Would you give PRN percocet and scheduled Oxycodone together?

Nurses Medications

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I saw one patient receive PRN percocet and his scheduled Oxycodone PO at the same time. She is VERY dependent on this narcotic. Would you give these two meds together? Or would you give the scheduled oxycodone and later give the PRN, even if the patient asks to take them together?

After taking both at the same time, the patient's BP decreased to 90/60, and respiration rate decreased from 20 to 7 breaths per minute, her O2 sats were 88% on 2L of oxygen. She became +++somnolent and it was very difficult to wake her up, she would fall asleep right in the middle of a conversation. If her respirations dropped to 6 per min, the nurse would have called code 66. She was given narcan and was fine after all.

Obviously she had an overdose, but, would you normally give these two meds at the same time if the patient asks? Do you consider this a "bad" nursing practice?

Specializes in Emergency Nursing.

I have given Oxycontin and Oxycodone together before for patients that have been receiving Oxycontin chronically that are experiencing acute pain.

For example, a patient has been taking Oxycontin 10mg q12h for 2 years for low back pain. Patient is currently hospitalized for an ankle fracture that was surgically reduced yesterday. The MD orders Oxycodone 5mg for moderate to severe pain s/t fracture.

Patient reports 5/10 pain to right ankle and requests prn with 9am meds prior to physical therapy at 930. VSS, I give both meds at 9am. The Oxycontin is for the back pain, the ankle pain is above and beyond the chronic pain and should be medicated.

Specializes in FNP, ONP.

Oxycontin is tamper resistant and cannot be broken, chewed or dissolved.

I'd probably not hesitate to give them together, but much would depend on circumstances unspecified in the narrative.

Depends on a lot of factors. In an opioid tolerant pt whose baseline is the scheduled oxy, who is in with something that increases pain, yes I would consider giving them together. It would depend on her current status, her history, her disease process, what she had previously been taking, but yes, under certain circumstances, I would give those two together.

Specializes in Acute Care - Adult, Med Surg, Neuro.
Oxycontin is tamper resistant and cannot be broken, chewed or dissolved.

I'd probably not hesitate to give them together, but much would depend on circumstances unspecified in the narrative.

This is interesting! I'm not doubting you, but I'm curious to know how this is achieved. Where I work, Oxycontin appears to be just a regular looking pill. Of course, I've never tried to crush or tamper with it!

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
This is interesting! I'm not doubting you, but I'm curious to know how this is achieved. Where I work, Oxycontin appears to be just a regular looking pill. Of course, I've never tried to crush or tamper with it!
Once upon a time, addicts on the streets were crushing Oxycontin ER, dissolving it with tap water, cooking it with a bent spoon over a lighter and slamming it into their veins. In the past, Oxycontin ER became an immediate release drug if a person crushed, chewed or dissolved it because the pill's outer coating was destroyed.

A few years ago, the drug companies reformulated Oxycontin ER so that it is rendered ineffective if crushed, chewed, pulverized, cooked, dissolved, or otherwise cut.

Specializes in Complex pedi to LTC/SA & now a manager.
This is interesting! I'm not doubting you, but I'm curious to know how this is achieved. Where I work, Oxycontin appears to be just a regular looking pill. Of course, I've never tried to crush or tamper with it!

It's not the same delivery system but if you look at Concerta that may give you an idea

It's protocol on my unit not to give the same pain meds together. With a dependent patient I doubt it would have hurt anything and in the mentioned case I'd highly suspect the patient of self treating. I might give together if the order was very specific but otherwise I try to keep any pain meds sedation things seperate by least an hour. I find that even with the dependent patients it forces them to be little more honest about the amount if relief. And in a lot of cases throne is all they need

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