Question

Shelby Grace is a 46-year-old Caucasian woman referred to you by her primary care physician for insomnia. Shelby complains of sleeplessness and sleepiness for approximately eight months. Initially, she only had difficulty staying asleep two to three nights per week. However, over the past five months, sleep and daytime fatigue have increased in severity and frequency. She now wakes up three or more times per night at least five nights per week, and on most nights has difficulty falling asleep (taking about 40 to 60 minutes). She has tried to maintain an active social and professional life. She notes increased irritability and a lack of motivation. During the visit, you note that she has always been a poor sleeper during times of stress, but nearly always improved after a few days. For this reason, she never thought that she had insomnia and had, on occasion, taken over-the-counter medications. She also notes an increase in her caffeine intake to four cups of coffee and one to three diet colas per day. Shelby states that while her primary care provider gave her a prescription for Ambien for sleep, she has heard “bad things about Ambien” and thus hasn’t filled the prescription. Questions From your perspective as Shelby’s psychiatric nurse practitioner, answer the following questions in a paper no longer than two double-spaced pages (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references. Why is Ambien an effective medication for insomnia? What education would you provide Shelby in regard to Ambien? What group of drugs does Ambien belong to? What are the main pharmacokinetic differences between the components of this class of drugs? What sleep hygiene education should you give Shelby? What complementary medication could you recommend for Shelby? What interactions should you watch out for with complementary medications and Ambien?

Answer 1

1, Zolpidem is a non-benzodiazepine receptor modulator primarily used in the FDA approved short-term treatment of insomnia aimed at patients with difficulty starting sleep. It is an effective medication in insomnia because it improves measures of sleep latency, sleep duration, and reduces the number of awakenings in patients with transient insomnia. It also improves sleep quality in patients with chronic insomnia as well and can act as a minor muscle relaxant. Zolpidem, a non-benzodiazepine hypnotic agent, works as a GABA receptor (gamma-Aminobutyric acid or GABA  is a neurotransmitter involved in many functions of the brain )and involved in a receptor chloride channel modulator/agonist that increases GABA inhibitory effects leading to sedation. It also has anticonvulsant, anxiolytic, and minor myorelaxant properties. The drug will induce fo sedative effects leading to the preservation of deep sleep.

2,

a, You are advised to take this drug just before your bedtime and 8-9 hours before your planned wake up.

b, Before taking Ambien, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

c,If you take Ambien and don’t get a full night’s sleep, you may have decreased awareness and slower reaction times the next day. This may cause trouble driving. You shouldn’t drive or do other activities that require alertness if you take this drug and don’t get a full night’s sleep.

d,When you take Ambien you shouldn’t drive or do activities that require alertness without getting at least 4 more hours of sleep after takin

e, Some behavioral changes such as increased agitation is expected if this causes problems in your daily life please inform and consult your doctor.

f, It can cause some addictive behavior so, never overdose your self to get more quality or longer sleep.

g, You shouldn't stop taking this drug abruptly without consulting your doctor

h, Eating food with Ambien may make the drug take longer to work. You should take this drug on an empty stomach.

i, Drinking alcohol can increase your risk of sedation and drowsiness from Ambien. You shouldn’t take this drug on nights when you drink alcohol. If you drink alcohol, talk to your doctor. You may need to be monitored more closely for side effect

3. Ambien or Zolpidem belongs to the class of sedatives/hypnotics.

4 , a, Shelby is advised to stop or minimize caffeine drinks as they act as stimulants, so she should avoid cola, coffee, and such items

b, She is recommended to maintain a routine sleep time

c, She should stop or limit phone/screen/lap usage before going to bed

d, use bed room only for sleeping only

e, No noise and lighting in the room during sleep hours

Reference

1, Efficacy of zolpidem in insomnia

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https://doi.org/10.1016/S0924-9338(97)80015-6

2,, Efficacy and Safety of Zolpidem Extended Release in Elderly Primary Insomnia Patients

Author links open overlay panelJames K.WalshPh.D.^abChristinaSoubraneM.D.^cThomasRothPh.D.^d

https://doi.org/10.1097/JGP.0b013e3181256b01

3,, Efficacy of Eight Months of Nightly Zolpidem: A Prospective Placebo-Controlled Study

Surilla Randall, PhD, Timothy A. Roehrs, PhD, and Thomas Roth, PhD

PMID: 23115404