Ethics & Law · single question
An Alzheimer's patient on lorazepam is uncooperative and nervous during the dental appointment. Accompanied by daughter. What is the best management?
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Correct answer: A. Interconsult with primary caregiver
For an uncooperative Alzheimer's patient with anxiety, the appropriate dental management involves CONSULTATION WITH THE PRIMARY CAREGIVER/PHYSICIAN before any dose adjustment or use of restraint. The physician can advise on appropriate anxiolytic doses, contraindications, and medical considerations. Unauthorized physical restraint is inappropriate. Tripling a benzodiazepine dose without physician authorization is dangerous (respiratory depression risk in elderly). The interconsult determines the safest approach.
- A. CORRECT. Interconsult with the primary caregiver/physician is the appropriate step. This allows medical review of the patient's current medications, medical status, and recommendations for appropriate pre-appointment anxiolytic dosing or alternative management strategies.
- B. INCORRECT. Physical restraint of an Alzheimer's patient without proper consent and protective stabilization protocols is ethically inappropriate and potentially dangerous.
- C. INCORRECT. Tripling the lorazepam dose without physician authorization is dangerous — benzodiazepines in elderly patients carry significant risk of oversedation, respiratory depression, and falls. Only the prescribing physician can adjust medication doses.