Handy PRN Meds

Discussion in 'Family Medicine' started by dj_smooth, Dec 1, 2005.

  1. dj_smooth

    dj_smooth Member
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    Doing inpatient right now and was wondering if anyone had some good prn meds that will help keep call nights a little more quiet and fewer worthless pages from nurses. I've sort of heard that you should always write something for pain, sleep, and bowels...anything else?
     
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  3. sdn1977

    sdn1977 Senior Member
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  4. Neurodropout

    Neurodropout Member
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    Other PRN stuff that I've found useful in my inpatient rotation:

    BP/Pulse control with for those anxious cardiac patients
    Nausea/Vomiting
    Sliding Scale if they are diabetic and don't already have one.
     
  5. NuMD97

    NuMD97 Senior Member
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    Tessalon Perles for cough. Saved me from losing a night's sleep. :)
     
  6. Anath

    Anath Senior Member
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    Ativan is always a favorite, especially with the nurses who will often find any excuse to use it to keep *their* nights quiet. Cant always blame em but heavily abuse. :p And if ya dont write for ativan, they'll call you and bug ya till ya do.
     
  7. gherelin

    gherelin Member
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    Lodine-NSAID no one has ever heard of, when you don't want to give narcs to a drug seeker and no GI or renal problems
     
  8. Blue Dog

    Blue Dog Fides et ratio.
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    Here's something I found in my Treo, left over from my intern days. It might help. As always, use at your own risk. "I accept no responsibility..." etc., etc., etc., yada-yada-yada, blah-blah-blah. ;)

    Service Medicine On-Call

    Agitation:

    Ativan 0.5-2.0 mg IM/PO q6-8h

    Haldol 1-5 mg IM/PO q4-8h


    Constipation:

    Dulcolax 10 mg PO/PR PRN

    Colace 100 mg PO BID PRN


    Indigestion:

    Maalox Plus 30 cc PO

    Riopan 30 cc PO

    (R/O CP of cardiac origin)


    Nausea:

    Inapsine 1.25-2.5 mg IV q4h

    Phenergan 12.5 mg IV or 25 mg IM


    Insomnia:

    Ambien 5 mg PO qHS PRN, may
    repeat x1 (best choice)

    Benadryl 25-50 mg PO qHS PRN
    (don't use if BPH present)

    Restoril 15-30 mg PO qHS PRN
    (don't use in elderly)


    Hypokalemia:

    KCl PO or 10 meq KCl in 100 cc NS
    over 1 hour, max. dose 40 meq

    (don't fluid overload if CHF
    present)


    Hypomagnesemia:

    2 grams MgSO4 in 100 cc NS over 1h


    Hyperglycemia:

    Sliding scale insulin

    200-250 --------> 2 units reg.

    251-300 --------> 4 units reg.

    301-350 --------> 6 units reg.

    351-400 --------> 8 units reg.

    >400 ------------> 10 units, call HO


    Hypoglycemia:

    Orange juice or skim milk, recheck.

    If no change, give 1 amp. D50


    Fever:

    Tylenol, blood cx. x2, U/A w/C&S,

    CXR, sputum cx.


    Chest Pain:

    EKG, VS, SL NTG, O2, +/- CXR


    SOB:

    O2, ABG, EKG, CSR, VS, SMA-7,

    H/H if anemia suspected


    Fall out of bed:

    Check for LOC, VS, obvious inj. (lacs, fx.), meds (anticoagulants, seizure meds), neuro exam. May suggest siderails up, posey, night light.


    Dobhoff Tube:

    Should be in stomach or duodenum (best placement). If in stomach, can give Reglan 10 mg IV and lay on left side for 30 min. then recheck KUB.


    ET Tube:

    Placement should be 1-2 cm above carina. Always check a CXR after intubation.


    Death Pronouncement:

    Check for response to painful stimuli, heart sounds, carotid pulse, spontaneous respiration, pupils fixed and dilated. Record findings and time of death. Notify attending and family. ?Autopsy if appropriate. Have family leave the room when pronouncing.


    Misc:

    If you order an ABG, always order an SMA-7.
     
  9. tridoc13

    tridoc13 SDN Donor
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    Awesome! Thanks, Kent. :)
     
  10. DrQuinn

    DrQuinn My name is Neo
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    Keep in mind that phenergan has never been FDA approved for IV use... and there are more than a handful of lawsuits about giving phenergan.

    Now that compazine is back on the market (there was a huge national shortage), that is probably the safest antiemetic out there... that is cheap, anyways.

    Q
     
  11. DOtobe

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    When I did night float I put in so many orders for Tylenol and Ambien I felt like buying a cart of both of them and just pushing it around the hospital.

    Also put in a lot of Ativan (I'm stingy - 0.5 mg IV X 1), morphine 1-2 mg IV, Zofran (why am I blanking on the dose? 8 mg?)

    And if the nurses can push it (comes in handy with ICU/cardiac pts), Lopressor 5 mg IV q6hrs prn for BP (we usually do SBP > 160), hydralazine 10 mg IV prn, Vasotec 1.25 mg IV prn. Our floor nurses can only push Vasotec, but the unit nurses can push any IV bp med.

    And if DT's get out of control...Haldol 5 mg.

    Other pearl I learned from night float - on any lethargic pt, check an ABG.
     
  12. ramonaquimby

    ramonaquimby I'm a PGY3?! WHAT?!
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    great thread, guys! :)

    thanks!
     
  13. ramonaquimby

    ramonaquimby I'm a PGY3?! WHAT?!
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    bumping for july's interns! ;)
     
  14. tridoc13

    tridoc13 SDN Donor
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    Thanks! Man, I'm starting to get nervous!!! July 1st isn't that far away and I've been out of school for a month already. Time to start reading!!!
     
  15. Bender

    Bender Junior Member
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    bumpety bump
     
  16. DOtobe

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    An addendum to my post above...

    Before you order Haldol on ANY patient, check an EKG for the QTc. Torsades is not good for patients...

    Also, regarding ET tube placement - I always have trouble seeing the carina, so I was taught that if the ET tube is at the level of the aortic knob (which is a lot easier to see!) then it is in the proper place.
     
  17. Blue Dog

    Blue Dog Fides et ratio.
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  18. rn29306

    rn29306 Drugs are bad, m'kay?
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    Forget Haldol - too short duration.

    IM Geodon man.
     
  19. DOtobe

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