Even where a patient’s overall health is good, advancing age remains a significant factor in the prescription of medication. This active octogenarian shows high blood pressure but no stents or history of infarction. What if any issues should the sedation dentist be careful to acknowledge? A member of DOCS Education writes:
My patient is an active and outgoing 81-year-old; however, I have a few concerns. He’s not remotely obese but carries a little extra weight. Medications he currently takes include lisinopril, metoprolol succinate, oxybutynin, sertraline and simvastatin.
I planned to use the gold standard protocol yet reduce dosages on account of the gentleman’s age. He was due to see a physician last week and I have requested faxes from his other doctors. The drug interaction presents a necessary modification because of the metoprolol succinate and sertraline. He shows no history of infarction or stents. On the other hand, his blood pressure is high—as I recollect 150/90. (He believes this reading is uncharacteristically elevated.)
I appreciate any comments or suggestions.
Dr. Leslie Fang, a member of the DOCS Education faculty, responds:
The patient’s age is absolutely a facto and here are some of considerations because of it:
1. Decreased hepatic clearance
2. Decreased upper-airway integrity
3. Increased sensitivity to drugs
4. Increased incidence of post-operative delirium
5. Occult coronary artery disease
6. Occult cerebrovascular disease
These are issues with which the man’s physicians can help. Yes, his blood pressure should be better regulated.
Remember that you will need to decrease drug dosage by at least half.
There is no significant drug/drug interaction except for C interaction between triazolam and Zoloft™.
