Would you give PRN percocet and scheduled Oxycodone together?

[lunaro16]

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?

[TheCommuter, BSN, RN]

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?

Are we referring to controlled release oxycodone (a.k.a. Oxycontin)? If so, I would give them together because it is going to take some time before the controlled release med kicks in and does its job. In addition, many of our patients have a high tolerance to these medications, so giving them together will not have much of an impact. As always, watch the respiratory rate.

[inchii]

TheCommuter is right. If it is the extended release Oxy, I'll give them at the same time. If it is the instant release Oxy, I'll give them separately.

[Pangea Reunited, ASN, RN]

It's difficult for me to believe that the two pain medications given were the cause of the patient's problems ...especially if she was known to be very tolerant. I would be suspicious that she'd taken a little something extra- on her own.

And yes, I would give both under some circumstances.

[TheCommuter, BSN, RN]

I would be suspicious that she'd taken a little something extra- on her own.

Yes, unfortunately. In my personal experience, many of these patients keep pain meds that were obtained from the streets stashed in their rooms. Also, many are addicted to heroin, and they like Oxy since it gives them the same euphoric feeling.

[SoldierNurse22, BSN, RN]

Depending on what she was admitted for and her pain level, yes, it could easily be acceptable to give both meds together, even if the Oxy was a short-acting drug. I used to work inpatient oncology. You'd be amazed at the level of tolerance people can develop to these drugs. I went through three (3) 50mg-bags of morphine in a single shift on a terminal breast cancer patient one night. But that's what happens when you've been on morphine for the past 5 years.

[lunaro16]

What the nurses had done before was giving the oxycodone CR and about 1 or 2 hours later give the percocet and she didn't have any problems, until this time that they were taken together. Maybe she did have something extra on her own, she has been managing her chronic pain for years now.

Thank you for sharing your thoughts!! I was curious. I will keep this in mind :)

[mrsboots87]

I'm a first block student who likes to read the regular boards to learn about stuff, so sorry if this sounds dumb. But, isn't Percocet just oxycodone with acetaminophen? So giving them together would be an overdose, or is generic oxycodone that is not quite the same? We have only had minimal lecture on analgesics so far, so I haven't learned this yet.

[adamRn79, BSN, RN]

I wouldn't give together. It's the same narcotic.

[MunoRN, RN]

I'm a first block student who likes to read the regular boards to learn about stuff, so sorry if this sounds dumb. But, isn't Percocet just oxycodone with acetaminophen? So giving them together would be an overdose, or is generic oxycodone that is not quite the same? We have only had minimal lecture on analgesics so far, so I haven't learned this yet.

Percocet is a trade name for ocycodone/acetaminophen combinations.

An "overdose" is not really a well medically defined term, but in general refers to the effects of a dose, not the size of the dose itself; 10 mg might produce effects which might be referred to as a "overdose" in one patient, but might have little effect in another patient.

[MunoRN, RN]

What the nurses had done before was giving the oxycodone CR and about 1 or 2 hours later give the percocet and she didn't have any problems, until this time that they were taken together. Maybe she did have something extra on her own, she has been managing her chronic pain for years now.

Thank you for sharing your thoughts!! I was curious. I will keep this in mind :)

It's quite possible the same thing happens at home when the patient takes them herself (RR down to 7 and SBP down to 90), they just now happen to have someone checking these things while they are taking it.

The general rule is that it depends on what the MD(s) intended when writing the order(s). With CR oxycodone it's very possible the MD was aware they'd be taken together, since oxycodone CR is typically ordered with a frequency that will provide continuous effect, so there would be no time where the oxycodone CR was no longer having any effect where the percocet could be given. It's not unheard of to see percocet ordered along with oxycodone CR in order to provide baseline as well as above-baseline pain control.

It's also possible however that they weren't intended to be given together and are potentially unsafe to be given together, such as when the two orders come from two different docs, if the percocet is an oderset default and the CR dose order came from a med rec, etc.

The main thing is there is no way to say that it's safe or not safe, it's too variable from one patient to another.

[OneDuckyRN]

If the patient was known to be opioid tolerant, and the scheduled oxycodone is extended-release, then yeah, I would most likely give both at the same time, unless the pt's respiratory rate and BP were already on the low side. I've done it before and not had problems, so I would also be suspicious of self-medicating.

If there's a concern that the combination might lead to an adverse reaction, I would probably give the short-acting percocet first, then wait an hour or so to give the extended-release, and explain to the patient why I am hesitant to give both at the same time. Just a thought.