One of the fastest-growing segments of your patient population is those suffering from chronic medical and psychological conditions.
By Genni Burkhart, Editor
This topic is included in DOCS Education's top 25 Safety Statements, compiled by our esteemed faculty. The first ten, by Dr. Leslie Fang, can be found here.
A well-established correlation exists between a patient's medication list and their health status, as the number of drugs a patient is on can provide valuable insights into their condition and complexity.
Over the last decade, the Food and Drug Administration (FDA) has approved an average of 38 new drugs yearly, a significant increase from the previous decade. As the number of new medications entering the market continues to rise, dentists must prioritize the awareness and maintenance of the safety and efficacy of interactions between a patient's medications and sedation drugs used in dentistry. Dentists must also consider if a patient is a suitable candidate for outpatient conscious sedation and, if necessary, adjust their DOCS protocol.
The decision to sedate a patient with multiple medical conditions and medications can be a challenging one, but it is essential to prioritize the patient's best interests. Let's explore factors to consider and the decision-making process to ensure optimal care and safety.
Medications and Patient Health
Medications can reveal a lot about a patient's health journey. When a patient is prescribed multiple medications, it's often an indicator that they have a complex medical situation. This could mean that they're dealing with a chronic illness, multiple coexisting conditions, or a disease that has progressed to a more advanced stage.
Each medication serves a specific purpose in managing various aspects of their health, and the more medications there are, the more intricate their health puzzle becomes. Patients might not always disclose all relevant information for various reasons, such as forgetfulness, lack of awareness, or even fear. However, medications can reveal much about their medical history, ongoing issues, and potential interactions between different conditions.
Sometimes, patients might not realize the significance of specific symptoms or details, but by studying their medication regimen, healthcare providers can uncover hidden patterns and make more accurate assessments.
Utilizing Patient Information
How can healthcare providers utilize this information to provide better care?
The medication list serves as a roadmap for healthcare providers. By understanding patients' medications, providers can tailor their treatment plans, anticipate potential complications, and prevent harmful drug interactions. It also enables them to have more informed discussions with patients, addressing concerns and clarifying the interconnected nature of their health issues.
How can dental providers ensure they have the most accurate and up-to-date medication information?
A proactive approach is essential. Patients should maintain a comprehensive and updated list of all their medications, including prescription drugs, over-the-counter products, and supplements. This list should be regularly reviewed with healthcare providers to ensure everyone is on the same page regarding the patient's health journey. Open communication is crucial, as it helps healthcare teams provide the best care possible.
Pharmacology and Sedation
As the Live Patient Experience Director for DOCS Education, Dr. Jerome P. Wellbrock, DMD, MAGD, brings a wealth of expertise in sedation and pharmacology, with over 210 hours of continuing education in anesthesia, sedation, and pain control.
Last year, Dr. Wellbrock authored an informative article for the Incisor on the topic of polypharmacy and sedation. His discussion includes thoroughly assessing the patient's current and past health issues and considering their medication regimen to allow for the most appropriate sedation technique.
Dr. Wellbrock also suggests reviewing the medical conditions and medications and not the details of an individual in terms of physical exams, particularly if the patient suffers from anxiety disorders with stress-induced panic attacks, major depressive disorder, hypoglycemia, hypothyroid disorder, and alopecia.
The medications for these conditions include:
- Armour 60mg qd for hypothyroidism
- Klonopin-Clonazepam 0.25 mg PRN (a benzodiazepine) for anxiety
- Lexapro-Escitalopram 20mg, an SSRI (Selective Serotonin Reuptake Inhibitor) for depression
- Atarax-Hydroxyzine 25mg tid, H1-antihistamine for anxiety/depression
- Zofran-Ondansetron 4mg, a Serotonin 5-HT3 antagonist, antiemetic
- Marijuana (Cannabinoid) daily
Medications considered for sedation include Diazepam, Lorazepam, and Hydroxyzine.
Further Analysis
Furthermore, Dr. Wellbrock suggests the best place to begin analyzing drug interactions is with a program such as Lexicomp. By conducting a thorough analysis, providers can obtain a comprehensive list of drug interactions for their patients, including significant interactions (D category), moderate interactions (C category), and minor interactions (B category). The primary concern is the number of interactions in any of these categories, as multiple interactions can harm the patient's health.
As a DOCS Education member, you can also access valuable online resources and tools, such as the Top 100 Prescribed Drugs Reference Guide, to support you in making critical decisions. DOCS Members can find this quick reference guide by logging into their DOCS Education membership online account. For more information on what’s included in a DOCS Education membership or how you can sign up, please visit our website here.
Want to Learn More?
For advanced clinical level training on this important topic, DOCS Education offers a training program for Master Series: Advanced Sedation, where you will gain the knowledge and confidence to safely sedate medically complex ASA III+ patients in your practice rather than referring them out. Presented by world-renowned doctors Anthony S. Feck, DMD, and Leslie Shu-Tung Fang, MD, PhD. It is worth 16 CE.
Pick from two different formats:
In Person
- August 24, 2024 in Atlanta, GA
Interactive (((Live))) Streaming
- May 18, 2024
- October 5, 2024
If you're not yet subscribed to receive the Incisor newsletter, filled with cutting-edge dental news sent directly to your inbox twice a month, you can do so here.
Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.
