Case Study – Shelby Grace

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.

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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 in APA format. Include at least three peer-reviewed, evidence-based references.

Why is Ambien an effective medication for insomnia?
What group/class of drugs does Ambien belong to? What are the main pharmacokinetic differences between the other medications in this class of drugs? Identify what differences (if any) there are between the medications in this class of drug and when or why you would use one medication versus another within this class.
What dose of Ambien would you start Shelby on? Why?
What sleep hygiene education should you give Shelby?
What complementary medication (either prescription or herbal) could you recommend for Shelby?
What interactions such as food-drug, substance-drug, herbal-drug, and/or drug-drug should you educate Shelby about while taking Ambien?
What education would you provide Shelby about Ambien? What FDA warning must you include in your patient education when prescribing this medication or others like it?

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