Which of the following are common PRN medications?

According to a study published in the International Journal of Nursing Studies, PRN prescriptions are a common practice across various healthcare settings. Which of the following are common PRN medications, and how are they used safely? This article explores typical 'as-needed' prescriptions for a range of conditions, from pain and anxiety to nausea and respiratory issues.

Quick Summary

Common 'as-needed' (PRN) medications treat intermittent symptoms like pain, anxiety, nausea, and allergic reactions. Categories include analgesics, anti-anxiety drugs, antiemetics, and respiratory inhalers. Safety considerations, potential risks, and the critical differences between PRN and scheduled medications are also detailed.

Key Points

• Categorization of Common PRN Medications: Common 'as-needed' medications are used for pain, anxiety, nausea, asthma, and allergies.

• PRN vs. Scheduled Dosing: PRN medications are taken for intermittent symptoms, while scheduled medications are taken at fixed times for consistent treatment.

• Controlled Substance Risks: Prescription PRN medications like opioids and benzodiazepines carry a risk of dependence and misuse, requiring careful monitoring.

• Role of Patient Assessment: Healthcare providers or patients must properly assess symptoms before administering a PRN to ensure it is appropriate and safe.

• Importance of Documentation: Detailed documentation of PRN administration helps track usage patterns, effectiveness, and potential overuse.

• Regular Review of Use: Frequent PRN administration may signal a need for a reevaluation of the patient's regular medication regimen by a healthcare provider.

Understanding PRN: 'As Needed'

PRN stands for the Latin phrase 'pro re nata,' which translates to 'as the thing is needed'. A PRN medication is prescribed for use only when a specific symptom occurs, rather than on a fixed, routine schedule. This approach gives patients and caregivers flexibility to manage intermittent or unpredictable symptoms effectively. Common conditions addressed by PRN medications include temporary pain, occasional anxiety, sudden nausea, or an asthma flare-up.

Common PRN Medications for Pain and Fever

Pain and fever are among the most frequent reasons for using PRN medications. Both over-the-counter (OTC) and prescription options are available depending on the severity of the symptoms.

• Over-the-Counter (OTC) Analgesics:
  • Acetaminophen (Tylenol®): Often used for mild to moderate pain and fever reduction.
  • Ibuprofen (Advil®, Motrin®): A nonsteroidal anti-inflammatory drug (NSAID) that treats pain, fever, and inflammation.
• Prescription Pain Medication:
  • Opioids (e.g., oxycodone, hydrocodone/acetaminophen): Reserved for moderate to severe pain, such as post-operative pain or breakthrough pain in chronic conditions. These carry a significant risk of dependence and must be used with caution.

PRN Medications for Anxiety and Sleep

For acute episodes of anxiety or occasional insomnia, certain medications may be prescribed on an 'as-needed' basis.

• Benzodiazepines (e.g., lorazepam, alprazolam): These fast-acting anxiolytics are often prescribed for panic attacks or severe anxiety. Due to the high risk of dependence and tolerance, they are typically limited to short-term or infrequent use.
• Hypnotics: Some sedative-hypnotic drugs are occasionally prescribed PRN for severe insomnia, but non-pharmacological interventions are often preferred.

Gastrointestinal PRN Medications

These medications help manage common and uncomfortable GI symptoms as they arise.

• Antiemetics (e.g., ondansetron, promethazine): Prescribed to alleviate nausea and vomiting caused by illness, chemotherapy, or post-operative recovery.
• Laxatives (e.g., senna, polyethylene glycol): Used to treat occasional constipation.
• Antacids (e.g., calcium carbonate, aluminum hydroxide/magnesium hydroxide): For temporary relief of heartburn and indigestion.

Respiratory and Allergy PRN Medications

Certain conditions require immediate relief, making PRN medications a cornerstone of treatment.

• Rescue Inhalers (e.g., albuterol): Used by patients with asthma or COPD to quickly open airways during a flare-up of shortness of breath.
• Antihistamines (e.g., diphenhydramine, cetirizine): Treat allergic reactions and symptoms like itching or sneezing.

Other Common PRN Prescriptions

• Migraine Medications (e.g., triptans like sumatriptan): Taken at the onset of a migraine attack to reduce severity and duration.
• Nitroglycerin (Nitrostat®): Used to treat episodes of chest pain (angina) in patients with heart disease.

Comparison of PRN vs. Scheduled Medications

Feature	PRN (Pro Re Nata)	Scheduled (Routine)
Timing	Administered only when a specific symptom arises, within dosage limits.	Taken at regularly scheduled intervals, such as daily or every few hours.
Flexibility	Allows for flexible dosing based on a patient's immediate and variable needs.	Adheres to a rigid schedule, ensuring consistent therapeutic levels in the body.
Purpose	Primarily for symptom relief rather than ongoing treatment of an underlying condition.	Often used for long-term management of chronic conditions like high blood pressure or cholesterol.
Patient Involvement	Patient or caregiver must actively assess symptoms and decide when to administer.	Administration is automatic based on the prescribed schedule.
Common Examples	Acetaminophen for headache, albuterol for asthma, lorazepam for anxiety.	Lisinopril for hypertension, atorvastatin for high cholesterol.

The Importance of Safe PRN Use

Administering PRN medications effectively requires careful consideration and adherence to safety protocols to prevent misuse and adverse events.

• Proper Documentation: In a clinical setting, nurses must document the administration of a PRN medication, including the dose, time, reason, and effect. This helps track medication frequency and effectiveness.
• Risk of Dependence: Some PRN medications, particularly controlled substances like opioids and benzodiazepines, carry a risk of physical or psychological dependence. Close monitoring and communication with a healthcare provider are essential.
• Assessment Before Administration: A proper assessment of the patient's symptoms is crucial before giving a PRN medication. This ensures the medication is appropriate for the current issue and not masking a different underlying condition.
• Overuse and Polypharmacy: Frequent administration of a PRN medication may indicate a worsening condition that requires a change to a regular medication regimen. Providers should review PRN use periodically to prevent overuse and polypharmacy.

Conclusion

PRN medications offer a flexible and targeted approach to managing intermittent and acute symptoms, and common examples span a wide range of categories, including pain relievers, anti-anxiety agents, antiemetics, and respiratory medications. While providing patients with more control over their symptom management, PRN use demands a high degree of responsibility and communication with healthcare providers. Adherence to prescribed guidelines, awareness of potential side effects, and caution with controlled substances are paramount to safe and effective treatment. Regular reviews of PRN usage can help ensure that treatment remains appropriate for a patient's evolving health needs, protecting them from potential risks associated with misuse.

For more in-depth information on safe medication practices, refer to the guidance from the National Institutes of Health (NIH).

Frequently Asked Questions

What does the abbreviation PRN mean?

PRN is a Latin abbreviation for 'pro re nata,' which means 'as the situation arises' or 'as needed.' It refers to medications or treatments that are administered based on a patient's immediate need for a specific symptom.

Is it safe to take PRN medications daily?

No, PRN medications are not intended for daily use. If a patient consistently needs to take a PRN medication every day, it indicates a chronic symptom that should be addressed by a healthcare provider, potentially leading to a change in the patient's routine medication regimen.

Are OTC medications ever considered PRN?

Yes, many over-the-counter medications like acetaminophen (Tylenol®) and ibuprofen (Advil®) are commonly used on a PRN basis for headaches, pain, or fever. These are taken only when symptoms are present.

Can I become addicted to a PRN medication?

Yes, certain PRN medications, particularly controlled substances like opioids and benzodiazepines, carry a risk of dependence and misuse. It is critical to use these exactly as prescribed and to discuss any concerns with a healthcare provider.

Who decides when a PRN medication is administered?

In a hospital or long-term care setting, a nurse or other healthcare professional decides based on their clinical judgment and assessment of the patient's symptoms, guided by the doctor's order. In an outpatient setting, the patient decides when to take the medication, following the provider's instructions.

What is a PRN medication for nausea?

Common PRN antiemetics for nausea include prescription medications like ondansetron and promethazine. These are given to provide relief when nausea or vomiting occurs.

How do PRN orders for psychotropic medications work?

PRN orders for psychotropic medications are used for acute or intermittent symptoms like anxiety or agitation. The order must clearly specify the indication and maximum dosage. In certain settings, like nursing homes, these orders are often subject to time limitations and require physician review for renewal.

What information should be included in a PRN medication order?

A complete PRN order includes the medication name, dosage, route of administration, frequency limits (e.g., 'every 4-6 hours'), and a clear indication for its use (e.g., 'for pain'). This ensures appropriate and safe administration.