Question about METOPROLOL!

[xiongmao]

Order:

Metoprolol tartrate 25mg/tab. Give 1/2 tab daily PRN SBP>100 or HR>100.

Patient background:

Paraplegic w/ hx of intracerebral hemorrhage and HTN.

I know the contrainidications for metoprolol are SBP

[MunoRN, RN]

The first problem with the order is that actual dose (12.5mg) appears nowhere in the actual order, the dose in an order should be the dose, not a equation to get the correct dose, but anyway.

It is weird to have it written as a prn, when what it actually seems to order is 12.5mg q daily, hold for SBP 100 regardless of what the BP is, even if it's less than 100.

[Lev, MSN, RN, NP]

xiongmao said:

Order:

Metoprolol tartrate 25mg/tab. Give 1/2 tab daily PRN SBP>100 or HR>100.

Patient background:

Paraplegic w/ hx of intracerebral hemorrhage and HTN.I know the contrainidications for metoprolol are SBP

The part of the order that's weird to me is give for SBP > 100. So does that mean as soon as the SBP reaches 101, you give the med?

[SierraBravo]

I agree with the above comments. For me, this would warrant contacting the provider who wrote this order for clarification before giving the medication. Typically the hold parameters are for SBP than 100. Of course, looking at the PMH, it makes sense why they are wanting to give this med and why they wrote the hold parameters the way they did. However, at the very least the dosage should be clarified and spelled out like MunoRN said. Also, I would be uncomfortable with seeing Metoprolol as a prn; that is not a medication that you want to give someone q1h or on some arbitrary prn schedule. It should be ordered on a schedule with hold parameters.

[psu_213, BSN, RN]

In addition to what others have said re: it being a poorly worded order…is there a frequency? Do I check BP q 4 hours and then give it if appropriate? Q 6 hours? Hourly? When I feel like it? This order should definitely be clarified.

[Been there,done that, ASN, RN]

Definitely clarify. However, the doctor may want to keep the systolic BP

Let us know!

[Nola009]

I think it's bc the pt has IICP. They wanna keep the pressure lower in that case.

[yoga pants]

I mean, while it's not an ideally worded order and not an order I've necessarily seen written before, it makes sense to me, especially considering the pt's history. I'm assuming if this is PRN the pt is already on a scheduled antihypertensive? Especially if they want SBP

[Here.I.Stand, BSN, RN]

The order should be written as a daily med with hold parameters, not as a PRN. Or at least specify the frequency as q 24 hrs, so that he's not getting a PRN at 2200 and another at 0200--one per day, but 4 hrs apart.

Given his hx of ICH, they probably want to keep his BP lower than normal so might not use the typical hold parameter of SBP