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Discussion

PRN and HS ordered together

Hi all!

Quick question that I'm likely over thinking- just looking for others input. I have an order for 0.25mg HS alprazolam and an order for PRN 0.25mg alprazolam for anxiety- should the pt. Require a PRN at 1400, does that mean the soonest they could receive their HS alprazolam would be 2200 or would they receive the HS med regardless? Would you hold the HS med should the PRN still be providing good relief of s/s? what if the order is written together, like- "0.25mg alprazolam HS and PRN q8H for anxiety"?

Would so appreciate any and all input, thank you!

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    You're overthinking.

    The time span between a 1400 dose and a 2200 dose is adequate.

    I would not hold the HS dose, as that is scheduled for that time for a reason. The patient may have anxiety that interferes with falling asleep, plus it may help the patient relax.

    Doctors take into consideration what is scheduled when they order PRNs. As long as it does not exceed the daily dose limit and is not given right on top of the other (and 0.25mg is a smaller dose anyway), the patient will be fine.

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    I would give the HS dose even if the patient required the PRN dose very recently, because 0.25 is a small dose. So for example, if the patient required a prn dose at 2000 and the HS dose is for 2100, I would still offer it, even though the pt just had a prn dose 1 hour before. Because 0.50 is not even a large dose, it's more like a medium/low dose. But I would give the pt a chance to refuse.

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    0.25 of alprazolam? What a cute dose.

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    If they need the PRN, they need the PRN, I dont' hold a scheduled med because I give a PRN med. If it were in the window I'd count the PRN as the scheduled but if no relief after an hour I'd give another dose, if that makes sense. If I feel like the PRN has made them overly sedated then I'd hold the scheduled but otherwise I give it.

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    They are two separate orders, and it's not like Tylenol where there is an established safe upper limit. To use the Tylenol example, say they have 1000 mg scheduled at HS, but they had 1000 mg 2 hrs before as a prn -- 2000 mg in 2 hrs is not a safe dose. 0.5 mg of alprazolam is a small dose --

    cute even, as CKPM2RN said. ;)

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