How to write a PRN (pro re nata, or as needed) order for atenolol (beta blocker) for blood pressure persistently above 150 mmHg after morning blood pressure medication?

PRN Atenolol Order for Persistent Hypertension After Morning Medication

For patients with blood pressure persistently above 150 mmHg after morning antihypertensive medication, prescribe atenolol 25-50 mg PRN once daily, with instructions to take only when BP remains >150 mmHg despite regular morning medication. 1

Dosing Recommendations

• Initial PRN dose should be 25 mg for elderly patients or those with renal impairment (creatinine clearance <35 mL/min), and 50 mg for other adults 1
• Maximum PRN dose should not exceed 100 mg per day when combined with regular antihypertensive medications 1
• Instruct patient to wait at least 1-2 hours after morning medication before checking BP and considering PRN dose 2
• PRN atenolol should be limited to once daily use, as the antihypertensive effect lasts 20-24 hours 3, 4

Patient Instructions for PRN Use

• Take PRN atenolol only if blood pressure remains >150 mmHg after morning antihypertensive medication 2
• Measure blood pressure twice, 5 minutes apart, before taking PRN dose to confirm elevation 2
• Document blood pressure readings before and 2-3 hours after taking PRN dose 2, 5
• Do not take if heart rate is below 60 beats per minute 2
• Report to healthcare provider if requiring PRN doses more than twice weekly 2

Monitoring and Follow-up

• Schedule follow-up within 2-4 weeks to assess effectiveness of PRN regimen 2, 5
• Consider adjusting regular morning antihypertensive medication if PRN doses are frequently needed 2
• Monitor for potential side effects including bradycardia, fatigue, and hypotension 2
• Evaluate renal function before initiating PRN atenolol and periodically during treatment 1

Special Considerations

• For patients with coronary artery disease, atenolol is particularly beneficial as a PRN agent for BP control 2
• For patients with diabetes, monitor glucose levels more closely as beta-blockers may mask hypoglycemia symptoms 6
• Avoid PRN atenolol in patients with asthma, COPD, heart block, or severe peripheral vascular disease 2, 1
• For patients already on beta-blockers as part of their regular regimen, consider alternative PRN agents such as amlodipine or clonidine 2, 5

Documentation in Order

• "Atenolol [25-50] mg PO once daily PRN for SBP >150 mmHg despite regular morning antihypertensive medication. Do not take if heart rate <60 bpm. Maximum one dose per 24 hours." 1