Typical adult background Morphine rate: 1 mg/hour

#### V. Step 4: Determine PCA bolus Dose

1. Bolus dose: (higher dose per hour)/(doses per hour)
2. For lockout at 10 minute intervals: 6 doses
1. Example: 30 year old with higher Morphine dose: 6 mg
2. Dose: 1 mg IV Morphine boluses up to q10 minutes

#### VI. Step 5: Convert from Morphine to other medication

1. Hydromorphone (Dilaudid) 1.5 mg per Morphine 10 mg
2. Meperidine (Demerol) 75 mg per Morphine 10 mg

#### VII. Examples for typical 30 year old

1. Morphine
1. Boluses: 1 mg
2. Background infusion rate: 1 mg/hour (optional)
3. Hourly maximum: 10 mg
4. Lockout: 6 minutes
2. Hydromorphone (Dilaudid)
1. Boluses: 0.1 mg
2. Background infusion rate: 0.1 mg/hour (optional)
3. Hourly maximum: 1.5 mg
4. Lockout: 6 minutes