title: Oxycodone induced delirium and agitation in an elderly patient following total right knee arthroplasty.
abstract: METHODS
  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 oxycodone, the patient's 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA. jcrane2@uthsc.edu
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Crane
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Suda
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D017109:Akathisia, Drug-Induced / Q000523:psychology*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology; D003693:Delirium / Q000139:chemically induced* / Q000523:psychology; D004338:Drug Combinations; D006801:Humans; D008297:Male; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011595:Psychomotor Agitation / Q000523:psychology*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D004338:Drug Combinations; D000082:Acetaminophen; D010098:Oxycodone