Allergy nasal sprays in LTC

[ChargerSRT]

Advertisement - Members don't see this ad

I am new to nursing home consulting. It seems that 50% of all residents in my nursing homes are on Flonase or another allergy nasal spray. Most likely they had a sniffle for a couple days and the doctor put them on the nasal spray for life. I want to suggest an appropriate duration of therapy to the doctor, but the packet insert for Flonase says "Greater symptom control may be achieved with scheduled regular use." "Maximum effect may take several days. (4-7 days)." "Symptom relief starts as soon as 12 hours."

My opinion: Change scheduled Flonase to PRN. Start at onset of symptoms and continue for only 2 weeks. If patient then needs a second treatment within the next 2 weeks, change back to daily scheduled dosing.

I cannot find any other professional opinion.

Thank you.

 

[WagsTale]

I think you're on the right track asking for a discontinuation of therapy if needed. Since you also have access to the patient's chart, maybe you want to check to see if chronic rhinitis or seasonal allergies were ever diagnosed. You may even want to leave a note to the physician asking him/her to make a diagnosis specifying if the medication is being used for chronic or just seasonal allergies. If seasonal, then I'd modify your suggestion to use therapy for 1 month. If after discontinuation the symptoms recur, continue for another month....etc.

If a chronic diagnosis is made, well then that'll be the end of that.

 

[Old Timer]

Without a diagnosis, I would hard pressed to be able to evaluate the appropriateness of the therapy. Could be necessary, but who knows. The diagnosis should be on the chart. If it's seasonal than when the season is over the drug should be D/C'd. If it's for an acute sinus condition it should be short term. If a whole bunch of people have the problem, is there an environmental factor that needs to be evaluated.?

 

[pinkpillowzz]

i dont understand how flonase would be PRN. the corticosteroid mechanism for which it works for allergies and asthma takes days for it to work. it's not like taking a claritin. to be effective, and to continue working, it has to be used everyday.

i just can't understand prn..