Content area
Full Text
Int J Clin Pharm (2011) 33:733736 DOI 10.1007/s11096-011-9553-7
CASE REPORT
Oxycodone induced delirium and agitation in an elderly patient following total right knee arthroplasty
Joseph H. Crane Katie J. Suda
Received: 30 March 2011 / Accepted: 7 August 2011 / Published online: 19 August 2011 Springer Science+Business Media B.V. 2011
Abstract Case Opioids are commonly prescribed for pain, and are often connected to mental status adverse events. Delirium is a side effect associated with narcotic analgesics, with a higher incidence in the elderly. This report describes an elderly male that received a total knee arthroplasty and received morphine post-operatively. On post-operative day 2, morphine was discontinued due to mental status changes and switched to oxycodone/acetaminophen. Twenty-four hours after administering oxyco-done, the patients mental status declined. After the patient returned to baseline he was transferred to rehabilitation and re-challenged with oxycodone/acetaminophen. The re-challenge was inadvertent due to inadequate documentation of the adverse event and lack of understanding by the health care team of delirium associated with opioids. A similar rapid decline in mental status occurred. Conclusion Clinicians should be cognizant of narcotic analgesics inducing mental status changes, even with an alternative. Detailed documentation of adverse events should occur to avoid accidental re-challenges.
Keywords Adverse drug reaction Delirium Medical
error Morphine Oxycodone
Impact of ndings on practice
Opioids are commonly prescribed medications for moderate to severe pain, and are often connected to mental status adverse events, with a higher incidence in the elderly population following surgery.
Typically delirium induced by morphine has been treated with oxycodone; however there is still a risk of drug-induced mental status changes.
Clinicians should be cognizant of the possibility of multiple opioid narcotic analgesics inducing mental status changes, even when switching to a less potent alternative agent.
Introduction
Delirium can arise from a precipitation of multiple issues or as a complication from an adverse drug reaction [1]. Oxycodone is a commonly used opioid narcotic analgesic for moderate to severe pain. It has agonist activity on mu, kappa, and delta receptors and has been linked previously to fewer adverse events and toxicity than morphine [2]. Delirium, a common side effect of analgesic agents, is connected to acute mental status changes that are exemplied by loss of attention and altered levels of consciousness [3,...