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Pete P. is a 45-year-old man who is new to your dental practice. He comes to the office a week following his last appointment and still reports pain from his periodontal debridement last week. He wants to speak to the doctor about getting a prescription for pain medication. He needed nitrous oxide and requested a pre-appointment prescription for Xanax before allowing the dental hygienist to proceed with treatment. He states on his medical history that he takes a baby aspirin to prevent heart disease, a multivitamin, Ginkgo biloba, and Xanax for anxiety. He also notes on his health history that he is a recovering alcoholic. The dentist writes a prescription for 800 mg of ibuprofen, but Pete tells his physician that ibuprofen does not work for him and that only OxyContin works for his pain. Discuss your initial concerns about this patient visit. What are the "conditions" that cause you this concern? Are there presentations about this patient that could cause you to have some situational bias about the conversation? You question Pete further about his "lack of effect" from ibuprofen, seeking to clarify if this could be an allergy. Pete responds that he starts yawning, tearing, gets a runny nose, becomes nauseated, feels his heart race and soon develops shaking, and chills. What is your assessment of what is happening when he tries to take ibuprofen? You pull Pete's chart and note the hygienist noted during his periodontal treatment that Pete’s pupils are constricted. He also requested a much higher dose of nitrous oxide than a typical patient. Noting this, what medication would you check to make sure the dental office stocked should another patient like Pete develop crisis-like symptoms? What would be your brief conversation with the dentist following your interaction with Pete?

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