A member of DOCS Education writes:
I have an upcoming patient who has many [D] and [X] interactions within his list of current medications. The only [C] interaction listed is with Triazolam and Diazepam. The patient received a lymph node dissection in 2001 and a frontal craniotomy in 2002. The patient also suffers from bipolar disorder and is currently under psychiatric care.
I would not have him take Diazepam the night before, but it still concerns me to even use Triazolam as some prescriptions show central nervous system depressants.
I would like to fax the patient records to one of the DOCS faculty members if I may. In case I cannot, here is a list of his current medications without dosages:
Atorvastatin, Buspirone, Cyclobenzaprine, Depakote®, Enoxaparin Injection, Gabapentin, Lisinopril, Mirtazapine, Seroquel®, Trazodone, Venlafaxine
Thank you for your time
Dr. Anthony Feck, Dean of DOCS Education Faculty, responds:
The existing [D] interactions are not a concern as the patient is, apparently, tolerating them. You should not introduce any new [D] or [X] interactions as you don't know what the patient’s reaction will be.
I like your plan regarding no Diazepam the night before. Triazolam and Hydroxyzine are acceptable sedative agents, used judiciously with careful monitoring.
DOCS Education regulatory counsel, John Bitting, Esq., adds:
Thank you, Dr. Feck, for answering the clinical side. As for the legal side, it doesn't sound like you need to send us any patient information now. However, if you did, you MUST remember to remove any patient-identifying information. Not taking this step opens you up to a slew of HIPAA violations. Likewise, if you were to email this information you would need to make sure that it was encrypted and password protected.