End result efficacy P.O. vs I.M. PRNs like Haldol / Ativan

[adnrnstudent, ASN, RN]

I understand that an IM injection of Haldol may have a quicker onset.

If a patient requests a PRN for say low-voices and they are not acting out, I encourage them to take PO over IM.

A 5mg Haldol PO should be as efficacious as a 5mg IM injection, correct?

Same true with 2mg Ativan? I really encourage PO here with my heroin users, but just want opinions if the efficacy the same, just slower to hit.

[Orca, ADN, ASN, RN]

It depends upon the context. If you are dealing with a severe acute issue, IM is the choice. If there is no immediate crisis, PO. I haven't run into any situations when I had to choose between the two, to be honest. I had orders for one or the other, not both.

[adnrnstudent, ASN, RN]

Our standing orders allow us to chose between PO or IM.

Yeah, in a severe acute issue I would chose IM for speed of onset.

I just want to make sure that a PO Haldol or Zyprexa or whatever is no less efficiacious than an IM besides the speed of onset.

[Meriwhen, ASN, BSN, MSN, RN]

I've had the PO/IM choice in some of my orders. The MDs would leave it up to the nurses to use our judgment.

If I believe that there's any reason that a patient WON'T get and keep a pill down (nausea, vomiting intentional or otherwise, cheeking, spitting it out, psychosis), then I'm going for the IM regardless of patient preference or CD history. That way I know the medication gets in them and stays in them.

[wingding]

When pt. is hearing "low voices" I usually choose a Zyprexa first - Haldol & Ativan more for agitation. Anyone else? I use the IM for when they need it now & if they are not too bad I go with PO.

[NurseJamie8]

In my facility we do Po meds then if they refuse the meds and are aggressive and a real danger, we then call the MD and get the order for IM meds.

[Umberlee]

Usually our orders state IM or PO. I'm relatively new to acute psych but I was just wondering this tonight as we treated a patient who was extremely psychotic but did agree (for me only) to take PO meds (haldol and ativan). I was wondering if we should have just tried to get IM meds down her, if the PO would be less effective overall than shootin' her up as I had a pt last week who needed geodon and I found that oral geodon's bioavailability is only 60% compared to 100% IM. But it looks like for haldol and ativan route just affects the peak time, not the bioavailability.

[Meriwhen, ASN, BSN, MSN, RN]

Usually our orders state IM or PO. I'm relatively new to acute psych but I was just wondering this tonight as we treated a patient who was extremely psychotic but did agree (for me only) to take PO meds (haldol and ativan). I was wondering if we should have just tried to get IM meds down her, if the PO would be less effective overall than shootin' her up as I had a pt last week who needed geodon and I found that oral geodon's bioavailability is only 60% compared to 100% IM. But it looks like for haldol and ativan route just affects the peak time, not the bioavailability.

IMO if you have a patient willing to take meds PO and you feel confident that they will keep the pills down, then give them PO. It's better to go the less invasive route if possible. It's also more comfortable for the patient, as IMs can hurt for quite a bit, especially Ativan.

Also, one of the reasons that psych patients act out is because they feel like they've lost control. Giving them the choice of how they'll take medication (PO vs IM) makes them feel like they do have some say in the matter and can help bring them under control better. But that's not an option for every patient...that judgment call comes with experience.

AFAIK the efficacy of PO and IM should be the same. IM may work somewhat faster, but we're not talking drastic speed differences. IM has the advantage of that the medication will stay where it's supposed to--in the patient.

In my experience, the effectiveness is the same; speed of onset is the primary difference.

The nice thing about the Zydis formulation of olanzapine is that, like Zofran ODT, it dissolves and is absorbed buccally so cheeking isn't a concern. I wish there were an ODT form of Haldol or Geodon.

I'm in the ED so we're generally dealing with acute agitation and psychosis. We usually start out with IV or IM meds and progress to PO over time.

[bymysoul2squeeze]

I would say its all about how fast do you need them to work. Most of the orders I get for prn Haldol say if refuses give IM. One in a while there is a patient that likes to get injections and refuses it on purpose (some kind of secondary gain, idk) but unless it's an emergency/ crisis I give po