QID PRN, HELP!

JKL33 · Feb 20, 2021

Yes, I know the tartrate/succinate thing; I thought we were talking about the format of the order as per the OP's question.

The spirit of what you wrote in your #2 is exactly the way the order was written as told by Muno; you wrote the word "for" instead of "PRN," but in the context "for" means exactly the same as PRN. The format you wrote is a PRN order in spirit. The use of "PRN" in the first order would not in any way prevent the med from being properly given as intended by the ordering provider; it can only mean one thing.

sleepwalker, MSN, NP · Feb 21, 2021

2 hours ago, JKL33 said:

Yes, I know the tartrate/succinate thing; I thought we were talking about the format of the order as per the OP's question.

The spirit of what you wrote in your #2 is exactly the way the order was written as told by Muno; you wrote the word "for" instead of "PRN," but in the context "for" means exactly the same as PRN. The format you wrote is a PRN order in spirit. The use of "PRN" in the first order would not in any way prevent the med from being properly given as intended by the ordering provider; it can only mean one thing.

no...I was indicating that it was dangerous the way the drug was ordered. I'm not interested in the "spirit" of the order. The way I wrote the order is not the same...the drug is dosed properly so that it's no longer being prescribed in a dangerous manner as per my original reply: "This Physician is a moron and is going to end up killing someone writing orders that way"

You're choosing to focus on the term "PRN"...I chose to focus on the dangerous aspect of the order

JKL33 · Feb 21, 2021

7 minutes ago, sleepwalker said:

You're choosing to focus on the term "PRN"...I chose to focus on the dangerous aspect of the order

Okay. I wasn't sure what your #2 was about then.

MunoRN, RN · Feb 21, 2021

4 hours ago, sleepwalker said:

1) the order is for metoprolol succinate...that's an extended release med to be given daily NOT twice a day...nice way to cause an overdose. Metoprolol Tartrate is administered to BID to maintain therapeutic dosing level

2) The order is written as PRN...why? If the med is to be given properly the order should be "metoprolol succinate 50mg PO daily for SBP >90 mmHG (which seems a little low to me but whatever)

55 minutes ago, sleepwalker said:

no...I was indicating that it was dangerous the way the drug was ordered. I'm not interested in the "spirit" of the order. The way I wrote the order is not the same...the drug is dosed properly so that it's no longer being prescribed in a dangerous manner as per my original reply: "This Physician is a moron and is going to end up killing someone writing orders that way"

You're choosing to focus on the term "PRN"...I chose to focus on the dangerous aspect of the order

There's nothing overtly dangerous about ordering metoprolol succinate BID, I would assume (hope) I'm misunderstanding your concern.

The Physician in question was an interventionalist who was part of a cardiology group that more often than not ordered metoprolol succinate (ER) BID, tartrate was typically TID.

You're certainly correct that if the highest dose that is safe for a patient is 200mg q daily, then giving 200mg BID would be unsafe. But giving 100mg BID to that same patient is, if anything, safer, not more dangerous.

Their reasoning was that while metoprolol succinate certainly has less of a sharp peak in duration of action than tartrate, it's also not flat. This can actually be ideal since it can match a patient's increased tolerance of beta blockade during the day, and then less tolerance in the evening and night. But the more pronounced peak of q daily dosing can limit the amount of beta blockade the patient is getting during the rest of that 24 hour period, but splitting the daily dose into BID doses the peak(s) is blunted and the trough is not as low.

If the concern is a beta blocker 'overdose' (excessively high levels during the peak of action), then BID dosing makes that less likely, not more likely.