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INTRODUCTION

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zolpidem (zole-pi-dem)

Ambien, Ambien CR

Classification

Therapeutic: sedative/hypnotics

Pharmacologic: imidazopyridines

Schedule IV

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Indications
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Insomnia.

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Action
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Produces CNS depression by binding to gamma-aminobutyric acid (GABA) receptors. Has no analgesic properties. Therapeutic Effects: Sedation and induction of sleep.

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Adverse Reactions/Side Effects
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CNS: abnormal thinking, amnesia, behavior changes, daytime drowsiness, dizziness, “drugged” feeling, hallucinations, sleep driving. GI: diarrhea, nausea, vomiting. Misc: ANAPHYLACTIC REACTIONS, hypersensitivity reactions, physical dependence, psychologic dependence, tolerance.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Monitor daytime drowsiness, anxiety, behavior changes, short-term memory deficits, hallucinations, and “drugged” feelings. Repeated or excessive symptoms may require change in dose or medication.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

  • Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.

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Patient/Client-Related Instruction
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  • Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal after 2 or more weeks of use may result in fatigue, nausea, flushing, light-headedness, uncontrolled crying, vomiting, GI upset, panic attack, or nervousness.

  • Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.

  • Caution patient and family/caregivers that “sleepwalking” and other complex activities including driving a car (sleep driving) may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor vehicles while under the influence of this drug.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged GI problems (nausea, vomiting, diarrhea), abnormal thoughts, or other bizarre behaviors.

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Pharmacokinetics
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Absorption: Rapidly absorbed following oral administration. Controlled-release formulation releases 10 mg immediately, then another 2.5 mg later.

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Distribution: Minimal amounts enter breast milk; remainder of distribution not known.

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Metabolism and Excretion: Converted to inactive metabolites, which are excreted by the kidneys.

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Half-life: 2.5–2.6 hr (increased in geriatric patients and patients ...

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