Case Review – High Dose Ambien

A 76 year old female presents with the following list of medications, including high dose Ambien (zolpidem).

  • Ambien 10-20 mg at bedtime as needed
  • Prednisone 20 mg daily
  • Warfarin 5 mg daily
  • Ventolin HFA 2 puffs QID prn
  • Glucotrol XL 10 mg daily
  • Fosamax 70 mg weekly
  • Lisinopril 20 mg daily
  • KCL 20 meq daily
  • Duonebs QID
  • Singulair 10 mg daily
  • Vicodin 5/325 BID prn

Just reviewing the medications, you should have quite a few questions to think about.

  1. The first thing that jumps out in my mind is the high dose Ambien as well as the age of the patient.  This has to be looked at.  As far as other medications contributing, I would look at the prednisone and assess why are we on it, how long is it supposed to be on board and if it is playing a role in contributing to insomnia.
  2. The next thing that I would look at is the respiratory medications and what diagnosis the patient has.  Have no long acting respiratory medications would be a little unusual.  It is certainly possible the prednisone could be for the respiratory issues.
  3. Fosamax is on board without Vitamin D or calcium.
  4. I would also look at the potassium supplement and if it is necessary without any diuretics on board.
  5. There are lots of labs to monitor here based upon the meds.  Kidney function, INR, A1C, hemoglobin, potassium would be very important.

What else would you look at?

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Written By Eric Christianson

July 2, 2017

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