N11me of Policy:

PRN Indications

Policy Nu mber:

3364-133-103

Department:

Phannacy

Approving Officer:

Vice President Clinical Services

Responsible Agent:

Director of Pharmacy

Scope:

University ofToledo Medical Center

(A)

New policy proposal

TOLEDO
Jl,l

Effective Date: 10/1/2014

Minor/technical revision of existing policy

Policy Statement

Physician orders for as needed medications (PRN) will contain all the required elements
including indication for use. When an indication is not indicated by the prescriber the FDA
approved indication approved by the medical staff w;l' ~e the defmed indication for use.

(B)

Purpose of Policy

In accordance with The Joint Commission, all rnedicalions must have an indication for PRN use.
This policy will decrease confusion amongst the nursing staff as to the intent of a medication.

(C)

Procedure
1. Order for a PRN medication is entered by the medical team. The prescriber may indi~:tt::
any appropriate indication outside of this policy in the written or electronic order.
2. If no indication is provided the pharmacist and the pharmacy informatics system will
assign the approved indication for specific medications.
3. Nursing and medical staff will be notified electronically in the EMR of the approved
indication.

(D) Standard Indications Included (Refer to Appendix A for list of medications)

1 I . .Edema
12. Flatulence
13. Fluid Replacement
14. Headache
15. Hemorrhoids
16. fliccups
17. Hypertension
18. Hypotension
19. Indigestion
20. Insomnia

21. rtchy Skin

Review/Revision Da te:

Appr oved by:

Renew!RevL.fiOII

Completed

Br:

Pharmacy

Next Review Date:

I 0/ 1/2017

Policies Superseded by This Policy:

i,\

the most curre/11

l"ei'St0/1

Appendix A
-

- --- -

Medication Name

-----------Class

----- Analgesic/Opioid
...-

Acetaminophen with Codeine

- ---

Indication
Pain

Acetaminophen/ Caffeine/Butalbital

Barbiturate

Headache

Albuterol
Albuterol and lpratropium
Alprazolam
Alum-M ag Hydroxjde-Simeth

Beta Agonist

Bronchospasm

Beta Agonist/Anticholinergic

Bronchospasm
Anxiety

Amitriptyline
Aripiprazole
Aspirin/Caffeine/Butalbital
Atenolol

Benzodiazepine
Antacid

Indigestion

Antidepressant

Insomnia

Atypical Antipsychotic
Ba rbiturate

Agitation
Headache

Beta Blocker

Hypertension

Azelastine

Antihistamine

Allergic rhinitis

Belladona Alkaloids-Opium

Analgesic

Benzocaine

Anesthetic

Benzocaine-M enthol
Benzonatate
Bisacodyl

Anesthetic
Antitussive

Urinary pain or
spasm
Pain
Sore Throat
Cough

Laxative, Stimulant

Constipation

Bumetanide

Loop Diuretic

Buprenorphine

Opioid

Edema
Pain

Butorphanol

Opioid

Pain

Calamine-Zinc Oxide

Topical Skin Protectant

Itchy Skin

Carvedilol

Beta Blocker
NSAID

Hypertension
Pain
Allergy

Celecoxib
Cetirizine
Chlordiazepoxide

Antih istamine
Benzodiazepine

Anxiety

of/he polrc_h

Cough

Chlorpheniramine-Hydrocodone

Antitussive

Chlorpromazine

Antipsychotic

Hiccups

Clonazepam
Clonidine

Benzodiazepine

Anxiety

Alpha Agonist

Hypertension

Codeine

Opioid

Cyclobenzaprine

Muscle Relaxant

Pain
Muscle Spasm

Cyproheptadine

Antihistamine

Allergy

Dextromethorphan-GG

Cough
Hypoglycemia

Diazepam

Antitussive
Intravenous Nutritional
Therapy
Benzodiazepine

Diphenhydramine
Diphenoxylate-Atropine

Antihistamine
Antidiarrheal

Allergy

Docusate
Epinephrine
Eszopiclone

Stool Softener
Alpha/Beta Agonist

Constipation

Hypnotic

Hypotension
Insomnia

Felodipine
Fentanyl

Calcium Channel Blocker

Hypertension

Opioid
Antihistamine

Pain

Dextrose 50%

Anxiety
Diarrhea

Fexofenadine-Pseudoephedrine
Fluticasone

Antihistamine/Decongestant

Allergy
Congestion

Nasal Steroid

Allergic rhinitis

Furosemide

loop Diuretic

Glycerin
Glycopyrrolate

Laxative, Osmotic
Anticholinergic

Edema
Constrpation

Guaifenesin
Haloperidol Lactate

Expectorant
Typical Antipsychotic

Cough
Agitation

Hydrochlorothiazide

Thiazide Diuretic

Hypertension

Hydralazine

Vasodilator
Corticosteroids

Hypertension

Fexofenadine

Hydrocortisone (rectal)
Hydrocodone/Acetaminophen

Secretions

Hemorrhoidal Pain

Opioid

Pain

Hydromorphone
Ibuprofen

Opioid
NSAID

Pain

lbuprofen-Hydrocodone
lpratropium

NSAID/Opioid
Anticholinergic

Ketorolac Tromethamine
Labetalol

NSAID
Beta Blocker

Lidocaine-Prllocaine
Loperamide

Anesthetic

Parn

Antidiarrheal

Diarrhea

loratadine

Antihistamine

Allergy

loratadine-Pseudoephedrine
lorazepam

Antihistamine/Decongestant

Congestion
Anxrety

Magic Mouthwash
Magnesium Citrate

Benzodiazepine
Mouthwash
Laxative

Pain
Pain
Bronchospasm
Parn
Hypertension

Oral Mucocitis
Constipation

----

Magnesium Hydroxide

laxative

Meclizine

Antihist amine

Melatonin

Sedative
Muscle Relaxant

Metaxalone
Metoclopramide

Antiemetic

Constipation
Dizziness or
Vertigo
Insomnia
Muscle Spasm
Nausea or
Vomiting
Hypertension

Metoprolol Tartrate

Beta Blocker

Milk of Magnesia
Mineral Oil

Ant acid
Laxative, Lubricant

Constipation

Morphine
Nalbuphine

Opioid

Pain

Opioid

Pain

Naproxen
Normal Saline (Nasal)

NSAID
Lubricant

Pain
Nasal Dryness

Ondansetron

Antiemetic

Oxycodone

Opioid

Nausea or
Vomit ing
Pain

Oxycodone/ Acetaminophen

Analgesic/Opioid

Pain

Oxymorphone
Phenol-Phenolate
Phenylephrine

Opioid

Pain
Sore Throat

Phenylep-Shark liv 011-Mo-Pet

Anti-hemorrhoidal
Laxative, Osmotic

Hemorrhoidal Pain
Constipation

Polyvinyl Alcohol

Ophthalmic Agent

Dry Eyes

Prochlorperazine

Typical Antipsychotic

Promethazine

Ant iemetic

Psyllium

Laxative, Bulk-producing
Atypica l Ant ipsychotic

Nausea or
Vomiting
Nausea or
Vomiting
Constipation

Quetiapine Fumarate
Rizatriptan Benzoate
Senna
Senna-Docusate
Simethicone
Sumatriptan Succinate
Temazepam
Throat lozenges (Cepastat)
Tizanadine

Anest hetic
Decongestant

Serotonin Receptor Agonist

Constipation

Congestion

Agitat ion
Migraine
Constipation
Constipation
Flatulence

Serotonin Receptor Agonist

Migraine

Benzodiazepine
Anesthetic

Insomnia
Sore Throat

Muscle Relaxant

Muscle Spasm

Tramadol

Analgesic

Pam

Tramadol-Acetaminophen
Trazodone

Ana lgesic

Pain

Antidepressant

Zaleplon
Ziprasidone Mesylate

Hypnotic
Atypical Ant ipsychotic
Hypnot ic

Insomnia
Insomnia

Zolpidem Tartrate

Agitation
Insomnia