What are your common psych prn meds?

[lovinghands]

Recently there was a thread about a shortage of liquid thorazine and it made stop and wonder what are the commmon psych prn meds you administer in your facility? I work in a midwest state hospital on an adult psych unit, rarely do you we give thorazine unless all else fails (only one doc prescribes it). For p.o. meds we generally usually ativan or seroquel, occasionally haldol. IMs are generally zyprexa, geodon, plus ativan or haldol & ativan. Just curious what you use and the type of population you work with...

[HeyFraydo]

Recently there was a thread about a shortage of liquid thorazine and it made stop and wonder what are the commmon psych prn meds you administer in your facility? I work in a midwest state hospital on an adult psych unit, rarely do you we give thorazine unless all else fails (only one doc prescribes it). For p.o. meds we generally usually ativan or seroquel, occasionally haldol. IMs are generally zyprexa, geodon, plus ativan or haldol & ativan. Just curious what you use and the type of population you work with...

Clonidine for aggressiveness, Ativan, Klonipin, Haldol, Seroquel , Benadryl for pregnant women (anxiety , sleep), Ambien for sleep, Trazadone for sleep,

[TitaniaSidhe]

NE - USA

Ativan-Haldol-Cogentin IM 2/5/1mg initially then Haldol/ Ativan 3/1mg Q 1hr til sedated for those very out of control situations.

Trazadone or benadryl for sleep, occasionally ambien but not so much.

Oral PRN meds would depend on the neuroleptic the patient is on, usually it is the same.

For agitation or anxiety most frequently ativan or vistaril.

[Acephalic]

NE - USA

Ativan-Haldol-Cogentin IM 2/5/1mg initially then Haldol/ Ativan 3/1mg

Trazadone or benadryl for sleep, occasionally ambien but not so much.

Oral PRN meds would depend on the neuroleptic the patient is on, usually it is the same.

For agitation or anxiety most frequently ativan or vistaril.

HAC stood for haldol 5mg ativan 2mg and cogentin 2mg.

Benadryl seems to be the wonder drug to me as far as psych is concerned as it is supposed to be light on the liver and has a max dd of 300mg? Does anyone know benadryl impeads the pt's recovery in some way with regards to anti psych meds?

[Birdie RN]

Trazodone for sleep is real common order.

Klonopin, ativan prn anxiety.

Almost never benadryl but I work in oupatient setting.

[SusanJean]

I worked in an out-pt setting -- a goal was to reduce the number of psych hospitalizations. Had one psychiatrist, that regardless of pt hx or how floridly psychotic the pt was, prescribed Stelazine 2 mg.

Needless to say, when possible, we would pick and choose who we took the pt to depending upon need...:chuckle

[Karina212]

I also saw the thread on thorazine and was suprised to find that not many places use IM thorazine. I have been working in child psyche for almost 3 months and the docs prescribe thorazine prn po or IM all the time....and unfortunately the kids get it quite often. What do you guys think about this?

[SusanJean]

1. Older doctor?

2. In my experience, this is used when you want more sedation, less anti-psychotic effect. (vs some of the "low dose" agents.)

[Meraki]

for the first four years i worked on my floor (child/adol psych) every patient was admitted with standing prn orders for aggression - thorazine po/im 50-100 mg + 2 mg ativan, anxiety - ativan 2 mg and sleep trazodone 50-75 mg.

then we got a new doctor...and now the standing order is

olanzapine (zydis) 5 mg if refuses then thorazine 50-100 mg

ativan 2 mg and either trazodone or zopiclone for sleep

[chad75]

Its varied from facility to facility I have worked in. One of the most common though is the infamous 5 or 10 and 2, Haldol and Ativan. I have noticed as of late alot of facilities are switching to Injectable forms of Zyprexa, which looks exactly like the zyprexa zytis tabs in little vials. Its a pain in the butt if you are in a hurry because you have to reconstitute it adding a couple minutes to the whole process (or longer if your med rooms is unorganized and you can never find the vial of NS lol), which doesn't sound like much...but I'm sure you all know 2 minutes is an eternity when you have several nurses/techs *assisting* an out of control person from hurting themselves, someone else or whatever happens to make a handy projectile on the unit.

Haven't used a whole lot of injectable CPZ, but once in a while a physcian will order it or I will work in a facility that uses it as its primary form of pharmecutical intervention.

[nurseratched]

I work in an acute psychiatric state hospital with adult patients. Many of our patients are repeat admissions; so, the psychiatrist is very familiar with them. He usually prescribes prns that have been effective for that patient in the past. Typically, we use lorazepam, zyprexa, haldol, thorazine, and hydroxyzine.

[Dr. Boot]

I'm from Toronto, in ACU. We are generaly using Loxapine 25-50 + 2 Ativan, on occasion Haldol 5 or Nozinnan up to 100.