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Manuela Velázquez Prieto
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Jaime E. Poquet Jornet
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Margarita Pamplona
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Tomás Casasín Edo
Virginia Hernández Corredoira
Ramón Jódar Masanés
Juan Carlos Juárez Giménez
Volume 19 - Issue 4, July-August 2017
ORIGINAL
ACUTE CONFUSIONAL STATE: CASE REPORT
HEREDIA BENITO MIRIAM, FRAGA FUENTES MARÍA DOLORES, VALENZUELA GÁMEZ JUAN CARLOS, NIETO SANDOVAL MARTÍN DE LA SIERRA PATRICIA, GÓMEZ LLUCH TERESA, NOTARIO DONGIL CLARA


It is presented a common patient case faced in our daily practice. An elderly frail patient who develops an acute confusional syndrome (ACS). We ruled out medication reconciliation. It was carried out literature search relevant to the topic. The patient is a 78-year-old female admitted to the hospital with a hip fracture. Respect to current home mediation pharmacist recommends: monitoring parameters such as prothrombin time, gradual tapering of alprazolam dose, stop apixaban 36 hour before surgery and non-pharmacologic measures. Concerning
hospital prescription, the pharmacist advices to reduce ketorolac and amitriptyline dose and an alternative opioid/analgesic drug to pethidine. Nevertheless, the physician stops abruptly alprazolam and continues with pethidine prescription and the same dose of amitriptyline. The patient develops an ACS. Pharmacist suggests
anticholinergic drugs discontinuation and low benzodiazepine dose re-introduction along with non-pharmacological measures with a favorable evolution of the patient. Pharmacist contributed providing continuity in individualized pharmacotherapeutic care. The case also demonstrates the benefits of medication reconciliation
and the contribution of pharmacist in the ward.

ACUTE CONFUSIONAL SYNDROME – ANTICHOLINERGIC DRUGS – DELIRIUM



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