seroquel PRN? Any Night Shifters on here?

[storyhill]

I just got an order for seroquel 100 mg po q4hprn racing thoughts/mania?
I've never got an order for seroquel to be given prn nor can I find it in our literature. Is anyone else familiar with this?
I've started working the night shift but am used to having some other pharmacists to bounce ideas off of as I only have a few years experience. If anybody has a better idea than here to interact with other night shift pharmacists let me know. Thanks.

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[rxlea]

I'm just a student...but I've seen a "qhs prn sleep" or something similar.

I am not surprised that it would be used prn especially if the patient is going through being stabilized. Just make sure the patient is on a maintenance mood stabilizer and whatever else and that the seroquel is just an adjunct.

I know some psych docs stay away from BZD and hypnotics in patients with abuse potential (ie manic).

 

[storyhill]

I should clarify. I am aware of using it for prn sleep but not q4hprn for racing thoughts. Thanks for your input.

 

[rxlea]

I should clarify. I am aware of using it for prn sleep but not q4hprn for racing thoughts. Thanks for your input.

Yeah, psych stuff is weird. Lots of off label prescribing/dosing. But from an MOA standpoint, I see why they could use it to "calm the brain" so to speak.

I would ask the patient of they've had it before. My trick is "what did the doctor tell you what this was for?" Depending on the status of the patient, they might be able to tell you. Maybe they had it before too. But I'd hate to let a person with BPD go without their meds until you can talk to the doc. You could always fill and call in the morning.

 

[Sparda29]

Docs at my old LTC facility used to do this a lot. We had to put a stop to it. Blanket ban on using psych meds PRN.

Nurse: Oh, Mr. Smith is getting very agitated when I try to feed him.
Doc: Alright, I'll order some Seroquel PRN.
Us: Nope. Either its every day or not at all.

I'd be getting ****ing agitated too if I had some ugly nurse trying to feed me crappy food while having to share rooms with smelly old people and not getting to stay up past midnight.

 

[rxlea]

Docs at my old LTC facility used to do this a lot. We had to put a stop to it. Blanket ban on using psych meds PRN.

Nurse: Oh, Mr. Smith is getting very agitated when I try to feed him.
Doc: Alright, I'll order some Seroquel PRN.
Us: Nope. Either its every day or not at all.

I'd be getting ****ing agitated too if I had some ugly nurse trying to feed me crappy food while having to share rooms with smelly old people and not getting to stay up past midnight.

Did they state their reasons for a blanket ban other than it's not fda indicated? Was there a therapeutic reason?

 

[rxlea]

OP, you should ask in the psych forum on here. They are a bunch of friendly practitioners.

 

[Sparda29]

Did they state their reasons for a blanket ban other than it's not fda indicated? Was there a therapeutic reason?

Reasons for blanket ban was simply that it wasn't FDA indicated.

Therapeutic reason for the drug? I don't know. I don't consider screaming, throwing stuff, and being angry to be a medical problem requiring treatment. If they have a temper tantrum, just give them what they want. A lot of the docs there were using the psychosis meds to calm down the angry patients or for sedation rather than for legit delusions and hallucinations.

 

[storyhill]

Sorry, I'm not well acquainted with this site. Is there a psych forum within the medical forums or do you mean the psychology forum?

 

[rxlea]

Sorry, I'm not well acquainted with this site. Is there a psych forum within the medical forums or do you mean the psychology forum?

Go into the forum for physicians...under there is psychiatry.

And Sparda, I imagine a LTC would be different because you're dealing with medicare and all that.

EDIT If a
Person with BPD.is going through initial stabilization, I could see the use for it until the patient is stabilized on their primary mood stabilizer.

So I looKed up a bit and the affinities are quite different for the receptors vs other atypicals. Hence the higher incidence of wtgain and other things.

But OP, like I said, I'm just a student. I've had psych on therapeutics and have taken a couple in depth psychopharmacology courses in my previous life 🙂

 

[storyhill]

OP, you should ask in the psych forum on here. They are a bunch of friendly practitioners.

I posted my question on the psych forum a few hours ago and I have no responses with 34 views. I guess they're just the silent friendly type!

 

[Ackj]

Did they state their reasons for a blanket ban other than it's not fda indicated? Was there a therapeutic reason?

Increased risk of death in elderly too. Not great to throw that risk on somebody just for the sake of chemical restraints. And I'm not a big fan of chemical restraints in the first place.

 

[rxlea]

Increased risk of death in elderly too. Not great to throw that risk on somebody just for the sake of chemical restraints. And I'm not a big fan of chemical restraints in the first place.

True. I'm not a fan either. I was reading the new Beers Criteria on that...

Since they can't use BZD (not covered) they're going to shift to other things. Sucks but that's the reality. Our society isn't very kind to our elderly, IMO.

 

[joetrisman]

True. I'm not a fan either. I was reading the new Beers Criteria on that...

Since they can't use BZD (not covered) they're going to shift to other things. Sucks but that's the reality. Our society isn't very kind to our elderly, IMO.

If I had a dollar for every beers-ish popup I've overridden at Wags this week...

 

[rxlea]

If I had a dollar for every beers-ish popup I've overridden at Wags this week...

Exactly.

 

[Alby]

The whole chemical restraints issue is a real hot topic these days. A lot of facilities are cracking down on the use of antipsychotics in said capacity.

 

[psychoandy]

that's a silly order. if someone is having PRN racing thoughts/mania they should probably be on standing antipsychotics. and even then i wouldn't start someone on a potential 600mg daily dose.

re: orders like seroquel 25mg PRN QHS. i don't really agree with atypical antipsychotics for sleep, especially for elderly, but it seems to be a very common "night float" thing to use. if i had to set up hospital guidelines i would recommend diphenhydramine or low dose trazodone or mirtazapine as 1st line.

i also decided to look at Seroquel AWP and it is absolutely insane how much it costs relative to other drugs (especially when using odd doses multiple times/day). maybe it'll be better cost with generic version but even then it was still 100x my recommended elderly sleep aids.

i'm also not a board certified psychiatrist, a pharmd/bcpp, or in any way qualified, so take my post at face value.

 

[474671]

Isn't Seroquel's effectiveness with treating/preventing mania in bipolar greatly questioned to begin with? A study from Harvard Medical School in 2008 or 2009 only found it effective on treating the depressive side... And yet, I've seen doctor's prescribe it along side an anti-depressant (but not a maintenance mood stabilizer as far as I know (Lexapro), though my knowledge on the subject is very limited), and then take the patient off . ithe anti-depressant... The result? Not a good one...
And a patient with mania would likely not want to take medication. I've heard it's a happy place.