Question

Ms. Espinosa is a 90-year-old Hispanic woman admitted to the hospital from her assisted living facility.  She had a history of hypertension and dementia, and had a stroke and a myocardial infarction 3 years ago.  She also had insomnia for the past month.  Ms.  Espinoza is admitted due to an alteration in her mental status. She has had a cold and a cough for a week, for she took Coricidin (acetaminophen and chlorpheniramine) and Tylenol PM (acetaminophen and diphenhydramine).  Her home medications include monthly Nascobal (vitamin B12) injections; Toprol-XL (metoprolol succinate), 100 mg daily; Plentil (felodipine),10 mg daily; Allegra (fexofenadine),180 mg daily; Ecotrin (aspirin EC), 325 mg daily; and Colace (docusate sodium), 100 mg daily. She also has a very unsteady gait.

Ms.   Espinoza’s   admitting   diagnosis   is   pneumonia.   The   physicians   order   the   following medications: Lasix (furosemide), 20 mg IV push, x 1; Pepcid (famotidine), 20 mg bid; Ecotrin (aspirin EC), 325 mg daily; Toprol-XL (metoprolol succinate), 100 mg daily; Colace ( docusate sodium),100  mg  daily;  Allegra  (fexofenadine),  180  mg  daily;  Levoquin  (levofloxacin),  250  mg daily IVPB; Plendil (Felodipine), 10 mg po daily; and Ambien (zolpidem), 5 mg at bedtime as needed

Questions

1. Which medication(s) may have contributed to Ms. Espinoza’s altered mental status? Make a drug study of all the medications taken by Ms. Espinoza.

2. In addition to the drug regimen, does Ms. Espinoza have other risk factors for altered mental status?

3.  Would you alter her drug regimen.  Does Ms.  Espinoza have any risk factors for altered mental status?

4. Would you alter her drug regimen in any way? If so, how?

Answer 1

1. Sleeping medicine before going to bed (Zolpidem 5mg);

Zolpidem is a non-benzodiazepine drug Z that can be used as a sedative and hypnotic. Zolpidem is a type A GABA receptor agonist of the imidazopyridine class. It increases the role of GABA in the central nervous system by binding to GABA receptors at the same position as benzodiazepines. Its half-life is usually two to three hours. It can also relax and calm people in a state of high levels of anxiety.

Answer 2

The normal treatment options for pneumonia include

1. Common-empirical antibacterial programs should use β-lactam drugs or new respiratory fluoroquinolones to cover Streptococcus pneumoniae, and atypical pathogens should be treated with macrolides or respiratory fluoroquinolones.

2. In this patient population, ward-oral treatment, and early discharge should be considered.

3. Severe cases-combined antibacterial therapy (β-lactam enlarged cyclic lactone or respiratory fluoroquinolone). The patient should be admitted to the Intensive Care Unit (ICU) to distinguish whether the patient is at risk of infection with Pseudomonas species and to be treated accordingly.

Treatment time

*7-10 days for patients who need to be hospitalized. But those with atypical pathogens (such as Legionella) should receive treatment for 10-14 days.

Ms. Espinoza is a 90-year-old woman. Considering her age, it is very important to control her condition as soon as possible.

Treatment points to consider include

*The clinical manifestations of pneumonia in the elderly may be subtle and maybe fever.

*The only findings may be changes in mental status, sudden decline in functional capacity, and deterioration of underlying diseases

*Even if there are no classic symptoms, physicians should be alert to the diagnosis of pneumonia in elderly patients.

Fluxacillin has been used in her treatment regimen, and it is best to add macrolide drugs, such as azithromycin or clarithromycin, for a better prognosis

label. Azithromycin can be taken orally once 500 mg on the first day, and then 250 mg for 4 consecutive days is beneficial.

Answer 3

Which medication may have contributed to ms. Espinoza alterd mental status? Make a drug study of all the medications taken by ms Espinosa?

Ambien ( zolpidem) 5 mg it affect the mental status.

Zolpidem is used to treat a certain sleep problem in adult .if you have trouble falling asleep,it helpes you fall asleep faster,so you can get a better nights rest. Zolpodem belongs to a class drug called sedative - hypotonics .its acts on your brain to produce a calming effect.

This drug using main side effect are,

A change vision

Feeling drowsy or sleeping

Abnormal dream

Confusion

Depression

Memory loss

Double vision

Generalized weakness

Muscle pain

Constipation

Dry mouth

Urinary tract infection

Vomiting

* coricidin ( acetaminophen)

It usefull for cold symptoms and relief the cold.

Acetaminophen helpes to reduce the fever and body pain

* Tylenol PM about tylenol acetaminophen and diphenhydramine is a combination medicine used to treat the headache,running nose,sneezing.

* Nascobal ( vitamin12)

It treat vitamin B12 deficiency.the deficiency may occur in pernicious anemia following surgical removal of stomach ,with fish tapeworm,or due to bowel cancer.it is less preferred than hydro coco bala mine for treating vitamin 12 deficiency.

* Toprol-xl

Iit is a selective B receptor blockers medication.

It used to treat high blood pressure and chest pain due to poor blood flow in the heart and abnormality fast heart rate.

* plendil 10 mg.

Felodipine is used to treat high blood pressure.lowering high blood pressure helpes prevent stroke,heart attack,and kidney problems.felodipine is know as calcium channel blocked.

* Allegra 180 mg

Fexofenadine, sold under the brand name Allegra among others.is an antihistamine pharmaceutical drugs used to allergic symptoms.such as fever and urticaria.

* Ectorin 325 mg

Used treat the pain reduce the fever inflammation.some time used for treating the heart attack ,stroke and chest pain.

* colace ( do us ate sodium)

Is a stool softener it make bowel movement softer and easier to pass.

* lasix

Used to treat fluid build - up due to heart failure ,liver scarring,or kidney disease.it used to treat the high blood pressure.

* pepcide

It releves symptoms such as cough that does not vgo away ,stomach pain,heart burn and difficulty swallowing.famotidine belongs to a class of drugs know as histamine-2 blockers.

* Aspirin EC

Reducing blood clot risk,also gastrointestinal benefit of enteric- coated aspirin is minimal to nonexistent.

* (levofloxacin) ,levaquin 250 mg

It is a antibiotics treat the number of bacterial infections including acute bacterial sinisities,pneumonia,UTI,chronic prostitis.

2. In addition to the drug regimen does ms Espinoza have other risk factors for alterd mental status?

Already she took zolpidem that tablet daily taking mean drowsiness ,and confusing and clumsiness and depression also patient .alredy she is a have hypertension and dementia and stroke.already she is tooking somuch of tablet.

And she using hypertension medicine also she the severe hypertension can overwhelm protective autoregulation mechanism leading to diffuse vasogenic edema with vasospasm and arterial ischemia ,when persistent,the syndrome recognized as hypertensive encephalopathy may develop resulting in alterd mental status,headache and vomiting.

3. Would you alter her drug regimen ? Does Espinoza have any risk factors for altered mental status?

1.Educate the patient about what expect

2.Nurture relationships with patient

3. Help the patient customize their support tools.

4. Synchronized medications.

5. Provide the activities with resting period

6. Reorient the patient again and again

7.Provide the adequate lightening.

8.Encourage use of safety devices

9.Help the patient day to day activities

10.Help to the patient have normal sleep.

This all the things following daily mean it reduce risk of the patient .