This document provides medical history information for a 51-year-old female patient along with details of her current medications and dental history. The patient has a history of childbirth, knee replacement surgery, weight loss due to a diet, blood transfusion for anemia, panic attacks, joint pain, and prior substance use. She is currently taking Zoloft, Xanax, birth control, Benadryl, ibuprofen, and Kava Kava. Additional questions are provided to obtain further details from the patient about her medical history.

1. PHARMACOLOGY
CASE STUDY: I
Megan Simpson
State Fair CommunityCollege

2. Patient Medical History

3. Patient
Medical
History
51-year-old female
Patient has been hospitalized for childbirth and knee replacement
Patient is on a beach body diet and has had a recent weight loss
due to this diet
Patient has required a blood transfusion due to anemia
Patient stated that they have used controlled substances
Patient wears contact lenses
Patient marked that they were allergic to Penicillin or other
antibiotic, as well as sulfa drugs

4. Patient
Medical
History
(cont.)
Patient marked yes to the following:
Heart trouble, Heart Attack, or Angina and wrote “panic”
Shortness of breath associated with panic attacks
Seasonal Hay Fever
Patient develops hives and skin rashes when they get nervous
Fainting or dizzy spells
Joint replacement in knee
Arthritis or Rheumatism
Patient marked “unsure” for epilepsy or seizures
Anemia
Mental health care
Back problems
Past chemical dependency
Nervousness
Tonsillitis
Cortisone treatment
Stomach Ulcer

5. Patient
Dental
History
Patient goes to regular dental visits every 6 months
Brushes 3x daily and flosses 1-2x daily and uses fluoridated
products
Received orthodontic treatment and wore a bite plate
Patient experiences:
• Sensitivity to hot and cold
• Pain in teeth
• Frequent headaches, upper shoulder pain, neck pain
• Clenching and grinding
• Biting lip and/or cheek frequently
Patient also stated that they want a brighter, whiter smile

6. QuestionsTo Ask Patient About Medical
History
■ When you were hospitalized for
childbirth, was there any serious
complications?
■ Why are you taking the medications that
are taking?
■ When did you have your knee
replacement?Which knee? Do you know
if you require an antibiotic
premedication?
■ When did your blood transfusion occur?
■ What type of anemia do you have?
■ What does the “beach body” diet entail?
■ If you had to guess, around how much
weight would you say you have lost in
how much time?
■ What controlled substances have you used?
When did you use last?
■ What antibiotic(s) are you allergic to?What
type of reaction do you have? When was your
last reaction?
■ What type of reaction did you have when you
encountered sulfa drugs? When was your last
reaction?
■ Did you have a heart attack, or do you just have
chest pain when you have panic attacks?
■ What triggers your panic attacks? Is there
anything I can do for you to aid in prevention?
■ Do you take any medications for your seasonal
allergies? Are you taking any currently?
■ Do you do anything to treat your skin rashes
induced by nervousness? Have you ever
consulted with your physician about this issue?

7. QuestionsTo Ask Patient About Medical
History
■ How often do you have fainting or dizzy
spells? Do you know what causes them?
Have you discussed this with your
physician?
■ What other allergies do you have?
■ Do you currently have a stomach ulcer?
When was your last one? Are you seeing a
physician for this?
■ What makes you believe that you have
epilepsy or seizures?
– What symptoms do you experience?
– Have you consulted your physician
about your concerns?
■ What causes your nervousness? Is there
anything I can do to reduce it?
■ What kind of arthritis do you have? Have
you been diagnosed?
■ What mental health care do you receive?
■ What symptoms do you experience with
your back problems?
■ Why do/did you receive cortisone
treatment?Are you still receiving this
treatment?
■ Are you currently suffering from tonsillitis?
– Are you being treated for tonsillitis?
– If past, did you have your tonsils
removed?

8. QuestionsTo
Ask Patient
about Dental
History
What area of your mouth do you experience
sensitivity to hold and cold?
What teeth are in pain? How long have you been
experiencing this pain?
Do you have frequent headaches, upper should pain,
or neck pain? Or all three?
Do you find yourself clinching and grinding at night
or throughout the day or both?
When did you receive orthodontic treatment? And
do you still wear any oral appliances (bite plate)?

9. Medications
Prescription
■ Zoloft
■ Xanax
■ Birth control
Non-Prescription
■ Benadryl
■ Ibuprofen
■ Kava Kava

10. Zoloft
(sertraline)
Antidepressant, SSRI
Used for the treatment of major depressive disorder, obsessive-compulsive
disorder, panic disorder, post-traumatic stress disorder, premenstrual
dysphoric disorder, social anxiety disorder.
Typical dose is 50mg once daily, may increase dose in increments of 25-
50mg once weekly to reach a maximum dose of 200mg/day.
Contraindications/precautions: Use of MAOI’s including linezolid or
methylene blue (concurrently or within 14 days of discontinuation);
concurrent use with pimozide; hypersensitivity to sertraline or any
component of its formulation; concurrent use with disulfiram.
Dental contraindications/precautions: Administer vasoconstrictor with
caution, patient may experience xerostomia, impairment of platelet
aggregation may occur. If patient is taking Aspirin, NSAIDS, Warfarin, or
any other anticoagulants, the risk for prolonged bleeding is increased.
Common adverse side effects: Diarrhea, nausea, xerostomia, agitation,
loss of appetite, anxiety constipation, increased appetite, tinnitus.

11. Xanax (alprazolam)
Benzodiazepine
Can be used to treat anxiety disorders, panic disorder, and preoperative dental anxiety.
Typical dose is 0.25mg to 0.5mg 3 times daily: usual maximum dose is 4mg/day.
Contraindications/precautions: Hypersensitivity to alprazolam or any component of the
formulation (cross-sensitivity with other benzodiazepines may exist); acute narrow-
single glaucoma; concurrent use with ketoconazole, itraconazole, or other potent
CYP3A4 inhibitors. Concomitant use with opioids may result in profound sedation,
respiratory depression, coma and death.
Dental contraindications/precautions: Patients may experience decreased salivary flow
(xerostomia) – salivary flow will resume upon discontinuation of the drug.
Common adverse side effects: ataxia, cognitive dysfunction, constipation, depression,
difficulty in micturition, menstrual disease, nervousness, sedated state, skin rash,
tremor, weight gain, blurred vision, decreased libido, increased appetite, and decreased
appetite.

12. Birth Control (estradiol, Systemic)
■ Estrogen Derivative
■ Can be used to treat breast cancer, hypoestrogenism, prevention of postmenopausal
osteoporosis, prostate cancer, symptoms of menopause, and vaginal atrophy.
■ Typical dose is 0.5-2mg one time daily.
■ Contraindications/precautions: Documented hypersensitivity, active or previous breast
cancer arterial thromboembolic disease, thrombophlebitis, deep vein
thrombosis/pulmonary embolism, thrombogenic valvular disease, estrogen-dependent
neoplasia, uncontrolled hypertension, diabetes mellitus with vascular involvement,
jaundice with previous oral contraceptive use, undiagnosed abnormal vaginal bleeding,
known pregnancy, liver disease, and liver tumors.
■ Dental Contraindications:There are no dental contraindications. Warn patient about
concurrent use of antibiotics and oral contraceptive if patient is using OC for pregnancy
prevention. Hormonal fluctuations may put the patient at risk for having a heightened
response to bacterial plaque biofilm.
■ Common adverse side effects: Abdominal cramping, bloating, breakthrough bleeding,
breast enlargement, breast tenderness, freckles or darkening of facial skin, changes in
menstrual periods.

13. Benadryl (diphenhydramine)
■ Antihistamine
■ Symptomatic relief of allergic symptoms caused by histamine release including nasal
allergies and allergic dermatosis; adjunct to epinephrine in the treatment of anaphylaxis;
occasional insomnia, prevention or treatment of motion sickness; antitussive;
management of Parkinsonian syndrome.
■ Typical dose is 25-50mg every 4 to 8 hours; maximum is 300mg daily.
■ Contraindications/precautions: Hypersensitivity to diphenhydramine, other structurally
related antihistamines or any component of the formulation; neonates or premature
infants, breastfeeding. Causes sedation, can impair activities that require alertness. Do not
administer to children under the age of 6, to make a child sleep, or any other
diphenhydramine products. Use caution in patients with asthma, hyperthyroidism,
increased ocular pressure, and cardiovascular disease.
■ Dental contraindications/precautions: Patients may experience decreased salivary flow
(xerostomia) – salivary flow will resume upon discontinuation of the drug. Chronic use may
contribute to periodontal disease and oral discomfort.
■ Common adverse side effects: Drowsiness, dizziness, disturbed coordination, constipation,
dry mouth/nose/throat, difficulty urinating, upset stomach, blurred vision, double vision,
tremor, loss of appetite, headache, or nausea.

14. Ibuprofen
■ Analgesic; Non-Steroidal Anti-inflammatory Drug
■ Can be taken to treat inflammatory diseases, rheumatoid disorders, mild to moderate pain,
fever, dysmenorrhea, osteoarthritis.
■ Typical dose is 400mg every 4 to 6 hours as needed. Maximum is 1,200mg/day.
■ Contraindications/precautions: Hypersensitivity to ibuprofen or any component of its
formulation; history of asthma, urticaria, or allergic-type reaction is aspirin or other
NSAIDS, use in the setting of coronary artery bypass graft surgery. NSAIDS cause an
increased risk of adverse cardiovascular thrombotic events.
■ Dental contraindications/precautions: Ibuprofen can interfere with the antiplatelet effect of
aspirin, thus increasing the risk for issues in cardiovascular patients taking low-dose aspirin.
Ibuprofen can also inhibit platelet aggregation and prolong bleeding time in some patients.
■ Common adverse side effects: Stomach pain, constipation, diarrhea, bloating, gas,
heartburn, nausea, vomiting, dizziness, headache, nervousness, skin itching or rash,
blurred vision, or ringing in the ears.

15. Kava Kava
■ Neurology and Psychiatry, Herbal Supplement
■ Several meta-analyses and systematic reviews of kava use in anxiety have found a favor of
kava over placebo, but results are inconsistent. Kava has also been studied for effects on
cognitive function and for potential cancer applications. However, concerns over
hepatotoxicity have limited clinical studies.
■ A maximum daily dose of 250mg is suggested to avoid hepatotoxicity.
■ Contraindications/precautions: Kava and kava-containing products are not recommended
for use in children or in patients with hepatic disease. Kava should be used cautiously in
patients with renal or liver disease, blood disorders, Parkinson disease, or depression. Kava
has been shown to interact with cytochrome P450 enzymes of the liver.Case reports on
alprazolam, alcohol, barbiturates, and levodopa.
■ Dental contraindications/precautions: No dental contraindications/precautions.
■ Common adverse side effects: Heavy kava use may cause a scaly skin rash.Visual
disturbances, urinary retention, GI discomfort, exacerbation of Parkinson disease,
extrapyramidal effects, and rhabdomyolysis have also been reported.

16. Medical Consultations/Referrals
Refer patient to primary
care physician about
medications and their risk
of adverse drug
interactions.
Cortisone treatment and
alprazolam are
contraindicated for
concurrent use
Use of kava kava and
patients with blood
disorders is
contraindicated
Use of alprazolam and kava
kava has been reported to
have adverse drug
Recommend that patient
see physician for
“unsureness” about
whether they have
epilepsy or seizures.
Refer patient for unusual
fainting or dizzy spells.
If patient is currently
experiencing a stomach
ulcer, refer to general
physician so she can
receive proper treatment.

17. Patient
Education
Educate patient about xerostomia caused by the
medications that she is taking
Discuss the benefits of fluoride treatment and
fluoridated products
Importance of 6-month dental recare appointments
Avoiding cariogenic snacking due to her increased risk of
developing periodontal disease and caries.
Discuss with patient the drug interactions that may be
occurring and the importance of consulting with their
physician before taking medications (both prescription
and non-prescription)

18. HandoutsTo Recommend
■ Handouts that include:
– What periodontal disease is and how to prevent it
– Importance of visiting the dental office regularly
– Importance of fluoride and how to prevents demineralization and
dental caries
– Nutritional information cariogenic snacksVS. healthy snacks
– Teeth whitening options

19. Dental
Recommendations
& Products
■ Power brush
■ ListerineTotal Care Mouthrinse
■ Floss picks or traditional string floss
■ Dry mouth products (Biotene, xylitol)
■ Sensodyne for patient sensitivity
■ Fluoridex for patients increased risk of
xerostomia
■ CrestWhitening Strips (after oral
health is met and maintained)

20. References
■ Weinberg, M. A., Theile, C. M. W., & Fine, J. B. (2013). Oral Pharmacology for the
Dental Hygienist. Boston: Pearson.
■ The Internet Drug Index for prescription drug information, interactions, and side effects.
(2019). Retrieved from https://www.rxlist.com/script/main/hp.asp.
■ Wynn, R. L., Meiller, T. F., Crossley, H. L., & Wynn, R. L. (2017). Drug Information
Handbook for Dentistry: Including Oral Medicine for Medically-Compromised Patients
&Specific Oral Conditions. Hudson, OH: Lexicomp.