By Genni Burkhart
On average, the Food and Drug Administration (FDA) approved approximately 38 new drugs per year over the last decade, an increase of 60 percent over the yearly average from the previous decade.
As new drugs continue to enter the market every year, it further emphasizes the awareness dentists must maintain when it comes to the safety and efficacy of interactions between the patient’s medications and sedation drugs used in dentistry.
One of the first questions dentists should consider is if the patent is an acceptable candidate for outpatient conscious sedation, and if so, are there any adjustments to DOCS protocol needed?
As a DOCS Education member, you have access to valuable online resources and tools, such as the Top 100 Prescribed Drugs Reference Guide to assist you in answering this very important question.
Tools for Following DOCS Protocol
To begin, any patient undergoing conscious sedation needs to have their medications assessed using pharmacology software, such as Lexicomp Online. DOCS Education recommends this software for its accuracy and ease of use. Lexicomp assesses a grade to the severity of the interaction using A, B, C, D, and X, with further consideration for those marked with the C, D, and X interaction.
DOCS has also created a reference guide for members listing the top 100 prescribed drugs and their potential to interact with DOCS recommended protocols. This 1-page double-sided printout is not meant to be a replacement for the Lexicomp analysis, but rather to give doctors and their sedation team readily accessible information to quickly determine what, and if any, severe interactions exist and the resulting changes to DOCS protocol thereby required.
Let’s review the three types of drug interactions that can occur between the patient’s current medications and sedation medications.
- Additive CNS Depression: When taken with a sedative agent, it’s not a contraindication. However, sedation dentists should monitor the patient carefully. If it’s graded as:
- C= Monitor carefully.
- D or X= Over the top.
- Induction of Metabolism: With this interaction, the existing medication effects the metabolism of sedation medication resulting in a lower circulated serum concentration of sedation medication. If graded as:
- C= Over the top, while monitoring.
- D or X= Alt. Protocol; use an alternative DOCS sedation regimen such as Lorazepam instead of Triazolam.
- Inhibition of Metabolism: Existing medications interact with sedation medication resulting in an increased circulated serum concentration. If graded as:
- C= Over the Top, monitoring patient.
- D or X=Alt. Protocol; use an alternative DOCS sedation regimen such as Lorazepam instead of Triazolam.
One of many perks to a DOCS Education membership is the 2022 updated Top 100 Prescribed Drugs Reference Guide, which members can easily view and print out when logged into their online account.
As a tool to help dentists determine a patient’s potential as an acceptable candidate for sedation – as well as possible interactions or adjustments required based on their current medications –this quick guide provides accessible information and recommended protocols. This includes the generic name, brand name, the number from 1-100 representing the frequency of prescription drug, drug class or therapeutic action, and the severity of action if marked with a C, D, or X, followed by the type of interaction with emphasis on those with the highest interactions, and the recommended course of action for drug interactions.
This regularly updated reference guide also adds a few more drugs over the top 100 that are commonly prescribed with information on those interactions.
“We are here to give you the support you need to safely and successfully treat your patient with sedation.” – Dr. Anthony Feck, Dean of Faculty and Cofounder of DOCS Education
Membership Has Value
Sedation dentists must stay current and informed of new drugs, as it directly impacts patients and the safest treatment plan possible. With a DOCS Education membership, knowing up-to-date drug interactions is made easier by following DOCS Education protocols and using the Top 100 Prescribed Drugs Reference Guide. Another value to your membership is a Lexicomp subscription through DOCS Education that offers additional materials.
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.
Author: With over 12 years as a published journalist, editor, and writer Genni Burkhart’s career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.