1. With dinner (1700)
2. Absolutely. We don't allow IV PPI for non-GI bleeds. The data VERY strongly support the pushes. Several large meta-analyses as well as individual studies have shown that there is no benefit of drip over IVP in any patient population. We do an 80 mg bolus then 40 mg Q12. There is no reason to do drips unless you like flushing money down the toilet. The only person who can order a drip is the section head of GI. If it is nighttime - too bad, you better call him at home.
3. Ambien: We enforce a max dose of 5 mg for all women, anyone age > 65, and anyone who was not on 10 mg at home. If a woman or senior was on 10 mg HS, they are still maxed at 5. No exceptions here. If someone complains I usually suggest trazodone instead which you can increase quite far if needed (although it rarely is). If it is a man < 65 yo and 10 mg is ordered (or 5-10 mg) we check home med list, if they were not on it we change to 5 as well. Same rule, no exceptions.
Tramadol: Our system automatically inputs a comment of max dose 400 mg/day or 300 mg/day for age > 75, so that we keep as is. For CrCl < 30, we adjust dose to whatever makes sense to not exceed 100 mg every 12 hours. So I will let 50 mg Q6 PRN go by but not 100 mg Q6, I will change that to Q12. If it is scheduled I change the frequency as needed - so if it is 100 mg TID I change to BID and put a note in the comments that max dose is 200 mg/day for CrCl < 30. Same thing for age > 75, if scheduled then I ensure that the frequency will not exceed 300 mg/day and if it does then I change it to comply with max dose. I do not change frequency for PRN doses in age > 75 because there is no restriction on frequency, just total daily dosage (unlike CrCl).
