CDA Essentials 2016 • Volume 3 • Issue 7 - page 28

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Volume3 Issue7
I
ssues and
P
eople
thesepatients. You’ll havea trulyenjoyableexperienceand
you’ll beable tobuild lasting, trusting relationshipswith
thesepatients.
PatientswithADHD:
WhatYouNeed toKnow
ADHDmedication.
Two typesof drugs canbe
prescribed topeoplewithADHD: stimulants andnon-
stimulants. Stimulants increase theavailabilityof dopamine
andnorepinephrine in thebrain,which improvesone’s
alertness andattention span, and reduceshyperactivity.
Non-stimulants alsohaveaneffect onnorepinephrine, but
haveno impact ondopamine levels.
Appointment scheduling.
Mayo recommends
scheduling shortmorningappointments. Patients
mayexperience increased fatigue later in theday
and theirmedicationmight bewearingoffby that
time,making it harder for them to sit through the
appointment and listen to instructions.
Oral sideeffectsofADHDmedication.
“A side
effect ofmany stimulants is xerostomia,”Mayoexplains.
Other oral sideeffectsmay includebruxism, stomatitis,
tongueedema, discoloured tongue, gingivitis
andglossitis.
Drug interactions.
ADHDmedications can increase
heart rateandbloodpressure.Whenperforming local
anesthesia, carefullyevaluate theuseof vasoconstrictors
andonlyadminister lowdoses.Monitor thepatient’sblood
pressureandheart rateclosely throughout theprocedure.
It is also important toachieveprofoundanesthesia toavoid
endogenous epinephrine reactingwith thepatient’s
medication. Ensureadequateaspirationand
avoid intravascular injections toprevent the
possibilityof increasing the stimulant effect
of theADHDmedication.
Avoid local anesthetics containing
levonordefrin for patientsonatomoxetine
(Strattera®) as thecombinationcan increasebloodpressure
andcausecardiacdysrhythmias (irregular heartbeats).
All narcotic-containinganalgesics shouldbeavoided
bothperioperativelyandpostoperatively inpatients
takingamphetamineanddextroamphetamine (Adderall®,
Dexedrine®), especiallymeperidine (Demerol®), as theycan
increase the risk for hypotension, respiratorycollapse, and
serotonin syndrome.
Symptomsmayoccurhours todaysafter
concomitantuse, particularlyafterdose increases.
Ciprofloxacin (Cipro®), levofloxacin (Levaquin®),moxifloxacin
(Avelox®)
,
erythromycin, azithromycin (Zithromax®),
carithromycin (Biaxin®),metronidazole (Flagyl®)
and
fluconazole (Diflucan®) shouldalsobeavoidedas theyhave
been shown tocause irregular heart rhythms inpatients
currently takingamphetamineanddextroamphetamine
(Adderall®, Dexedrine®). The same is also true for certain
coughandallergymedications. It is therefore strongly
recommended to seekmedical advicebefore suggestingor
prescribing theseagents.
Oral sedationcanbechallenging toachieveasADHD
medications affect thecentral nervous system. Inhalational
sedationwithnitrousoxide-oxygenmaybe the safest
modality, but it is strongly suggested to seekmedical advice
beforehand.
Limiteddistractionsandsurprises
. Sitting through
adental procedurecanbeanoverwhelmingexperience
for childrenwithADHDbecauseof themany
sensatory stimuli in the room.When
treatingchildrenwithADHD,Mayo
suggests limitingdistractionsbyusing
musicandearbudsor by turningon
the television. Thiswill help them isolate
themselves from theofficebrouhaha. It is
also important todiscusswith themexactly
what theappointmentwill entail. “Avoid
surprises and let them knowwhatwill happen
andwhen.Most of themwant to know the ‘why’
behind things,” she says. “Theydonot like things
that are just put on themwithnoexplanation. But get to the
point anddo that quickly!”
Toneofvoice.
Keepaneutral,monotonevoice, especially
whengivingoral care instructions. “Fluctuations in toneand
volumemaydistract patientswithADHD,making it harder
for them topayattention towhat you’re saying,”Mayo says.
“Additionally, theymight interpret thedifferent tones as
havingdifferentmeanings.”When it comes tochildrenwith
ADHD,Mayomentions that theycanbeparticularly sensitive
tovoice tones. “They’reused togetting in trouble! Youdon’t
want them to interpret your toneasbeingupsetwith them.”
Eyecontact.
To keepyour patient’s attention,maintain
eyecontactwith themwhenperformingaprocedureor
giving them instructions.
Time to think.
When treatingpatientswithADHD,Mayo
stresses the importanceof giving themonlyonecommand
at a time, andof giving thema few seconds toprocess the
information. “Wait about 5 seconds for them toprocesswhat
you’veasked insteadof repeatingyourself immediately.”
Positive reinforcement.
ChildrenwithADHD respond
verywell topositive reinforcement. Give thempraise for
followingyour instructions and for their at-homeoral health
care routine. “Make sureyou smileat them; give themhigh-
fivesor patson theback,”Mayo says. “Thesechildrenare
usuallyvery social and like itwhenadults interact them.”
Youcanalso tell them that if they followyour instructions,
theywill receivea rewardat theendof theappointment
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