Question

Ms. Espinoza is a 90-year-old Hispanic female admitted to the hospital from her assisted living facility. She has a history of hypertension and dementia and had a stroke and a myocardial infarction 3 years ago. She has 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 which 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; Plendil (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, x1; 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?

Answer 1

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 .