Nitroglycerin Rx - SBP<90 written in the sig???

[aboveliquidice]

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Yesterday, consulted on an rx that had "Do not use if SBP<90" in the sig.

You definitely consult on the above - among other things - is it typically written in the sig? It seems like a consult point.

You would think you would put use 1 tab every 5 minutes until relief - if you take 2 and still no relief - call 911 instead...

Just curious what you have all seen.

 

[npage148]

was it the SL tablets or patches/paste?

 

[aboveliquidice]

was it the sl tablets or patches/paste?

sl

 

[Old Timer]

This kind of sig is very common in an institutional setting such as long term care. Hold if systolic blood pressure less than X. I would question the order but without the full sig, the diagnosis in question and other pertinent information it's hard to make a judgment.

 

[Vitamin K]

Keep in mind that the prescriber likely knows this patient better than you do. It may seem like "a counseling point" to you, but what if this particular patient is prone to hypotension and has a hard time remembering where the cutoff is?

 

[aboveliquidice]

This kind of sig is very common in an institutional setting such as long term care. Hold if systolic blood pressure less than X. I would question the order but without the full sig, the diagnosis in question and other pertinent information it's hard to make a judgment.

Checking EPIC reported unstable angina - SBP at last contact was 119. It seemed like an instruction for the medical / pharmacy team - but the Rx was from an out-of-system referral. I am interning at Kaiser Perm. in Oregon.

I simply rolled the SBP into the consult - and discussed pt monitoring of BP - just curious what others are seeing - this was the first nitro consult I have done.

 

[grizzlesgrizzlies]

seems like a LTC type of comments for me too.

many orders for anti-HTN meds include monitoring parameters such as SBP, pulse, etc.

 

[FORTLIVINGROOM]

Seems like one of those deals where they were supposed to give the pt an Rx for discharge, but gave them the Rx order from the hospital system that when printed included the communication order. We'va had a couple pts come in with pieces of paper like that and thought it was a Rx, but all it was is the med list so we had to call the MD for the Rx. Not fun tracking down a resident in the hospital.

I've never seen a Rx in the community with a sig like that....hospital...everyday.

Don't know any pts who check their BP before taking their med...but I guess it could happen.

 

[Old Timer]

Checking EPIC reported unstable angina - SBP at last contact was 119. It seemed like an instruction for the medical / pharmacy team - but the Rx was from an out-of-system referral. I am interning at Kaiser Perm. in Oregon.

I simply rolled the SBP into the consult - and discussed pt monitoring of BP - just curious what others are seeing - this was the first nitro consult I have done.

So, is this an inpatient order or an outpatient order? Is the patient taking any long acting nitrates or any other vasodilator that would tend towards hypotension? Is the patient on a beta blocker? If this is outpatient, what is there history of NTG use? If this is inpatient it is a normal order that should not be questioned perse, but I would question why a patient with unstable angina would not be on a more aggressive medical regimen.

 

[rxforlife2004]

Yesterday, consulted on an rx that had "Do not use if SBP<90" in the sig.

You definitely consult on the above - among other things - is it typically written in the sig? It seems like a consult point.

You would think you would put use 1 tab every 5 minutes until relief - if you take 2 and still no relief - call 911 instead...

Just curious what you have all seen.

If you are a patient and you're experiencing a chest pain, would u have ti me to measure your blood pressure and see what the current SBP? Even if you know ur previous SBP is <90 in the morning and now at 5PM you have CP, would you still take a chance NOT taking the NTG? It would be dumb if you do so. Bottom line, tell the patient that take it when you have chest pain. Keep in mind that when pt has chest pain, it could lead/develope to acute MI, which can be fatal if you don't resolve/relieve the angina in the first place.

The idea is that taking NTG will lower your BP and that is also clinically bad. However, choosing between slowing down the progression of an MI vs. risking decrease BP, i would definitely go with the first case. Decreasing in BP can be resolved quickly and easily with a bunch of IV drips (levophed, dopamine, etc..).

 

[aboveliquidice]

Outpatient setting... It seemed like it didn't belong there - but was clearly written in the sig. In the end, it didn't appear to take away anything from the Rx - and I consulted on the Take as Directed portion and what SBP < 90 meant. Thanks for the responses 👍