A DOCS Education member seeks the faculty’s advice:
I have a patient that was a severe burn victim in 1997. Consequently, he takes many medications on a daily basis. He is a healthy, 58-year-old male and weighs approximately 230 pounds. His current medications are:
- Amlodipine besylate 5 mg (Norvasc®) 1 tab daily
- Atenolol 100 mg (Tenormin®) 1 1/2 tab daily
- Diclofenac Sodium 50 mg (Voltaren®) 1 tab 2x daily
- Escitalopram Oxalate 10 mg (Lexapro®) 1 tab daily
- Hydrochlorothiazide 25 mg (Hydrodiuril®) 1 tab daily
- Lisinopril 10 mg (Prinivil®, Zestril®) 1 tab daily
- Metformin HCL 500 mg (Glucophage®) 1 tab 2x day
- Methadone 10 mg (Dolophine®) 8 tabs daily
Medications taken as needed are as follows:
- Amiodarone HCL 200 mg (Pacerone®) 1 tab daily
- Flucinodiden .05% ointment (Lidex®) apply 2x day
- Triamcinolone .1% cream (Kenalog®) apply 3x day
DOCS Education faculty member, Dr. Jerome Wellbrock, responds:
This is not a healthy patient and not a patient to be sedated in your office. I would recommend this patient be treated in a hospital or an outpatient facility with advanced anesthesia providers and immediate access to emergency equipment and care. There are several red flags here and multiple drug interactions even before we would add our sedation medications to the list. Amiodarone should be an indicator of the seriousness of this patient’s cardiac status—not to mention he is taking amlodipine, atenolol, hydrochlorothiazide and lisinopril to control BP and possible angina. He is also taking metformin, an anti-diabetic; diclofenac, an NSAID; Lexapro®, an SSRI antidepressant; and Methadone. 10 mg with eight tabs daily is a very large dose. Methadone is an "X" interaction with the benzodiazepines. There is also no information here on your patient’s BMI, sleep habits, vital signs at pre-sedation workup, possible tobacco, alcohol or any other OTC drug use. Bottom line, this is not a patient I would sedate or recommend sedating.
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.
