Verapamil is a calcium channel blocker often prescribed for high blood pressure, chest pain and arrhythmia. It is also a CYP3A4 enzyme inhibitor, which means it will increase the bioavailability of benzodiazepine sedation medication. How should the DOCS protocol be tailored to these patients?
A DOCS Education Member writes:
We are seeing a patient who is 64 years old and weighs 220 Ibs. She will be here Monday for crowns on #30 and #31 with sedation. I am concerned with a level C interaction on diazepam, triazolam, and verapamil. She will be with us for 3 hours in the morning.
Dr. Jerome Wellbrock, DOCS Education faculty member, responds:
It would be helpful to include more detailed information on this patient. Date of last physical exam, results of pre-sedation work up appointment, etc. All vital signs, heart rate, oxygen saturation, blood pressure etc. Any other medications either prescribed or OTC, reason for taking the Verapamil, any sleep apnea, snoring, etc, Airway classification, ASA classification. A "C" interaction is usually something we can sedate over and is not a problem but other info on this patient could possibly make a difference. At age 64, 220 lbs, and a medical condition she is being treated for you would want to cut her sedation meds in half of usual dosage, use an incremental protocol and "dose low and go slow." Airway maintenance is going to be a concern on this patient.
The DOCS Education Member elaborates:
She did state she was under the care of a medical doctor within the past two years. She does not have a date of event, but it was for high blood pressure. When here on May 10th her blood pressure was 166/85 with her pulse at 73. She does take Aleve® and an antacid once a month.
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