Pharmacology · patient case with 1 question
Patient who has replaced medications with herbal remedies
Patient: 52-year-old woman presenting for extraction of a non-restorable molar.
Chief complaint: Wants the broken back tooth out.
History: Describes herself as a naturist. Has stopped all prescribed medication and now takes garlic capsules, St John's wort, ginkgo and fish oil daily.
Findings: Non-restorable tooth 19. No other relevant findings on examination.
Question 1
What is the MOST important precaution before this extraction?
Show answer and explanation
Correct answer: A. Anticipate an increased risk of bleeding
- A. CORRECT. GARLIC inhibits platelet aggregation, as do the other 'G' herbs — ginkgo, ginger and ginseng — along with vitamin E and fish oil. ST JOHN'S WORT is a potent CYP3A4 and P-glycoprotein INDUCER that lowers plasma levels of warfarin, oral contraceptives, benzodiazepines and other drugs, and carries serotonin syndrome risk with tramadol. The dominant surgical concern here is HEMOSTASIS: take a full supplement history, consider discontinuation one to two weeks preoperatively in consultation with her physician, and plan local hemostatic measures.
- B. There is no established prolongation of local anesthetic effect from these products.
- C. The assumption that natural means free of interaction is exactly the error this item tests.
- D. Herbal supplements are not associated with a general increase in infection risk.