International journal of clinical pharmacy
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To obtain community pharmacists' opinions of their role in administering Pharmacy (S2) and Pharmacist Only (S3) Medicines in a medical emergency. These medicines can only be sold in a pharmacy and are not available for self-selection by patients. Whilst qualified pharmacy assistants can supply S2 medicines, pharmacists must be directly involved in the supply of S3 medicines. ⋯ Community pharmacists have direct access to S2 and S3 medicines that could be required in the management of a variety of medical emergencies. This study demonstrates that some pharmacists have administered S2 and S3 medicines in an emergency situation. However, there are currently no clear guidelines for pharmacists when faced with a medical emergency other than to act within their professional competence. To promote patient safety through the appropriate use of S2 and S3 medicines in the event of a medical emergency, additional training of pharmacists on the administration of these readily accessible medicines is needed. Clarification of the role of pharmacists in an emergency situation is required.
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We report the case of a patient who presented with unilateral mydriasis after a scopolamine patch application. The specific clinical context (cancer) reported here may have led to the misinterpretation of the etiology of mydriasis. ⋯ Our case description warns against diagnostic mistakes related to this side effect and highlights the advantages of pilocarpine test in the differential diagnosis of unilateral mydriasis.
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Case Reports
Oxycodone induced delirium and agitation in an elderly patient following total right knee arthroplasty.
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. ⋯ 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.