Patient is requesting PRN Xanax with PRN Ativan at the same time..Is that allowed?

[Dunno?]

I have a patient..In his MAR, the doctor said that he can have PRN Xanax for anxiety..Also in the MAR, the doctor says that he can have PRN Ativan for anxiety..I know that they both are anti anxiety drugs..The patient requested both at the same time..I refused telling him that it is not allowed and he started to yell and scream at me because he says it is allowed and his mom says it is okay to do it..But I am thinking that it cannot be since they are both anti anxiety drugs and cannot be both given at the same time..

What are your thoughts?

[SICU Queen]

I've given them together plenty of times.

[Virgo_RN, BSN, RN]

...rather than tell the patient "it's not allowed" end of discussion, I would have said "let me check into this and I'll be right back".

I noticed this too. I would not recommend telling any patient this unless you know for a fact that it isn't allowed. You don't know that.

If I were the patient and this is how I took my meds, and you told me "it's not allowed", I might be a bit annoyed with you too.

This could very easily be his regular medication regimen as prescribed by the doctor. Better to clarify first.

[Virgo_RN, BSN, RN]

Maybe-& this is just a thought-the Dr wants to combine a short-acting strong BZD (alprazolam) for like HS orhigh-stress situations & an intermediate-acting weaker BZD (lorazepam) for maintenance anxiety prevention for longer periods; since both are BID PRN that may be a way to reduce using a strong BZD QID. Since either can be used up to TID/QID it is not an overdosage of BZDs but rather a way to reduce stronger drug while achieving proper anxiety control...but still should be rechecked...

This makes a certain amount of sense. The duration of action of Xanax is up to 24 hours, while Ativan is 8-12 hours. Their onset of action peak effects are also staggered. Given together in low dosages, I don't see the harm unless the patient has liver or renal impairment.

[jackson145]

Maybe-& this is just a thought-the Dr wants to combine a short-acting strong BZD (alprazolam) for like HS orhigh-stress situations & an intermediate-acting weaker BZD (lorazepam) for maintenance anxiety prevention for longer periods; since both are BID PRN that may be a way to reduce using a strong BZD QID. Since either can be used up to TID/QID it is not an overdosage of BZDs but rather a way to reduce stronger drug while achieving proper anxiety control...but still should be rechecked...

My Doc prescribed me Klonopin and Xanax for this reason.

[crissrn27, RN]

I would have called the doc and checked before giving, but I would not have just told him no, end of story. There might be a really good reason he is getting both at the same time, and if he takes it regularly, he might go in to withdraw without it, even at this low of a dose. Seizures are no fun, and benzo withdraw can kill.

[leslie :-D]

if his mom had confirmed he had been taking this all along, i would have given it.

you can always check w/the doctor, later.

but why would you abruptly stop one's regular regimen, when there are no blatant contraindications?

leslie

[CrispyRN]

You don't want them bothering you do you??? Give it!! Have a restful day!! Ha Ha!!

[Dunno?]

He had PRN Xanax and PRN Ativan for more than 5 or more years together and it was in the MAR for that long..His mom gives it to him like that together..

[Virgo_RN, BSN, RN]

I'd give it.

[EmmaG, RN]

He had PRN Xanax and PRN Ativan for more than 5 or more years together and it was in the MAR for that long..His mom gives it to him like that together..

You don't want to change that routine, especially in someone who's been taking those drugs for that long.

[Tweety, BSN, RN]

if his mom had confirmed he had been taking this all along, i would have given it.

you can always check w/the doctor, later.

but why would you abruptly stop one's regular regimen, when there are no blatant contraindications?

leslie

People, family members aren't always compliant in following their ordered medication regimes, nor honest either. I still wouldn't have been 100% comfortable.

I can think to two family members on my floor right now that drug up their adult children to the point of being in a narcotic addicted stupor. It's sad. They are frequently asking for medication for their kids and the nurses assessment finds them quite sedated.

Agree, though that since the op has returned to say it's been his regime for 5 years, there is definately no need to change it while hospitalized.

[nghtfltguy, BSN, RN]

yup... aint gonna kill him

doc wrote the orders...

clarify...

then dose him if he is uber anxious....

i have a couple of patients in the LTC i do weekend shifts at that get both @ the same time..scheduled... not prn... scheduled...