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.
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