1st March 2024

A 58-year-old man has been admitted with severe left flank pain, nausea and fever.

DATE	DRUG NAME	DOSE	ROUTE	FREQUENCY	Prescriber’s signature
08/04/23	Ramipril	10mg	Oral	Once daily	DR
08/04/23	Atorvastatin	20mg	Oral	Once daily	DR
08/04/23	Cyclizine	50mg	Oral	PRN	DR
08/04/23	Diclofenac	50mg	Oral	Twice daily	DR
08/04/23	Morphine	25mg	Oral	PRN	DR
08/04/23	Paracetamol	1g	Oral	PRN	DR
08/04/23	Tinzaparin	3500 units	SC injection	Once daily	DR
08/04/23	Ciprofloxacin	500mg	Oral	Twice daily	DR

A 58-year-old man has been admitted with severe left flank pain, nausea and fever. A diagnosis of renal colic is suspected. His medications since admission are shown above. Over the last 2 hours he has become drowsy and nauseous, and his respiratory rate has decreased from 18 breaths per minute to 11.

Select the one drug which is most likely to have caused this presentation.

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