Oral Sedation is Not for Extremely Ill Patients

A DOCS Education member asks:
I would like to know if I can use OCS on a 62 year old female patient. She is a nonsmoker, She is also Pre- diabetic and not obese. She does have slight gag reflex.

However, she has a laundry list of meds she is taking for arthritis, asthma, Heart attack in 2000, heart stint 2005, Psychiatric issues, heart burn, daily painmeds(for back surgery), constipation, border-line diabetes and acid reflux.

The long list of medication:

  • Albuterol
  • Theophylline
  • Breo Ellipta®
  • Xanax®
  • Norco®
  • Gabapentin
  • Zetia®
  • Vytorin®
  • Tricon
  • Sertraline
  • Nexium®
  • Ondansetron
  • Robaxin®
  • Nameda®
  • Macrobid®
  • Ambien®
  • Generlac®
  • Wellbutrin®
  • Singuliar®
  • Flect Enema

Do you feel like we can safely sedate this patient? I know she can come off of Nexium, and put her on Pepsid AC, but I am not sure how to address the class D reactions, with Ambien, Narco, Therophylline. I understand that she has many medications listed but I feel like this may not be no-go, just because she is on so many medications.


DOCS Education faculty member, Dr. Jerome Wellbrock, responds:

This is a patient with multiple drugs for multiple different medical issues. Any time you seed a patient on at least four meds for a problem it is usually an issue that is not well controlled an example here is four meds for I presume Asthma. Also she is on multiple CNS depressant meds including sedatives, sleep aids, pain meds, muscle relaxants, anti-depressants, and the list goes on. It is not just a list of meds that determine if we should sedate a patient or not but also their medical health and status. The majority of the meds do have a "D" interaction with are sedation meds. I personally would not expect to have a safe and successful sedation with this patient with Oral Conscious Sedation. If she is sedated it would be better controlled with IV Sedation even with IV there are still many issued to overcome. Remember we do not have to sedate everyone who wants sedation.

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